What is this medication for?

Tocilizumab is an Interleukin-6 inhibitor (IL-6i). IL-6i belongs to a class of medication called biologics or more specifically, biological disease modifying anti-rheumatic drugs (bDMARDs).

Biologics are small molecules that work by blocking certain parts of the immune system that cause inflammation in the body.

IL-6i targets and blocks natural substances called cytokines which causes inflammation in the body. This improves symptoms, reduces flares, slows disease progression and improves quality of life.

It may be used alone or together with other DMARDs.

How should I take/use this medication?

• Tocilizumab may be given as

  • subcutaneous injection (inject under the skin at the abdomen or thigh). This can be done by yourself at home.

  • Intravenous infusion (inject into the blood vessel). This has to be done in the hospital or clinic for typically 1 hour.

• Do not stop taking your medication without checking with your healthcare professional.

• Other medications such as corticosteroids (e.g. prednisolone) or disease modifying anti-rheumatic drugs (DMARDs) may be taken with Tocilizumab.

What should I do if I forget to take/use this medication?

If you forget to inject a dose, do it as soon as you remember. Then inject your next dose at the usual time. Do not take two doses to make up for the missed dose.

If you miss your infusion appointment, book another appointment as soon as possible. Inform your doctor about the missed/ late dose.

What precautions should I take?

Inform your healthcare professional if:

• You are allergic to this medication or any of the other ingredients of this medication.

• You plan to start a family or to breastfeed.

• You are taking any other medications, including over-the-counter medicines, supplements, traditional medications and herbal remedies.

• You have any existing infections.

• You have a history of diverticulitis or any stomach/intestinal ulcers.

• You have a condition that affects the nervous system, such as multiple sclerosis.

Avoid overcrowded places and stay away from people who are sick to prevent getting an infection.

Reactivation of infections such as tuberculosis (TB) and hepatitis B may happen when you are on this medication, hence, your doctor will check for such infections before starting Tocilizumab.

What are some common side-effects of this medication?

• Infections: symptoms include colds, sinusitis, urinary tract infections and skin infections

  • If you develop a fever, sore throat or feel generally unwell, see a doctor immediately. The doctor whom you consult should be told that you are on Tocilizumab.

• Injection site reactions: symptoms include transient bruising, redness, itching, pain and swelling
  

  • If you are using subcutaneous injection, rotate the injection site each time.

• Infusion reactions: symptoms include flushing, chills, chest tightness, shortness of breath, low blood pressure or high blood pressure

  • Medications may be given before the infusion to prevent these reactions.

  • You will also be monitored closely during and after the infusion.

• Low blood cell count (platelet, red and/or white blood cell)

• Headache

• Stomach or bowel discomfort

• Skin rash or itch

• Reversible increase in liver enzymes level

• Reversible increase in cholesterol level

It is important to monitor the effects of your new treatment, particularly during the first few months of treatment. For your safety, you need to do regular blood tests for monitoring by your doctor.

What are some rare but serious side-effects that I need to seek medical advice immediately?

The symptoms of a drug allergy include one or more of the following:

• Swollen face/eyes/lips/tongue

• Difficulty in breathing

• Itchy skin rashes over your whole body

Some rare but serious side effects include:

• Combined low blood cell count (symptoms include infection, feeling very tired or weak, sudden uncontrolled bleeding)

• Tear in the stomach or intestine (symptoms include severe abdominal pain or cramps, bleeding during passing motion, nausea and vomiting)

• Liver injury (symptoms include yellowing of eye whites or skin, dark or tea-coloured urine or constant abdominal pain)

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

What food or medication should I avoid when I take this medication?

Avoid eating raw, undercooked or half-cooked food.

Tocilizumab may interact with other medicines or supplements that you are taking. These include:

• Over-the-counter medications 

• Nutritional supplements 

• Traditional or herbal remedies

Inform the doctor, pharmacist or specialty nurse before starting on a new medicine or supplement.

Pneumococcal, influenza (flu) and Hepatitis B vaccinations are safe and may be given if required. Avoid live vaccines such as MMR (measles, mumps and rubella), OPV (oral polio vaccine), yellow fever or BCG (tuberculosis). Discuss with your doctor before receiving any vaccines. Also, direct contact with persons who have taken oral polio vaccine or those with infections should be avoided.

How should I store this medication?

Store in the refrigerator between 2-8◦C and protected from light. Do not freeze. Keep this medication away from children.

How should I throw away this medication safely?

Pack this medication into a black trash bag and seal it tightly before throwing it into the rubbish chute or bin. Dispose needles in a sharp box or tightly closed container to avoid needle prick injury.

Disclaimers

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last updated on Oct 2022