ACTEMRA

*Moderate to severe active rheumatoid arthritis alone or with methotrexate if other DMARD or TNF inhibitor has been inadequate, or intolerance to such drugs:* BY IV INF: Adult: 8 mg/kg every 4 wks (max. per dose 800 mg), for dose adjustments in patients with liver enzyme abnormalities, or low absolute neutrophil or platelet count, consult product literature.

Dilute to 100 ml and administer by IV infusion over 1 hour

Severe active infection, absolute neutrophil count less than 2x109/litre

History of diverticulitis, history of intestinal ulceration, history of recurrent or chronic infection low absolute neutrophil count, low platelet count, hepatic or renal impairment, predisposition to infection (interrupt treatment if serious infection occurs), reduce dose in elderly. Patients with latent tuberculosis should be treated with standard therapy before starting tocilizumab. Monitor renal function closely in moderate or severe impairment, perform regular blood counts. Monitor lipid profile 4-8 weeks after starting treatment and then as indicated, monitor for demyelinating disorders, monitor hepatic transaminases every 4-8 weeks for first 6 months, then every 12 weeks, monitor neutrophil and platelet counts 4-8 weeks after starting treatment and then as indicated.

Live vaccines, drug metabolized by CYP450 enzymes, TNF inhibitors

Headache, dizziness, abdominal pain, antibody formation, gastritis, gastric ulcer, GI perforation, hypercholesterolaemia, hypersensitivity, hypertension, infection, leucopenia, mouth ulceration, neutropenia, peripheral oedema, pruritus, raised hepatic transaminases, rash, upper respiratory-tract infection, anaphylaxis. Rare: Hypertriglyceridaemia, hypothyroidism, infusion related reactions, nephrolithiasis, thrombocytopenia