Actemra (Tocilizumab) - Intravenous, Subcutaneous

Warning:

Actemra (tocilizumab) contains a boxed warning about the risk of serious infections reported in individuals receiving this medication. These infections include tuberculosis (TB), bacterial, invasive fungal, viral, and other opportunistic infections. Due to this risk, you'll likely be tested for latent TB before starting Actemra. If a severe infection develops during treatment, you may need to stop Actemra until the infection is controlled.

What Is Actemra?

Actemra (tocilizumab) is an injection given every one to four weeks to treat several types of arthritis (an autoimmune disease).

This drug is called an interleukin-6 (IL-6) receptor antagonist. IL-6 is an excess protein in people with arthritis and other inflammatory conditions. Actemra works by preventing these proteins from binding to their receptors, ultimately decreasing the downstream effects of inflammation and joint pain.

The generic name for Actemra is tocilizumab. Actemra is a biologic drug, which means it is made of proteins derived from a living thing. Because of how it's manufactured, it can be an expensive medication. However, manufacturer coupons and patient assistance programs are available to improve affordability.

Actemra is considered a specialty drug; you must get it from a specialty pharmacy. It can be self-administered through a subcutaneous (under the skin) injection or received in a medical office intravenously (IV, into the vein).

Drug Facts

Generic Name: Tocilizumab

Brand Name: Actemra

Drug Availability: Prescription

Therapeutic Classification: Immunological agent

Available Generically: No

Controlled Substance: N/A

Administration Route: Intravenous, subcutaneous

Active Ingredient: Tocilizumab

Dosage Form: Injection

What Is Actemra Used For?

The Food and Drug Administration (FDA) approved Actemra to treat a few different types of arthritis and other inflammatory conditions, such as:

  • Rheumatoid arthritis (RA) that is moderate to severe in adults who have tried one or more other disease-modifying anti-rheumatic drugs (DMARDs) with not enough improvement
  • Polyarticular juvenile idiopathic arthritis (pJIA) in children 2 years and older
  • Systemic juvenile idiopathic arthritis (SJIA) in people 2 years and older
  • Giant cell arteritis (GCA), or inflammation in the lining of the arteries, commonly in arteries in the head
  • Systemic sclerosis-associated interstitial lung disease (SSc-ILD), or lung disease brought about by a disease of connective tissue
  • Cytokine release syndrome (CRS), also called cytokine storm, in adults and children at least 2 years old

How to Take Actemra

You will receive Actemra once every one to four weeks, depending on what you’re taking it for.

You may receive the injection intravenously (into your vein) at an outpatient clinic or office. In this case, a nurse or healthcare provider will take care of preparing and giving the medication. Infusions usually last one hour.

Actemra may also be given subcutaneously, which means the medicine is injected right under your skin. You may eventually be able to do subcutaneous injections yourself at home if you and your healthcare provider feel it’s appropriate. While it can be intimidating or scary to think about injecting yourself, Actemra comes in devices that make the process simple. It’s available in prefilled syringes and prefilled ACTPen autoinjectors. Neither of these requires you to attach needles or draw up liquid.

The needles are small, only about a quarter of an inch long. You can use your thighs or stomach area (except for the 2-inch space around your belly button), as these areas commonly have the most fat. Do not inject into cut, tender, bruised, or scarred skin, and do not inject through clothing.

Before taking subcutaneous Actemra, ask your healthcare provider to show you how to use it. Below are general steps for how to administer Actemra.

For ACTPen autoinjectors:

