Select a medication above to begin.
Actemra
tocilizumab
Black Box Warnings .
Serious Infection Risk
weigh tx benefit vs. risk in pts w/ chronic or recurrent infection; pulmonary and extrapulmonary tuberculosis (TB), invasive fungal infections, and other opportunistic infections observed, incl. fatal; most infections occur in combo w/ other immunosuppressants; evaluate for TB risk factors and screen for latent TB infection before and during tocilizumab tx, except in COVID-19 pts; initiate anti-TB tx before tocilizumab tx; monitor for infection s/sx during and after tocilizumab tx; since active TB has developed in pts w/ negative tuberculin skin test, monitor all pts for active TB s/sx; D/C tocilizumab tx if serious infection occurs
Adult Dosing .
Dosage forms: INJ (ActPen auto-injector): 162 mg; INJ (pre-filled syringe): 162 mg per 0.9 mL; INJ (vial): various
rheumatoid arthritis, mod-severe
- [IV route]
- Dose: 8 mg/kg/dose IV q4wk; Start: 4 mg/kg/dose IV q4wk; Max: 800 mg/dose; Info: use alone or w/ methotrexate or other non-biologic DMARDs; see pkg insert for dose adjustments based on AST/ALT, ANC, and Plt
- [SC route]
- Dose: 162 mg SC qwk; Info: in pts <100 kg, start 162 mg SC q2wk, then may incr. to 162 mg SC qwk; use alone or w/ methotrexate or other non-biologic DMARDs; see pkg insert for dose adjustments based on AST/ALT, ANC, and Plt
giant cell arteritis
- [IV route]
- Dose: 6 mg/kg/dose IV q4wk; Max: 600 mg/dose; Info: use w/ tapering course of glucocorticoids, then may cont. as monotherapy; see pkg insert for dose adjustments based on AST/ALT, ANC, and Plt; may transition from IV to SC dosing at next scheduled IV dose
- [SC route]
- Dose: 162 mg SC q1-2wk; Info: use w/ tapering course of glucocorticoids, then may cont. as monotherapy; see pkg insert for dose adjustments based on AST/ALT, ANC, and Plt
systemic sclerosis-associated interstitial lung dz
- [162 mg SC qwk]
- Info: see pkg insert for dose adjustments based on AST/ALT, ANC, and Plt
cytokine release syndrome, severe or life-threatening
- [8 mg/kg/dose IV x1]
- Max: 800 mg/dose; Info: for pts w/ chimeric antigen receptor T cell-induced syndrome; may repeat dose up to 3x, each >8h apart; use alone or w/ corticosteroids; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
COVID-19
- [8 mg/kg/dose IV x1]
- Max: 800 mg/dose; Info: for hospitalized pts requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO); give w/ systemic corticosteroids; may repeat dose x1 after 8h
renal dosing
- [see below]
- CrCl >30: no adjustment; CrCl <30: not defined
- HD/PD: not defined
hepatic dosing
- [COVID-19]
- baseline AST/ALT >10x ULN: avoid use
- [all other indications]
- active hepatic dz or baseline AST/ALT >1.5x ULN: avoid use
Peds Dosing .
- Dosage forms: INJ (ActPen auto-injector): 162 mg; INJ (pre-filled syringe): 162 mg per 0.9 mL; INJ (vial): various
Special Note, COVID-19
- [FDA emergency use authorization (EUA)]
- Info: for use w/ systemic corticosteroids in hospitalized pts w/ suspected or confirmed COVID-19 requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO); not FDA approved for COVID-19; avail. from Genentech's Authorized Distributors at www.genentech-access.com/hcp/brands/actemra; for clinical trial eligibility and enrollment info, check www.clinicaltrials.gov
- [mandatory reporting for EUA]
- Info: serious medication errors and adverse events must be reported to FDA MedWatch (www.fda.gov/medwatch/report.htm or 1-800-FDA-1088) and Genentech (1-888-835-2555)
polyarticular juvenile idiopathic arthritis
- [IV route, 2 yo and older, <30 kg]
- Dose: 10 mg/kg/dose IV q4wk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
- [IV route, 2 yo and older, >30 kg]
- Dose: 8 mg/kg/dose IV q4wk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
- [SC route, 2 yo and older, <30 kg]
- Dose: 162 mg SC q3wk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
- [SC route, 2 yo and older, >30 kg]
- Dose: 162 mg SC q2wk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
systemic juvenile idiopathic arthritis
- [IV route, 2 yo and older, <30 kg]
- Dose: 12 mg/kg/dose IV q2wk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
- [IV route, 2 yo and older, >30 kg]
- Dose: 8 mg/kg/dose IV q2wk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
- [SC route, 2 yo and older, <30 kg]
- Dose: 162 mg SC q2wk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
- [SC route, 2 yo and older, >30 kg]
- Dose: 162 mg SC qwk; Info: use alone or w/ methotrexate; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
cytokine release syndrome, severe or life-threatening
- [2 yo and older, <30 kg]
- Dose: 12 mg/kg/dose IV x1; Max: 800 mg/dose; Info: for pts w/ chimeric antigen receptor T cell-induced syndrome; may repeat dose up to 3x, each >8h apart; use alone or w/ corticosteroids; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
- [2 yo and older, >30 kg]
- Dose: 8 mg/kg/dose IV x1; Max: 800 mg/dose; Info: for pts w/ chimeric antigen receptor T cell-induced syndrome; may repeat dose up to 3x, each >8h apart; use alone or w/ corticosteroids; see pkg insert for dose interruptions based on AST/ALT, ANC, and Plt
COVID-19
- [2 yo and older, <30 kg]
- Dose: 12 mg/kg/dose IV x1; Max: 800 mg/dose; Info: for hospitalized pts requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO), per FDA EUA; give w/ systemic corticosteroids; may repeat dose x1 after 8h
- [2 yo and older, >30 kg]
- Dose: 8 mg/kg/dose IV x1; Max: 800 mg/dose; Info: for hospitalized pts requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO), per FDA EUA; give w/ systemic corticosteroids; may repeat dose x1 after 8h
renal dosing
- [see below]
- CrCl >30: no adjustment; CrCl <30: not defined
- HD/PD: not defined
hepatic dosing
- [COVID-19]
- baseline AST/ALT >10x ULN: avoid use
- [all other indications]
- active hepatic dz or baseline AST/ALT >1.5x ULN: avoid use