Select a medication above to begin.
Avtozma (tocilizumab-anoh)
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 (auto-injector): 162 mg; INJ (pre-filled syringe): 162 mg per 0.9 mL; INJ (vial): various
Special Note
- [formulation clarification]
- Info: nonproprietary name = tocilizumab-anoh
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
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
systemic sclerosis-associated interstitial lung dz (off-label)
- [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 (off-label)
- [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
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 (auto-injector): 162 mg; INJ (pre-filled syringe): 162 mg per 0.9 mL; INJ (vial): various
Special Note
- [formulation clarification]
- Info: nonproprietary name = tocilizumab-anoh
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 (off-label)
- [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 (off-label)
- [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
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- infection, active
- ANC <2000 (except CRS or COVID-19 use)
- ANC <1000 (COVID-19 use)
- Plt <100,000 (except CRS or COVID-19 use)
- Plt <50,000 (COVID-19 use)
- ALT or AST >1.5x ULN (except CRS or COVID-19 use)
- ALT or AST >10x ULN (COVID-19 use)
- hepatic dz, active
- caution: TB infection risk
- caution: residents of area w/ endemic TB
- caution: residents of area w/ endemic mycosis
- caution: travelers in area w/ endemic TB
- caution: travelers in area w/ endemic mycosis
- caution: opportunistic infection hx
- caution: HBV infection
- caution: HBV infection hx
- caution: infection risk
- caution: malignancy risk
- caution: GI perforation risk
- caution: CNS demyelinating dz
- caution: infection, chronic
- caution: infection, recurrent
Drug Interactions .
Overview
tocilizumab
IL-6 antagonist
- CYP2C19 inducer, weak
- CYP3A4 inducer, minor
- GI mucosal injury/bleeding risk
- immunosuppressive effects
- myelosuppressive effects
- caution advised w/ narrow therapeutic index drugs; chronic inflammatory conditions may alter metabolic enzyme formation; tx w/ immune modulators may reverse this effect, resulting in altered levels of concomitant drugs
Contraindicated
- adenovirus vaccine, live
- BCG live intravesical
- chikungunya vaccine, live
- cholera vaccine, live
- dengue vaccine, live
- influenza nasal vaccine, live
- measles/mumps/rubella vaccine, live
- rotavirus vaccine, live
- smallpox vaccine, live
- talimogene laherparepvec
- typhoid vaccine, live
- varicella vaccine, live
- yellow fever vaccine, live
Avoid/Use Alternative
- abatacept
- abrocitinib
- adalimumab
- anakinra
- anifrolumab
- atazanavir
- atogepant
- belatacept
- belimumab
- canakinumab
- certolizumab pegol
- chloramphenicol
- cladribine oral
- deferiprone
- desogestrel (contraceptive)
- deuruxolitinib
- dienogest (contraceptive)
- dolutegravir
- drospirenone (contraceptive)
- estradiol (contraceptive)
- etanercept
- ethinyl estradiol (contraceptive)
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- etrasimod
- fexinidazole
- fosamprenavir
- ganciclovir
- golimumab
- ibritumomab tiuxetan
- infliximab
- levonorgestrel (contraceptive)
- levonorgestrel (post-coital contraceptive)
- lopinavir/ritonavir
- lumateperone
- mavacamten
- medroxyprogesterone (contraceptive)
- meperidine
- natalizumab
- norelgestromin (contraceptive)
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- obinutuzumab
- ocrelizumab
- ofatumumab
- penicillamine
- pimecrolimus topical
- primaquine
- rabies vaccine
- radium Ra 223 dichloride
- ranolazine
- rilonacept
- ritlecitinib
- rituximab
- ropeginterferon alfa-2b
- ruxolitinib topical
- sarilumab
- segesterone (contraceptive)
- tofacitinib
- ublituximab
- ulipristal (post-coital contraceptive)
- upadacitinib
