ACTEMRA (Tocilizumab)

What is this medication?

ACTEMRA (Tocilizumab)
Antirheumatic, Disease Modifying; Interleukin-6 Receptor Antagonist

ACTEMRA (Tocilizumab) is indicated for treatment of cytokine release syndrome, giant cell arteritis, polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, systemic juvenile idiopathic arthritis.

What are the ingredients in this medication?

ACTEMRA
Medicinal ingredient:
Tocilizumab
Non-medicinal ingredients:
Disodium phosphate dodecahydrate, polysorbate 80, sodium dihydrogen phosphate dihydrate, sucrose, and water for injection. Preservative-free.

How does this medication work? 

ACTEMRA (Tocilizumab) acts as an antagonist of the interleukin-6 (IL-6) receptor. Endogenous IL-6 is induced by inflammatory stimuli and mediates a variety of immunological responses. Inhibition of IL-6 receptors by Tocilizumab will reduce cytokine and acute phase reactions leading to an overall decrease in inflammation.

How should I take this medication? 

SQ: Inject 162mg subcutaneously once every week.

IV: When used in combination with DMARDs or as monotherapy, the recommended starting dose is 4 mg/kg intravenous infusion every 4 weeks followed by an increase to 8 mg/kg intravenous infusion every 4 weeks based on clinical response. 

How to Take: Allow diluted solution for infusion to reach room temperature prior to administration; infuse over 60 minutes using a dedicated IV line. Do not infuse other agents through the same IV line. Do not administer IV push or IV bolus. If additional doses are necessary for the management of cytokine-release syndrome, the interval between doses should be at least 8 hours. Do not use if opaque particles or discoloration is visible.

What should I watch for while using this medication? 

Before starting make sure your physician is aware of any allergies or medications you currently take, you can experience changes in hematological values (i.e. thrombocytopenia, neutropenia); hepatic impairment, hyperlipidemia and even perforation of the bowel has been reported. 

What is the difference between a prefilled syringe and an autoinjector?

Both an auto-injector device and prefilled syringe are comparable with respect to ease of use, tolerability, and efficacy.  However the addition of an autoinjector to deliver a prefilled syringe can enhance patient safety.

What if I miss a dose?

If you miss an appointment to receive your ACTEMRA (Tocilizumab) infusion, call your doctor or the clinic, hospital, or infusion center right away to reschedule.

If you forget to give yourself an injection, talk with your doctor. They can describe what you should do next based on your typical dosing schedule.

How should I store this medication?

Intravenous:
Store vials in a refrigerator at 2-8°C. Do not freeze. Keep the vial in the outer carton to protect it from light. Do not use beyond expiration date written on the vial + carton.

For prepared infusion solution: ACTEMRA (Tocilizumab) does not contain preservatives, therefore reconstitution and dilution of the product should be performed under aseptic conditions. The prepared infusion solution of Tocilizumab is physically and chemically stable in 0.9% w/v sodium chloride solution at 2-8ºC or 30ºC for 24 hours. The prepared infusion should be used immediately. Unused product remaining in the vials should not be used.

Subcutaneous:
ACTEMRA (Tocilizumab) should not be used after the expiry date shown on the prefilled-syringe (PFS) or autoinjector and the outer pack. Store the PFS or autoinjector in a refrigerator at a temperature of 2-8°C. Do not freeze, Protect from light, and moisture. Once removed from the refrigerator, Tocilizumab solution for injection must be administered within 8 hours and should not be kept above 30°C. For the autoinjector, allow to sit at room temperate outside the box for 45 minutes before use.

What are the possible side effects of using this medication?

Upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT, injection site reactions.

Note this is not a complete list of side effects for ACTEMRA (Tocilizumab), only common ones.