  1. Remove one autoinjector from your refrigerator and let it come to room temperature for 45 minutes. This will make injecting more comfortable. Have your sharps container handy. Do not try to warm the medicine up by shaking it or using any external heating source.
  2. Hold the pen injector in the middle of the body with the green cap pointing down. You can take a look at the medicine through the small window to make sure it is clear to pale yellow in color. Do not use it if it’s cloudy or has large lumps or flakes.
  3. Wash your hands and clean the area of skin you plan to inject with an alcohol swab. Then, allow your skin to dry without blowing on it or touching it again.
  4. Once you’re ready to inject, remove the cap by twisting it and pulling it off. Do not try to put the cap back on. Use the injector within three minutes of removing the cap.
  5. Hold the injector in your fist by the upper part of it so that you can still see the viewing window of the medicine. Then, gently pinch a small area of skin at the injection site with your other hand.
  6. Hold the injector against your skin at a 90-degree angle. Then press down firmly against your skin and click the green activation button until you hear a click. The first click indicates that the injection has started.
  7. Keep the green button pressed and continue holding the injector against your skin. You’ll see the purple indicator move along the viewing window throughout the injection, which can take up to 10 seconds. You may hear a second click, but keep pressing until the purple indicator stops moving.
  8. Release the green button and lift the injector off your skin, then place the entire injector into your sharps container.
  9. If you see any blood, you can lightly press a cotton ball over the injection site, but do not rub your skin.
  10. Keep track of where you inject each dose of Actemra, as you’ll want to rotate sites each time you administer the drug.

For Actemra prefilled syringe injection:

  1. Remove the syringe from your refrigerator and let it come to room temperature for 30 minutes. This will make injecting more comfortable. Have your sharps container handy. Do not try to warm the medicine up by shaking it or using any external heating source.
  2. Hold the syringe at the clear part where you can see the medicine. Take a quick look to ensure the medicine is clear to pale yellow in color. Do not use it if it’s cloudy or has large lumps or flakes.
  3. Wash your hands and clean the area of skin you plan to inject with an alcohol swab. Then, allow your skin to dry without blowing on it or touching it again.
  4. Remove the needle cap with the needle pointing away from yourself. You may see a drop of liquid at the end of the needle. This is normal. The syringe must be used within five minutes of removing the needle cap.
  5. Hold the syringe like a pencil in one hand. With the other hand, pinch a section of your skin between your thumb and other fingers, and insert the needle completely between a 45 to 90-degree angle. 
  6. Relax the hand that is pinching the skin and slowly push the plunger down all the way to inject the medicine. Hold the syringe in place for five seconds.
  7. Keep the plunger fully pressed and carefully pull the needle straight from the injection site.
  8. Carefully release the plunger, allowing the needle guard to cover the exposed needle.
  9. Place the entire syringe into your sharps container.
  10. If you see any blood, you can lightly press a cotton ball over the injection site, but do not rub your skin.
  11. Keep track of where you inject each dose of Actemra, as you’ll want to rotate sites each time you administer the drug.

Storage

Keep your unused autoinjectors and syringes in their original cartons in the refrigerator (36 F to 46 F). Do not freeze Actemra.

Your autoinjectors and syringes can be stored outside the fridge for up to two weeks below 86 F, but they must always be kept in their original cartons to protect the medicine from light and moisture. Don’t expose Actemra to extremely hot or cold temperatures, such as by freezing it or leaving it in your car on a hot day.

If you'll be doing your own subcutaneous injection, you will likely get a sharps container sent to you from your specialty pharmacy along with Actemra. If not, call the specialty pharmacy or ask your local pharmacist about getting a sharps container so that you don’t have loose needles or medicine in your household garbage.

If you’re traveling by plane, keep Actemra in your carry-on luggage if your checked baggage goes missing.

How Long Does Actemra Take to Work?

You may see some symptom improvement from Actemra as quickly as two weeks after starting, although it may take three to six months to take full effect.

If no improvement is seen after this time, it is unlikely the medicine is going to help. Let your healthcare provider know if your symptoms get worse or don’t improve for several months after starting Actemra.

What Are the Side Effects of Actemra?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

These are the most common side effects of Actemra. If you experience these side effects and think they are severe or do not go away, you should notify your healthcare provider:

  • Injection site reactions if using subcutaneous Actemra, such as mild pain, itching, or redness in the area where you received your injection
  • Upper respiratory bacterial and viral infections, such as sinusitis (sinus infections), pharyngitis (a sore throat), or influenza
  • Headache
  • Hypertension, or increased blood pressure
  • Dizziness

Severe Side Effects

Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Potential severe side effects can include:

