Tocilizumab
About
Tocilizumab belongs to the class of 'immunosuppressants', primarily used to treat rheumatoid arthritis, ankylosing spondylitis, and giant cell arteritis (inflammation of the lining of your arteries) in adults. It is also used to treat rheumatoid arthritis in children, such as systemic juvenile idiopathic arthritis (SJIA) and polyarticular juvenile idiopathic arthritis (PJIA). Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks its own cells and cause joint pain with inflammation. Tocilizumab is currently being trialled to treat breathing complications in COVID-19 (Corona Virus Disease-19) patients.
Tocilizumab consists of 'Tocilizumab' that belongs to the class of 'interleukin inhibitors.' It works by blocking the Interleukin-6 (IL-6), a substance released by the body that causes inflammation. Lately, Tocilizumab is also being used in COVID-19 infection to reduce the severity of inflammation and damage in the lungs. It is thought to decrease the cytokine storm, an excessive immune response that occurs in the lungs of a COVID-19 infected person.
Your doctor will decide the dose and duration based on the medical condition. Common side effects of Tocilizumab include runny nose, sinus pain, sore throat, increased blood pressure, pain and swelling at the injection site, and headache. These side effects are not familiar to everyone and vary individually. However, if the side effects are persistent, please reach out to your doctor.
Before starting Tocilizumab, inform your doctor if you have any liver, heart or kidney diseases, stomach and intestinal ulcers, multiple sclerosis (nerve and muscle disease), diabetes, weak immune system (HIV), hepatitis B, cancer, and active infections. Let your doctor know if you are pregnant or breastfeeding before starting Tocilizumab. Tocilizumab may cause dizziness, so drive only if you are alert and focused. Tocilizumab should not be given to children under two years of age as safety has not been established. Avoid consuming alcohol along with Tocilizumab as it could lead to increased dizziness and risk of liver damage.
Uses of Tocilizumab
Medicinal Benefits
Tocilizumab treats pain, redness, and inflammation (swelling) in patients with rheumatoid arthritis, ankylosing spondylitis, and giant cell arteritis. It contains 'Tocilizumab,' an 'interleukin inhibitor.' It works by blocking the Interleukin-6 (IL-6), a substance released by the body that causes inflammation. Lately, Tocilizumab is also being used in COVID-19 infection to reduce breathing complications, the severity of inflammation, and damage in the lungs. It is used to decrease the cytokine storm, an excessive immune response that occurs in the lungs of a COVID-19 infected person.
Directions for Use
Storage
Side Effects of Tocilizumab
- Runny nose
- Sinus pain
- Sore throat
- Increased blood pressure
- Pain and swelling at the injection site
- Headache
In-Depth Precautions and Warning
Drug Warnings
Inform your doctor if you have any liver, heart or kidney diseases, stomach and intestinal ulcers (diverticulitis), multiple sclerosis (nerve and muscle disease), low blood cell count, diabetes, weak immune system (HIV), hepatitis B, cancer, and active infections before starting Tocilizumab. Avoid close contact with people who have infections like chickenpox, measles, tuberculosis, and flu that can be easily spread. Thoroughly wash your hands to prevent the spread of infection. Do not take live vaccines while being treated with Tocilizumab to prevent any serious consequences. Tocilizumab may cause dizziness and drowsiness, so drive only if you are alert and focused. Avoid consuming alcohol along with Tocilizumab as it could lead to increased dizziness and risk of stomach bleeding/ulcers. Tocilizumab is not recommended in children younger than two years of age as safety and efficacy is not established. Store Tocilizumab at temperatures of 2°C to 8°C. Do not freeze the vial.
Drug Interactions
Drug-Drug Interaction: Tocilizumab may interact with other immunosuppressants (certolizumab, golimumab, infliximab, adalimumab, rituximab), medicines used to treat rheumatoid arthritis (abatacept, etanercept, anakinra), blood thinners (warfarin), cholesterol-lowering drugs (atorvastatin, lovastatin, simvastatin), acidity treating medicines (omeprazole), cough suppressants (Dextromethorphan), and birth control pills.
Drug-Food Interaction: Alcohol consumption may cause dizziness and increases the risk of stomach ulcers and bleeding.
Drug-Disease Interaction: Tocilizumab should be used with caution in cases of liver, heart or kidney diseases, stomach and intestinal ulcers (diverticulitis), multiple sclerosis, low blood cell count, diabetes, weak immune system (HIV), hepatitis B, cancer, and active infections.
Drug-Drug Interactions Checker List:
Safety Advice
Alcohol
cautionYou are recommended to avoid alcohol consumption if you are being treated with Tocilizumab. Alcohol intake, along with Tocilizumab, may cause increased dizziness and risk of stomach bleeding/ulcers.
Pregnancy
cautionTocilizumab is a pregnancy category C drug and is not recommended during pregnancy since animal studies showed harmful effects on the developing baby. Your doctor will prescribe Tocilizumab only if the benefit outweighs the risk.
