Home Drug Guide Tocilizumab

Drug Guide

Generic Name

Tocilizumab

Brand Names Actemra

Classification

Therapeutic: Immunosuppressant, Anti-rheumatic Agent

Pharmacological: Interleukin-6 (IL-6) Receptor Antagonist

FDA Approved Indications

  • Rheumatoid arthritis (moderate to severe)
  • Polyarticular juvenile idiopathic arthritis
  • Systemic juvenile idiopathic arthritis
  • Giant cell arteritis
  • COVID-19 (for severe cases under emergency use authorization)

Mechanism of Action

Tocilizumab is a monoclonal antibody that blocks interleukin-6 (IL-6) receptors, inhibiting IL-6-mediated signaling. This reduces inflammation and immune response.

Dosage and Administration

Adult: Typically 4-8 mg/kg intravenously every 4 weeks, dosage varies based on condition and clinical response.

Pediatric: Dosing varies; for rheumatoid arthritis, typically 12 mg/kg IV every 2-4 weeks for children >2 years old, depending on weight.

Geriatric: No specific dosage adjustment, but caution advised due to potential comorbidities.

Renal Impairment: No specific adjustment recommended; however, monitor closely.

Hepatic Impairment: Use caution; limited data available.

Pharmacokinetics

Absorption: Administered IV; rapid distribution.

Distribution: Wide distribution; approximately 7-15 days half-life dependent on dose and patient factors.

Metabolism: Catabolized by proteolytic enzymes into small peptides and amino acids.

Excretion: Primarily via catabolic pathways; not significantly excreted unchanged.

Half Life: Typically 6-14 days, variable based on dose and patient factors.

Contraindications

  • Known hypersensitivity to tocilizumab or any of its components.
  • Active serious infections.

Precautions

  • Screen for latent infections such as tuberculosis before initiation.
  • Monitor for signs of infection during therapy.
  • May increase risk of gastrointestinal perforation, especially in patients with diverticulitis.

Adverse Reactions - Common

  • Infections (upper respiratory, urinary tract) (Frequent)
  • Headache (Common)
  • Elevated liver enzymes (AST, ALT) (Common)

Adverse Reactions - Serious

  • Serious infections including sepsis, pneumonia (Less common)
  • Gastrointestinal perforation (Rare)
  • Liver Function Abnormalities (Rare)
  • Hypersensitivity reactions (Rare)

Drug-Drug Interactions

  • Other immunosuppressants, biologic agents, live vaccines

Drug-Food Interactions

  • No significant interactions noted

Drug-Herb Interactions

  • Use caution with herbal supplements that affect immune function or bleeding.

Nursing Implications

Assessment: Monitor for signs of infection, liver function, blood counts, and lipid levels.

Diagnoses:

  • Risk for infection
  • Impaired skin integrity

Implementation: Administer as prescribed, monitor patient for adverse effects, educate about infection risks.

Evaluation: Assess therapeutic response and adverse effects regularly.

Patient/Family Teaching

  • Report signs of infection immediately.
  • Do not receive live vaccines during treatment.
  • Follow up appointments for monitoring.
  • Maintain good hygiene and avoid contact with sick individuals.

Special Considerations

Black Box Warnings:

  • Serious infections, including tuberculosis, are increased with tocilizumab use.
  • Gastrointestinal perforation is a rare but serious complication.

Genetic Factors: Limited data, no specific genetic considerations identified.

Lab Test Interference: Can cause false decrease in C-reactive protein (CRP) levels, which may confound infection monitoring.

Overdose Management

Signs/Symptoms: N/A, experience limited due to controlled dosing.

Treatment: Supportive care; no specific antidote.

Storage and Handling

Storage: Store at 2°C to 8°C (36°F to 46°F); protect from light and do not freeze.

Stability: Stable until expiration date on the packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.