  • Infections: Since IL-6 blockers like Actemra work by affecting your immune system, you may be more vulnerable to various types of infections while you’re on the medicine. This may be especially true if you have a suppressed immune system, or are a carrier of some viruses like hepatitis B or tuberculosis. Your healthcare provider should check for these infections before starting you on Actemra.
  • Gastrointestinal perforation is rare but may occur. This is when a hole is formed in the lining of your intestine. Most people who developed these perforations in clinical trials were also taking nonsteroidal anti-inflammatory medications (NSAIDs), corticosteroids, or methotrexate, but how much these medications versus Actemra contributed to perforations is unknown.
  • Hypersensitivity reactions, including anaphylaxis, are infrequent but do require stopping Actemra. These reactions during clinical trials were generally seen during the second to fourth infusion.
  • Lab abnormalities were seen during clinical trials in a small percentage of people receiving Actemra. Neutropenia is a decrease in neutrophil count, which may lower your ability to fight infections and may slow your healing time. Thrombocytopenia is a lowered platelet count, which may make you more prone to bleeding and increase the time it takes for your blood to clot. Transaminitis, or elevated liver enzymes, may indicate some liver damage or hepatotoxicity. In most cases, adjusting Actemra dosing helped normalize liver enzymes during clinical trials.

Report Side Effects

Actemra may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Actemra Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form (prefilled syringe):
    • For giant cell arteritis:
      • Adults—162 milligrams (mg) injected under the skin once a week or once every other week. Your doctor may adjust your dose as needed and tolerated.
      • Children—Use and dose must be determined by your doctor.
    • For moderate to severe rheumatoid arthritis:
      • Adults weighing 100 kilograms (kg) or more—162 milligrams (mg) injected under the skin once a week. Your doctor may adjust your dose as needed and tolerated.
      • Adults weighing less than 100 kg—At first, 162 mg injected under the skin once every other week. Your doctor may increase the dose to 162 mg once a week as needed and tolerated.
      • Children—Use and dose must be determined by your doctor.
    • For systemic sclerosis-associated interstitial lung disease:
      • Adults—162 milligrams (mg) injected under the skin once a week. Your doctor may adjust your dose as needed and tolerated.
      • Children—Use and dose must be determined by your doctor.
    • For polyarticular juvenile idiopathic arthritis:
      • Adults and children 2 years of age and older weighing 30 kilograms (kg) or more—162 milligrams (mg) injected under the skin once every 2 weeks.
      • Children 2 years of age and older weighing less than 30 kg—162 milligrams (mg) injected under the skin once every 3 weeks.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.
    • For systemic juvenile idiopathic arthritis:
      • Adults and children 2 years of age and older weighing 30 kilograms (kg) or more—162 milligrams (mg) injected under the skin once a week.
      • Children 2 years of age and older weighing less than 30 kg—162 milligrams (mg) injected under the skin once every 2 weeks.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.

Modifications

Your dosage or treatment of Actemra may need to be adjusted in certain cases.

Pregnancy

There is not enough data regarding the use of Actemra in pregnant people to make a recommendation on the risk of birth defects, miscarriage, or adverse outcomes. The medicine does get transferred from the pregnant person to the fetus in small amounts via the placenta, which can potentially harm the fetus, but the effect is not well established. Speak with your healthcare provider about whether to use Actemra if you’re planning to become pregnant.

There is a pregnancy exposure registry that monitors pregnancy outcomes in people exposed to Actemra during pregnancy. Healthcare providers are encouraged to register pregnant people, and pregnant people are encouraged to register themselves by calling 1-877-311-8972.

Breastfeeding

It’s unknown whether Actemra is present in human milk. A breastfed baby may absorb a small amount of the drug. The effects this may have are unknown due to a lack of data. As in pregnancy, the clinical benefit of Actemra for pregnant people should be weighed against any risk the drug and the pregnant person’s autoimmune condition may pose to a newborn.

Children

Actemra is approved to treat several conditions in children 2 years and older, including SJIA, pJIA, and CRS. However, it hasn’t been studied in children younger than 2, and its safety and effectiveness in that population are unknown.

Adults Over 65

The frequency of serious infections during clinical trials for Actemra was higher among individuals older than 65 versus younger than 65. Since older people are generally more prone to infections, caution should be used when treating people older than 65 with Actemra.

Missed Dose

You will most likely be receiving Actemra once every one to four weeks. Ensure you understand how often you’re supposed to get an injection or infusion. It can help to set phone or calendar reminders to give yourself doses. Whenever you receive your Actemra infusion, schedule your next infusion appointment.