- valganciclovir
- zuranolone
Monitor/Modify Tx
- abemaciclib
- acalabrutinib
- ado-trastuzumab emtansine
- afamitresgene autoleucel
- afatinib
- albendazole
- aldesleukin
- alemtuzumab
- alendronate
- allopurinol
- amlodipine
- anthrax vaccine
- anti-thymocyte globulin
- arsenic trioxide
- asciminib
- asenapine
- aspirin
- atidarsagene autotemcel
- auranofin
- axicabtagene ciloleucel
- axitinib
- azacitidine
- azathioprine
- balsalazide
- baricitinib
- belantamab mafodotin
- belinostat
- bendamustine
- benznidazole
- betamethasone
- betibeglogene autotemcel
- bevacizumab
- bexarotene
- blinatumomab
- bortezomib
- bosutinib
- brentuximab vedotin
- brexucabtagene autoleucel
- buprenorphine
- busulfan
- cabazitaxel
- cabozantinib
- capecitabine
- carbamazepine
- carboplatin
- carfilzomib
- carmustine
- celecoxib
- chikungunya vaccine
- chlorambucil
- cidofovir
- ciltacabtagene autoleucel
- cinacalcet
- cisplatin
- cladribine injection
- clofarabine
- clozapine
- colchicine
- copanlisib
- corticotropin
- cortisone
- COVID-19 vaccine
- crizotinib
- cyclophosphamide
- cyclosporine
- cysteamine
- cytarabine
- dacarbazine
- dactinomycin
- dapsone
- daratumumab
- dasatinib
- daunorubicin
- decitabine
- deferasirox
- deflazacort
- dexamethasone
- dexrazoxane
- diclofenac
- diclofenac topical
- diflunisal
- diltiazem
- dimethyl fumarate
- dinutuximab
- diphtheria/tetanus vaccine
- diphtheria/tetanus/pertussis vaccine
- diroximel fumarate
- disopyramide
- docetaxel
- donepezil
- dostarlimab
- doxorubicin
- duvelisib
- ebola vaccine, live
- eflornithine
- elivaldogene autotemcel
- elranatamab
- enfortumab vedotin
- entrectinib
- epcoritamab
- epirubicin
- eribulin
- erlotinib
- etelcalcetide
- ethanol
- etodolac
- etoposide
- everolimus
- exagamglogene autotemcel
- fam-trastuzumab deruxtecan
- fedratinib
- fenoprofen
- floxuridine
- flucytosine
- fludarabine
- fludrocortisone
- fluorouracil
- fluphenazine
- flurbiprofen
- foscarnet
- fosphenytoin
- fostamatinib
- fruquintinib
- galantamine
- gefitinib
- gemcitabine
- gemtuzumab ozogamicin
- givinostat
- glasdegib
- glofitamab
- Haemophilus b vaccine
- hepatitis A vaccine
- hepatitis B vaccine
- human papillomavirus vaccine
- hydrocortisone
- hydroxychloroquine
- hydroxyurea
- ibandronate
- ibrutinib
- ibuprofen
- ibuprofen lysine
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- iloperidone
- imatinib
- imetelstat
- indomethacin
- influenza H5N1 vaccine
- influenza vaccine
- inotuzumab ozogamicin
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- irinotecan
- isatuximab
- isradipine
- ivosidenib
- ixabepilone
- Japanese encephalitis vaccine
- ketoconazole
- ketoprofen
- ketorolac
- leflunomide
- lenalidomide
- lenvatinib
- lifileucel
- linezolid
- lisocabtagene maraleucel
- lomustine
- lonafarnib
- loncastuximab tesirine
- lovotibeglogene autotemcel
- lurbinectedin
- lutetium Lu 177 dotatate
- lutetium Lu 177 vipivotide tetraxetan
- lymphocyte immune globulin, anti-thymocyte globulin
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- melphalan
- meningococcal vaccine
- mercaptopurine
- mesalamine
- mesalamine rectal
- methotrexate
- methylprednisolone
- midostaurin
- mitapivat
- mitomycin
- mitotane
- mitoxantrone
- mogamulizumab
- momelotinib
- monomethyl fumarate
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nabumetone
- naproxen
- nelarabine
- nicardipine
- nilotinib
- nimodipine
- nintedanib
- niraparib
- nisoldipine
- obecabtagene autoleucel
- olaparib
- oliceridine
- olsalazine
- oxaliplatin
- oxaprozin
- paclitaxel
- pacritinib
- palbociclib
- panobinostat
- pazopanib
- peginterferon alfa 2a
- peginterferon beta 1a
- pemetrexed
- pentamidine
- pentostatin
- perampanel
- phenytoin
- piroxicam
- pirtobrutinib
- pneumococcal vaccine
- polatuzumab vedotin
- poliovirus vaccine
- pomalidomide
- ponatinib
