Tocilizumab is a drug used to treat rheumatoid arthritis in adults as well as children. Rheumatoid arthritis is an autoimmune disease that attacks healthy joint cells, causing inflammation in the joints.
Tocilizumab works by inhibiting the production of a natural protein called interleukin 6 (IL-6) in the body. That way, the immune system response will decrease and inflammation will subside.
In some COVID-19 patients with severe symptoms, the body releases cytokines, including IL-6 in excessive amounts (cytokine storm). The use of tocilizumab is expected to control the overproduction of cytokines, including IL-6.
Since July 2021, the World Health Organization (WHO) has recommended this drug to treat a cytokine storm in COVID-19 patients.
Tocilizumab trademark: Actemra
What is Tocilizumab
| group | Prescription drugs |
| Category | Antiinterleukin 6 (IL-6) type immunosuppressant |
| Benefit | Treating rheumatoid arthritis or managing a cytokine storm in COVID-19 patients |
| Used by | Adults and children 2 years old |
| Tocilizumab for pregnant and lactating women | Category C: Animal studies have shown adverse effects on the fetus, but there are no controlled studies in pregnant women. Drugs should only be used if the expected benefit outweighs the risk to the fetus. It is not known whether tocilizumab is absorbed into breast milk or not. If you are breastfeeding, do not use this medicine without consulting your doctor first. |
| Drug form | Inject |
Precautions Before Using Tocilizumab
Injectable tocilizumab will be given by a doctor or medical officer at a health facility. Note the following points before using tocilizumab:
- Tell your doctor about any allergies you have. Tocilizumab should not be given to patients who are allergic to this drug.
- Tell your doctor if you have or have had liver disease, stomach ulcers, duodenal ulcers, diverticulitis, multiple sclerosis, diabetes, infectious diseases, such as tuberculosis or hepatitis B.
- Tell your doctor if you have a weakened immune system due to HIV/AIDS.
- Tell your doctor if you plan to vaccinate with live vaccines, while taking tocilizumab, as this medicine can decrease the effectiveness of the vaccine.
- As much as possible, avoid close contact with people with infectious diseases that are easily transmitted, such as chickenpox or the flu, because these drugs can make it easier for you to catch an infection.
- Tell your doctor if you are pregnant, breastfeeding, or planning a pregnancy.
- Tell your doctor that you are taking tocilizumab before undergoing certain medical procedures or surgery.
- Tell your doctor if you are taking certain medications, supplements, or herbal products.
- Report to your doctor if you have an allergic drug reaction, serious side effect, or overdose after using tocilizumab.
Dosage and Rules for Use Tocilizumab
Tocilizumab will be injected through a vein (intravenous / IV) by a doctor or medical officer under the supervision of a doctor.
The dose of tocilizumab given depends on the condition to be treated, the age and weight of the patient. Here is the explanation:
Purpose: Treating rheumatoid arthritis
- Mature: 4 mg/kg, for 60 minutes, once every 4 weeks. The dose can be increased up to 8 mg/kg body weight.
Purpose: Handle systemic juvenile idiopathic arthritis
- Children with body weight <30kg: 12 mg/kg body weight, once every 2 weeks.
- Children with body weight30 kg: 8 mg/kg body weight, once every 2 weeks.
Purpose: Handle polyarticular juvenile idiopathic arthritis
- Children with body weight<30kg: 10 mg/kg, once every 4 weeks.
- Children with body weight30 kg: 8 mg/kg, once every 4 weeks.
Purpose: Tackling a cytokine storm in COVID-19 patients
- Patients weighing <30 kg: 12 mg/kg body weight, over 60 minutes.
- Patients weighing 30 kg: 8 mg/kg body weight, over 60 minutes.
The maximum dose of tocilizumab to treat rheumatoid arthritis and cytotoxin storm in COVID-19 patients is 800 mg.
How to Use Tocilizumab Correctly
Tocilizumab will be injected directly by a doctor or medical officer under the supervision of a doctor. Injection is done into a vein (intravenous / IV) through a slow infusion over 60 minutes.
Follow your doctor's advice and recommendations while you are on treatment with tocilizumab. Do not stop taking medication without consulting your doctor first.
During your treatment with tocilizumab, you will have regular liver function tests to monitor your condition, response to therapy, and possible side effects.
Tocilizumab Interactions with Other Drugs
Tocilizumab can cause drug interactions when used with other drugs. Some of the drug interactions that can occur are:
- Increased risk of infection from vaccination when used with live vaccines, such as BCG vaccine or influenza vaccine
- Increased risk of developing dangerous and fatal infectious diseases when used with other immunosuppressant drugs, such as adalimumab, etanercept, baricitinib, anankira, or infliximab
- Increased risk of bone marrow disorders when used with teriflunomide
Side Effects and Dangers of Tocilizumab
Tell your doctor or medical officer if the following side effects do not subside or get worse:
- Pain, redness, or swelling at the injection site
- Headache
- Constipation
- Feeling anxious
- Nauseous
In addition, report to your doctor immediately if you experience an allergic reaction to the drug or experience more serious side effects, such as:
- Symptoms of infection, such as coughing, coughing up blood, sore throat, fever, or chills
- Liver disease, which can be characterized by symptoms such as loss of appetite, jaundice, dark urine, or persistent vomiting
- Severe abdominal pain, diarrhea or severe constipation
- Easy bruising
Although rare, the use of tocilizumab can increase the risk of perforation, which is the appearance of a hole or tear in the digestive tract.