If you inject your own Actemra and forget to give a dose, do not give yourself two injections to make up for a missed one. If you realize you’ve missed a dose and it’s been less than seven days since you missed one, you can give yourself the missed dose. Beyond that point, contact your healthcare provider for advice on giving the missed dose and setting a new schedule for injections.

Overdose: What Happens If I Take Too Much Actemra?

Since Actemra is an injection that you will either go to a clinic to receive or give yourself every one to four weeks, it would be difficult to overdose on this medication. Contact your healthcare provider if you accidentally give yourself too much Actemra and are worried. If you have symptoms and are concerned about an overdose, go to the emergency room.

What Happens If I Overdose on Actemra?

If you think you or someone else may have overdosed on Actemra, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Actemra, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your or your child's progress at regular visits to make sure that this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

You or your child will need to have a skin test for tuberculosis before you start using this medicine. Tell your doctor if you or anyone in your home has ever had a positive reaction to a tuberculosis skin test.

This medicine will lower the number of some types of blood cells in your body. Because of this, you may bleed or get infections more easily. To help with these problems, avoid being near people who are sick or have infections. Wash your hands often. Stay away from rough sports or other situations where you could be bruised, cut, or injured. Brush and floss your teeth gently. Be careful when using sharp objects, including razors and fingernail clippers. Tell your doctor if you have any kind of infection before you start using this medicine. Also tell your doctor if you have ever had an infection that would not go away or an infection that keeps coming back.

Call your doctor right away if you or your child start to have a cough that would not go away, weight loss, night sweats, fever, chills, or flu-like symptoms, such as a runny or stuffy nose, headache, blurred vision, or feeling generally ill. These may be signs that you have an infection.

This medicine may cause serious stomach and bowel problems, especially if you have a history of ulcers or diverticulosis. Check with your doctor right away if you or your child start having severe stomach cramps or pain, black, tarry stools, diarrhea, fever, or vomiting that is severe and sometimes bloody while being treated with this medicine.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Using this medicine may increase your risk of having certain cancers. Talk to your doctor if you have unusual bleeding, bruising, or weakness, swollen lymph nodes in the neck, underarms, or groin, or unexplained weight loss. Also, check with your doctor right away if your skin has red, scaly patches, or raised bumps that are filled with pus.

Tocilizumab may cause headaches and skin reactions, such as a rash or itching, while you are receiving the injection or within 24 hours after you receive it. Check with your doctor or nurse right away if you or your child have any of these symptoms.

This medicine may cause serious types of allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Tell your doctor right away if you or your child have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth after using this medicine.

While you or your child are being treated with tocilizumab, and after you stop treatment with it, it is important to see your doctor about the immunizations (vaccinations) you should receive. Do not get any immunizations (vaccines) without your doctor's approval. Tocilizumab may lower your body's resistance, and there is a chance you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance that they could pass the virus on to you. Some examples of live vaccines include measles, mumps, influenza (nasal flu vaccine), poliovirus (oral form), rotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor.

This medicine may increase the amounts of cholesterol and fats in your blood. If this condition occurs, your doctor may give you some medicines that can lower their amounts. Talk to your doctor if you or your child have concerns.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn't Take Actemra?

You should not take Actemra, or it may not be the best choice for you, if you have any of the following.

  • An allergy to Actemra or any of its ingredients.
  • A current active infection. Let your healthcare provider know if you have an active, chronic, or recurrent infection of any organ or if you think you're displaying signs of an infection, such as sweating or chills, muscle aches, shortness of breath, or feeling very tired. The infection should be treated and resolved before starting Actemra.
  • Liver problems such as hepatitis or if you recently received lab results with high liver enzymes.
  • Abdominal pain or if you’ve been diagnosed with diverticulitis or ulcers, as Actemra may increase the risk for gastrointestinal perforation.
  • Neurological disorders. Central or peripheral nervous system demyelinating disorders, such as multiple sclerosis, optic neuritis, Guillain-Barré syndrome, and peripheral neuropathies, may be worsened by Actemra.

What Other Medications Interact With Actemra?

Avoid live vaccines while you’re taking Actemra. Live vaccines include:

  • Chickenpox (varicella)
  • FluMist (flu vaccine nasal spray)
  • MMR (measles, mumps, rubella)
  • Yellow fever vaccine

Let anyone who may be giving you a vaccine know that you take Actemra. Non-live or inactivated vaccinations, such as the seasonal flu shot, are fine to receive.