- porfimer
- pralatrexate
- prednisolone
- prednisone
- procarbazine
- proguanil
- pyridostigmine
- pyrimethamine
- quetiapine
- quinidine (antiarrhythmic)
- quizartinib
- ramucirumab
- regorafenib
- respiratory syncytial virus vaccine
- ribavirin
- ribociclib
- rifabutin
- risedronate
- rivastigmine
- romidepsin
- rucaparib
- ruxolitinib
- sacituzumab govitecan
- salsalate
- satralizumab
- selinexor
- sipuleucel-T
- sirolimus
- sirolimus albumin-bound
- smallpox/mpox vaccine, live
- sorafenib
- stiripentol
- streptozocin
- succimer
- sulfasalazine
- sulindac
- sunitinib
- tacrolimus
- tafasitamab
- tagraxofusp
- talazoparib
- talquetamab
- tarlatamab
- tazemetostat
- teclistamab
- temozolomide
- temsirolimus
- teplizumab
- teriflunomide
- thalidomide
- thioguanine
- thiotepa
- tiagabine
- tick-borne encephalitis vaccine
- tisagenlecleucel
- tivozanib
- tolmetin
- topotecan
- trabectedin
- trametinib
- trastuzumab
- treosulfan
- triamcinolone
- trifluridine
- trimethoprim
- typhoid vaccine
- ubrogepant
- vadadustat
- valproic acid
- vamorolone
- venetoclax
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- warfarin
- willow bark
- zanubrutinib
- zidovudine
- ziv-aflibercept
Caution Advised
- alfentanil
- alprazolam
- amiodarone
- aprepitant
- artemether/lumefantrine
- atorvastatin
- avacopan
- avapritinib
- basiliximab
- beclomethasone inhaled
- beclomethasone nasal
- bictegravir
- bimekizumab
- brigatinib
- brodalumab
- budesonide
- budesonide inhaled
- budesonide nasal
- budesonide rectal
- buspirone
- capivasertib
- capmatinib
- carisoprodol
- clarithromycin
- clobetasol ophthalmic
- cobicistat
- cobimetinib
- codeine
- crovalimab
- danicopan
- daridorexant
- darunavir
- deucravacitinib
- dexamethasone ophthalmic
- difluprednate ophthalmic
- doravirine
- dronedarone
- dupilumab
- eculizumab
- efgartigimod alfa
- elacestrant
- elbasvir
- elexacaftor/tezacaftor/ivacaftor
- eliglustat
- elotuzumab
- elvitegravir
- emapalumab
- erdafitinib
- esomeprazole
- felodipine
- fentanyl
- finerenone
- fingolimod
- flunisolide nasal
- fluocinolone intravitreal
- fluorometholone ophthalmic
- fluticasone furoate
- fluticasone propionate
- fosaprepitant
- ganaxolone
- gepirone
- gilteritinib
- glecaprevir
- grazoprevir
- guanfacine
- guselkumab
- haloperidol
- hydrocortisone ophthalmic
- inebilizumab
- infigratinib
- iptacopan
- isavuconazonium
- istradefylline
- itraconazole
- ivacaftor
- ixazomib
- ixekizumab
- lapatinib
- larotrectinib
- lazertinib
- lebrikizumab
- lefamulin
- lenacapavir
- leniolisib
- letermovir
- levoketoconazole
- levonorgestrel intrauterine device (contraceptive)
- lorlatinib
- loteprednol ophthalmic
- lurasidone
- macitentan
- maraviroc
- methadone
- midazolam
- mirikizumab
- mobocertinib
- mometasone implant
- mometasone inhaled
- mometasone nasal
- nadofaragene firadenovec intravesical
- naldemedine
- naloxegol
- nefazodone
- nelfinavir
- neratinib
- netupitant
- nevirapine
- nifedipine
- nirmatrelvir
- nirogacestat
- olutasidenib
- omeprazole
- oxycodone
- ozanimod
- pegcetacoplan
- pemigatinib
- pimavanserin
- ponesimod
- pozelimab
- praziquantel
- prednisolone ophthalmic
- pretomanid
- quinine
- ravulizumab
- repotrectinib
- rilpivirine
- ripretinib
- risankizumab
- ritonavir
- roflumilast
- rolapitant
- rozanolixizumab
- samidorphan
- secukinumab
- selpercatinib
- selumetinib
- sildenafil
- siltuximab
- simvastatin
- siponimod
- sonidegib
- spesolimab
- sutimlimab
- suzetrigine
- tadalafil
- tamoxifen
- tezacaftor/ivacaftor
- ticagrelor
- tildrakizumab
- tipranavir
- tolvaptan
- toremifene
- tralokinumab
- tramadol
- tuberculin purified protein derivative
- ustekinumab
- vanzacaftor/tezacaftor/deutivacaftor
- vedolizumab
- velpatasvir
- verapamil
- vilobelimab
- voclosporin
- vonoprazan
- voxelotor
- voxilaprevir
- zilucoplan
Adverse Reactions .
