Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Tocilizumab

🔗 Related Subjects: 🧠 Temporal (Giant Cell) Arteritis | 💉 Tocilizumab

📖 About

Always check the BNF entry for up-to-date dosing and safety information. Tocilizumab is a humanised anti-IL-6 receptor monoclonal antibody.

⚙️ Mode of Action

🧬 Humanised IgG1 antibody targeting IL-6 receptors (both soluble and membrane-bound).
⛔ Blocks IL-6 signalling → reduced CRP production, inflammation, and immune activation.
🌡️ Results in immunomodulation and reduced disease activity.

💊 Indications (Specialist Use)

🤲 Rheumatoid Arthritis: moderate–severe disease not controlled with DMARDs.
🧒 Systemic Juvenile Idiopathic Arthritis (sJIA): ≥2 years old.
🧠 Giant Cell Arteritis: active disease including cranial manifestations.
🧪 Cytokine Release Syndrome (CRS): post CAR-T cell therapy.
🦠 COVID-19: emergency use for severe systemic inflammation.

📌 Typical Doses (check BNF/SmPC for updates)

🤲 Rheumatoid Arthritis: IV 4 mg/kg every 4 weeks; SC 162 mg weekly or fortnightly.
🧒 sJIA: 8 mg/kg IV every 4 weeks.
🧠 GCA: 8 mg/kg IV or 162 mg SC weekly/fortnightly.
🧪 CRS: 8 mg/kg IV, may repeat after 8 hours if required.
🦠 COVID-19: 8 mg/kg IV (repeatable in 12–24 h if needed).

⚠️ Precautions

🧫 Screen for latent TB and hepatitis before initiation.
🧪 Monitor LFTs and FBC regularly.
🚫 Avoid use in active infections.
⚡ Use caution in diverticulitis (risk of GI perforation).
🔬 Monitor lipids, neutrophils, and platelets.

🔀 Interactions

💊 ↑ Risk of infection with other immunosuppressants.
🧩 May alter CYP450 metabolism → drug levels affected (e.g. warfarin, ciclosporin).
💉 Avoid live vaccines during therapy.

💥 Side Effects

Common: 🤧 URTIs, 🤕 headache, 🩸 hypertension, 💉 injection-site reactions.
Serious:
- 🦠 Infections (including opportunistic).
- 🧪 LFT elevation, hyperlipidaemia.
- ⚡ GI perforations.
- 🧬 Neutropenia, thrombocytopenia.
Other: 📈 ↑ cholesterol/triglycerides, risk of malignancy, hypersensitivity reactions.

🔎 Cautions

🩺 CRP may be suppressed → infection/inflammation can be masked.
🧫 Treat latent TB before starting.
🧮 Stop if neutrophils <0.5 × 10⁹/L or platelets <50 × 10³/µL.

🚫 Contraindications

❌ Severe active infection.
❌ Baseline neutrophils <2 × 10⁹/L.

📚 References

BNF – Tocilizumab

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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