Breast Feeding
cautionIt is not known if Tocilizumab passes into the breastmilk when used by breastfeeding mother. Your doctor will prescribe Tocilizumab only if the benefit outweighs the risk.
Driving
unsafeTocilizumab may make you feel dizzy and sleepy. Do not drive or operate machinery if you experience dizziness or drowsiness.
Liver
cautionPlease consult your doctor since Tocilizumab should be used with caution in patients with liver impairment/liver disease. Dose adjustment may be needed in patients with liver impairment. However, Tocilizumab is not recommended in patients with active liver diseases.
Kidney
cautionPlease consult your doctor since Tocilizumab should be used with caution in patients with kidney impairment/kidney disease. Dose adjustment may be required.
Children
cautionTocilizumab is not recommended in children younger than two years of age.
Habit Forming
Diet & Lifestyle Advise
- Exercising regularly helps in muscle stretching that is less likely to spasm, tear and sprain. Mild exercises such as jogging and walking are helpful for muscle stretching.
- Massages can also be helpful.
- Avoid freezing and hot temperatures.
- Avoid wearing tight-fitting clothes; instead, wear loose garments.
- Rest well and get plenty of sleep.
- To avoid developing pressure sores, change your position at least every two hours.
- Hot or cold therapy can help treat muscle spasms. Apply an ice-pack or hot-pack on the muscle for 15-20minutes.
- Stay hydrated; drink plenty of water.
Special Advise
- It is advised to closely monitor the patient for infections like active tuberculosis during and after the treatment though the patient gets a negative tuberculin test.
- It is essential to inform your doctor if you have any active viral, bacterial, and fungal infections before starting Tocilizumab.
Patients Concern
Disease/Condition Glossary
Rheumatoid arthritis: It is an autoimmune disease (the body's immune system attacks its tissue), leading to joint pain and damage. Symptoms of rheumatoid arthritis include pain, swelling, stiffness, deformities, and loss of joint function.
Ankylosing spondylitis: It causes pain and stiffness in the spine. The pain usually starts in the lower back and can spread to the neck, damaged joints, or other body parts. Symptoms of ankylosing spondylitis include decreased flexibility, which usually leads to a hunched-forward posture, and pain in the back and joints.
COVID-19: It is a disease caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2). It mainly affects the respiratory system and is spread through droplets generated when an infected person coughs, sneezes, or exhales. Common symptoms include fever, dry cough, tiredness, body aches, sore throat, loss of taste and smell, and conjunctivitis. With the severity of the disease, symptoms like dropping oxygen saturation levels, shortness of breath, chest pain, high fever, and severe weakness are also noticed. The coronavirus can further lead to complications like pneumonia, respiratory failure, heart problems, liver problems, septic shock, and death.
FAQs
Tocilizumab contains Tocilizumab, an immunosuppressant. It blocks the action of Interleukin-6 (IL-6), a substance released by the body that causes inflammation. Thus, it helps in decreasing pain and inflammation in various diseases like rheumatoid arthritis, ankylosing spondylitis, and giant cell arteritis.
When a person is infected with the coronavirus, his/her immune system responds in such a way that it sends useful immune chemicals to the affected areas of the lungs to fight the infection. However, in some people, this release of immune chemicals is overactive, resulting in a cytokine storm, an excessive immune response in the lungs. This can further lead to severe breathing complications in an infected person. Tocilizumab reduces this cytokine storm and further prevents the inflammation and damage in the lungs of a COVID-19 infected person.
Though Tocilizumab in Tocilizumab is under the clinical trial stage of development by FDA for being used in COVID-19 infection, it is currently used to treat breathing complications for COVID-19 patients. It is known to show improvement in pneumonia during coronavirus infection.
Tocilizumab is not recommended for every person infected with the coronavirus. Tocilizumab has potential hazards and is only prescribed by doctors in patients with severe breathing difficulties and who have highly dropping saturation levels (blood oxygen level (SpO2)).
Tocilizumab is to be carefully administered with caution in patients under doctor's supervision only since it can cause potential side effects like elevated liver enzymes, neutropenia (low levels of neutrophils), and thrombocytopenia (low levels of platelets). It can also cause serious viral infections like hepatitis B, bacterial infections including active tuberculosis, and fungal infections including candidiasis, aspergillosis, and pneumocystis.
Tocilizumab affects your immune system and makes you more susceptible to infections. Hence, it is not recommended in people with active infections like tuberculosis, hepatitis B, abnormal liver enzymes, and platelet counts less than 50,000. Tocilizumab can also increase the risk of developing cancers; hence it is essential to mention your doctor if you had a history of any cancer.
Even if there is no improvement after administering Tocilizumab, your doctor may suggest an alternate course. Please note that Tocilizumab does not reverse the damage caused due to coronavirus infection, but it will further prevent the inflammation of the lungs. It is also advised to medically examine for other lung and heart related dysfunctions even the patient suffers breathlessness after Tocilizumab administration.
It is not recommended to get live vaccines like measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine while being treated with Tocilizumab. This could lead to a severe infection. Please consult a doctor before you start Tocilizumab if you are undergoing any vaccinations.