Other notable interactions involve drugs that are metabolized (or cleared) by certain proteins called cytochromes. Taking Actemra may cause these proteins to be more active, processing drugs and potentially clearing them from your body more quickly, causing them not to work as well. This means that some dose adjustments may need to be made for some drugs, including:

What Medications Are Similar?

There are many other biologic medications like Actemra. They all have slightly different mechanisms, but work similarly in that they mimic or improve a certain part of the function of your immune system.

  • Kevzara (sarilumab) is another IL-6 blocker like Actemra. It was approved in 2017 and is also used for rheumatoid arthritis.
  • Enbrel (etanercept) is a biologic drug called a tumor necrosis factor (TNF) inhibitor that is very expensive and injected subcutaneously. It is also used for rheumatoid arthritis and other autoimmune diseases.
  • Humira (adalimumab) is another biologic drug that is also a TNF inhibitor. It is used to treat two forms of inflammatory bowel disorder (IBD), Crohn’s disease and ulcerative colitis, both autoimmune diseases affecting the digestive system.
  • Remicade (infliximab) is given intravenously rather than subcutaneously, every eight weeks in an infusion clinic. Biosimilars for Remicade (highly similar products that are usually cheaper to manufacture and purchase) include Avsola (infliximab-axxq), Inflectra (infliximab-dyyb), Ixifi (infliximab-qbtx) and Renflexis (infliximab-abda).
  • Cimzia (certolizumab pegol) is another biologic used to treat many autoimmune conditions.
  • Simponi (golimumab) is a monoclonal antibody that is injected subcutaneously. It’s also available as Simponi Aria, which is given intravenously at an infusion clinic.

This is a list of drugs also prescribed for immune-mediated conditions such as arthritis, digestive issues, or skin conditions. It is NOT a list of drugs recommended to take with Actemra. In fact, you should not take these drugs together. Talk to your pharmacist or a healthcare provider if you have questions.

Frequently Asked Questions

  • What is Actemra used for?

    Actemra is an injectable medicine given either into the vein or under the skin once every one to four weeks. It is used to treat several types of autoimmune diseases, including different types of adult and pediatric arthritis.

  • How does Actemra work?

    Actemra is an IL-6 blocker, or interleukin-6 blocker. IL-6 is a protein produced by cells. Too much of this protein, called a cytokine, can cause inflammation and joint damage, like in rheumatoid arthritis and other autoimmune conditions. Actemra blocks the activity of this protein, decreasing inflammation.

  • What interactions can occur with Actemra?

    Avoid live vaccinations while taking Actemra, such as the chickenpox vaccine, FluMist (nasal spray flu vaccine), and MMR vaccines. Other medications that may need to be adjusted due to how Actemra affects their metabolism include omeprazole, some statin drugs such as simvastatin, lovastatin, and atorvastatin, oral contraceptives or birth control pills, warfarin, and cyclosporine.

How Can I Stay Healthy While Taking Actemra?

Conditions caused by an overactive immune system, known as autoimmune diseases, are difficult to understand because our immune systems are so complicated. Uncontrolled arthritis can be very frustrating because every type of arthritis can profoundly impact everyday life in both children and adults.

While it may seem scary to be prescribed a medicine that has to be injected, subcutaneous injections are very easy, quick, and cause little to no pain—many people even self-inject subcutaneous drugs. Plus, medications like Actemra help relieve joint pain and stiffness and can improve your quality of life. You should also talk to your healthcare provider about additional ways to relieve symptoms, such as through diet or exercise changes.

Being patient and sticking to your dosing schedule while continuing to use other medicines you have been prescribed will all help you fight arthritis and give you the best shot at reducing your symptoms.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Actemra prescribing information.

  2. Roche. Consumer medicine information: Actemra® solution for subcutaneous injection.

  3. Boyman O, Comte D, Spertini F. Adverse reactions to biologic agents and their medical management. Nat Rev Rheumatol. 2014;10(10):612-27.

By Sara Hoffman, PharmD
Sara is a clinical pharmacist that believes everyone should understand their medications, and aims to achieve this through her writing.