Tocilizumab - Side effects, Precautions and Contraindications
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Tocilizumab - Side Effects, Precautions, and Contraindications

What side effects can Tocilizumab cause?

You may experience side effects with your treatment. Contact your doctor if you have any concerns about possible side effects

Most common possible side effects

  • Infusion reactions (e.g. fever or chills, itch, dizziness, headache, chest pain, shortness of breath or changes in blood pressure). These effects are more likely to occur during the first or second infusion and can usually be reduced by giving steroids, antihistamines and paracetamol before the treatment
  • Headache or cough
  • Stomach or bowel discomfort
  • Skin effects (e.g. rash, dermatitis and itching)
  • Reversible elevation of liver enzymes
  • Reversible increase in cholesterol level
  • Mild infections (e.g. colds) 

Less common or rare possible side effects

  • Decrease in white blood cell count
  • Serious infections (e.g. tuberculosis)
  • Perforations of the stomach or gut
  • Contact your rheumatologist if you have concerns about any of these possible side effects
  • Many side effect disappear when tocilizumab treatment is stopped

Before taking Tocilizumab , what precautions must I follow?

If you have an active infection of any kind, treatment with tocilizumab will not be given until the infection is treated successfully.

Tocilizumab will not be given if you have active untreated tuberculosis or HIV infection, as it is likely to worsen these conditions.

If you have latent (inactive) tuberculosis, preventive anti-tuberculosis treatment will be started at least 4 weeks before tocilizumab. The anti-tuberculosis treatment will need to be taken for 9 months.

Hepatitis B or C infection may not necessarily exclude treatment.

Before of the risks associated with infection, laboratory tests will be conducted before commencing treatment with tocilizumab.

Blood tests will be required during your treatment to monitor your condition and to determine the effectiveness of treatment.

You should receive annual pneumococcal and seasonal flu vaccinations to reduce risks of infections.

If you require surgery for any reason, treatment will be stopped before surgery and restarted again after the surgery at a time determined by your surgeon and rheumatologist.

If cancer has previously been treated and cured, it is unclear whether a biological DMARD such as tocilizumab can be used safely.

At present an interval of at least 5 years is recommended between cure of a cancer and starting biological DMARDs.

Talk to your rheumatologist if you have any concerns about issues relating to cancer risk.

What food or medicine must I avoid when I take Tocilizumab ?

You may drink alcohol while taking tocilizumab

However, since you are likely to be also taking methotrexate, you should be cautious about your alcohol intake

It is not known precisely what level of drinking is safe when on methotrexate, however there is general agreement that 1 to 2 standard drinks taken once or twice a week is unlikely to cause a problem

Drinking more than 4 standard drinks on one occasion, even if infrequently, is strongly discouraged

  • Updated on 6/12/2015 12:00:00 AM
  • Article contributed by Pharmacy, Rheumatology & Immunology Singapore General Hospital
The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth


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