Serious Reactions
- infection, serious
- sepsis
- opportunistic infection
- tuberculosis
- HBV reactivation
- malignancy
- GI perforation
- pancreatitis
- hepatotoxicity
- hepatic failure
- hepatitis
- acute kidney injury
- hypersensitivity rxn
- anaphylaxis
- Stevens-Johnson syndrome
- drug rxn w/ eosinophilia and systemic sx
- neutropenia
- thrombocytopenia
- demyelinating CNS dz
- thrombosis
Common Reactions
- injection site rxn (SC use)
- infusion rxn (IV use)
- dyslipidemia
- constipation
- URI
- nasopharyngitis
- headache
- acute kidney injury
- HTN
- anxiety
- diarrhea
- ALT or AST elevated
- hypokalemia
- hyperglycemia
- insomnia
- delirium
- nausea
- hypoglycemia
- pain
- dizziness
- bronchitis
- rash
- oral ulcer
- abdominal pain
- gastritis
- thrombosis
Safety/Monitoring .
Monitoring Parameters
RA or GCA or SSc-ILD: hepatitis B serology incl. HBsAg at baseline; TB test at baseline, then active TB s/sx; AST/ALT, alk phos, total bilirubin at baseline, then q4-8wk x6mo, then q3mo; ANC, Plt at baseline, at 4-8wk, then q3mo; lipid panel 4-8wk after tx start
PJIA: hepatitis B serology incl. HBsAg at baseline; TB test at baseline, then active TB s/sx; AST/ALT, alk phos, total bilirubin, ANC, Plt at baseline, at 2nd infusion, then q4-8wk; lipid panel 4-8wk after tx start
SJIA: hepatitis B serology incl. HBsAg at baseline; TB test at baseline, then active TB s/sx; AST/ALT, alk phos, total bilirubin, ANC, Plt at baseline, at 2nd infusion, then q2-4wk; lipid panel 4-8wk after tx start
COVID-19: AST/ALT, ANC, Plt at baseline and during tx
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; possible risk of embryo-fetal toxicity based on animal data at 1.25x and 6.25x recommended human dose
Lactation
Clinical Summary
may use while breastfeeding; no human data available, though risk of infant harm not expected based on drug properties; no human data available to assess effects on milk production
Pharmacology .
Metabolism: unknown; CYP450: unknown
Excretion: unknown; Half-life: 5-13 days (SC use, RA pts), 4.2-18.9 days (SC use, GCA pts), 12-13 days (SC use, SSc-ILD pts), 10-14 days (SC use, JIA pts), 11-13 days (IV use, RA pts), 13.2 days (IV use, GCA pts), 16-17 days (IV use, JIA pts)
Subclass: Coronavirus ; DMARDs, Interleukin (IL) Antagonists ; Interleukin-6 (IL-6) Antagonists ; Interstitial Lung Disease
Mechanism of Action
binds to and inhibits IL-6 receptors, reducing inflammation and altering immune response (monoclonal antibody)
Formulary .
No Formulary Selected
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