Tocilizumab

Tocilizumab

Where it is used and how does it work?

Tocilizumab is used for the treatment of rheumatoid arthritis. Tocilizumab is approved by the Food and Drug Administration (FDA). This belongs to the family of medications called a human monoclonal antibody. Tocilizumab helps reduce swelling in your blood vessels so blood can flow more easily. This is supplied as single-dose vials that contain 80 mg/4 mL, 200 mg/10 mL, and 400 mg/20 mL. 

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems (eyes, skin, lungs, heart or blood vessels). An autoimmune disorder, rheumatoid arthritis happens when your immune system mistakenly attacks your own body’s tissues. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints that causes painful swelling. That it can eventually result in bone erosion and joint deformity. When the disease is active, the signs and symptoms may include:

  • Loss of energy
  • Fatigue
  • Low-grade fever
  • Lack of appetite
  • Joint redness
  • Joint swelling 
  • Joint warmth
  • Joint tenderness 
  • Rheumatoid nodules
  • Joint deformity 
  • Limping
  • Loss of joint function
  • Loss of joint range of motion
  • Stiffness 

People with active inflammation of joints form rheumatoid arthritis can also experience:

  • Social withdrawal
  • Frustration
  • Anemia
  • Depression 

Rheumatoid arthritis happens when your immune system attacks the synovium. It is the lining of the membranes that surround your joints. The resulting inflammation thickens the synovium which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Slowly, the joint loses its shape and alignment.  

Tocilizumab is suppressing a part of the immune system and modifying the process of inflammation. This medication works in a similar way to the natural antibodies produced by our immune system. Our natural antibodies recognize foreign invaders and bind to them. It helps our immune system attack them and protect us from infections. This drug is made in laboratories and is intended to recognize particular proteins similarly. 

This medication specifically recognizes and binds to a protein produced by the body called interleukin-6. This protein is involved in causing inflammation and is found at high levels in people with rheumatoid arthritis. By preventing the action of interleukin-6, Tocilizumab decreases the inflammation and other symptoms of rheumatoid arthritis. It improves the physical function of the joints and reduces the rate of joint damage. When treating arthritis, Tocilizumab is referred to as a disease-modifying antirheumatic drug (DMARD). 

How to use the medication?

Before using, take this medication out of the refrigerator. If you are using the prefilled syringe, let it warm up to room temperature for at least 30 minutes. If you are using the auto-injector, let it warm up to room temperature for at least 45 minutes. Do not heat it any other way such as by placing in hot water or heating in the microwave. Do not leave in direct sunlight. Check this product visually for particles or discoloration. If either is present, do not use the liquid. 

If you are using this medication to treat rheumatoid arthritis in adults, inject this under the skin as directed by your doctor. This is usually given by starting with once every 2 weeks then increasing to once a week. The dosage will depend on your age, weight, medical condition and response to the treatment. This medication should be used regularly to get the most benefit from it. Mark the days you need to inject the medication on a calendar to help you remember. Take this at the same time each day. 

Recommended injection sites included the abdomen or the front of your thigh. The outer area of the upper arms may also be used if another person is giving you the injection. Clean the injection site with rubbing alcohol before injecting each dose. Each time, you must change the injection site to reduce injury under the skin. Learn how to store and discard medical supplies safely. Let your doctor know if your condition does not improve or if it gets worse. If you missed a dose, call your doctor right away for instructions. Do not double the dose to make up for the missed dose. It may result in a worsening of your condition or may develop another one. 

Common and Serious Side Effects

  • Itching
  • Mild stomach cramps
  • Headache
  • Dizziness
  • Sore throat
  • Sinus pain
  • Runny or stuffy nose

Tell your doctor right away if you have these side effects:

  • Jaundice or yellowing of the eyes or skin
  • Clay-colored stools
  • Dark urine
  • Loss of appetite
  • Vomiting 
  • Upper stomach pain
  • Painful blistering skin rash with itching, burning, or tingly feeling
  • Coughing up blood or vomit that looks like coffee grounds 
  • Bloody or tarry stools
  • Severe stomach pain with constipation 

Call for medical help right away if you experience signs of an allergic reaction including:

  • Hives 
  • Difficulty or trouble breathing 
  • Swelling in your lips, throat, face, or mouth 

Things to Remember 

  • You will need to have a blood test to check your liver function every 4-8 weeks for the first 6 months of treatment with this drug. It is followed by every 12 weeks after. 
  • You will also need to have regular blood tests to monitor the levels of white blood cells, platelets, and fats such as cholesterol in your blood during treatment.
  • Tocilizumab used with caution in people with liver disease, carriers of hepatitis virus, severe kidney function, with low levels of white blood cells, history of recurrent or long-term infections, or conditions that increase the risk of getting infections. 
  • People who have recently been receiving treatment that suppresses the activity of the immune system, with increased risk factors for cardiovascular diseases, inflammation in the gut or abdomen, history of or current cancer, and heavy smokers, this medication should also be used carefully. 
  • This is not recommended for use in people with active tuberculosis and severe active infections. 
  • This should also not be used in children and adolescents under 18 years old. 
  • Let your doctor know if you ever had an allergic reaction to this drug. Tell as well if you have any allergies. This drug may contain an inactive ingredient that causes an allergic reaction.