Generic Name

Tocilizumab

---

Classification

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

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.