TOCILIZUMAB (TOE si LIZ ue mab) is used to treat rheumatoid arthritis and juvenile idiopathic arthritis. It may also be used to treat giant cell arteritis, cytokine release syndrome, and to slow a decrease in lung function for patients with systemic sclerosis-related lung disease.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

This medicine is injected into a vein or under the skin. It is usually given by a health care provider in a hospital or clinic setting. If you get this medicine at home, you will be taught how to prepare and give it. Use exactly as directed. Take it as directed on the prescription label at the same time every day. Keep taking it unless your health care provider tells you to stop.

If you use a pen, be sure to take off the outer needle cover before using the dose.

It is important that you put your used needles and syringes in a special sharps container. Do not put them in a trash can. If you do not have a sharps container, call your pharmacist or health care provider to get one.

A special MedGuide will be given to you before each treatment or by the pharmacist with each prescription and refill. Be sure to read this information carefully each time.

Talk to your health care provider regarding the use of this medicine in children. While the drug may be prescribed for children as young as 2 years for selected conditions, precautions do apply.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once. NOTE: This medicine is only for you. Do not share this medicine with others.

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions (skin rash, itching or hives; swelling of the face, lips, or tongue)
• changes in vision
• increase in blood pressure
• infection (fever, chills, cough, sore throat, pain or trouble passing urine)
• light-colored stool
• liver injury (dark yellow or brown urine; general ill feeling or flu-like symptoms; loss of appetite, right upper belly pain; unusually weak or tired; yellowing of the eyes or skin)
• low red blood cell counts (trouble breathing; feeling faint; lightheaded, falls; unusually weak or tired)
• pain, tingling, numbness in the hands or feet
• tears in the stomach or intestines (fever; stomach pain; sudden change in bowel habits)
• trouble breathing
• unusual bruising or bleeding

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• dizziness
• headache
• pain, redness, or irritation at site where injected

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Keep out of the reach of children and pets.

If you are using this medicine at home, you will be instructed on how to store this medicine. Throw away any unused medicine after the expiration date on the label.

To get rid of medicines that are no longer needed or have expired:

• Take the medicine to a medicine take-back program. Check with your pharmacy or law enforcement to find a location.
• If you cannot return the medicine, ask your pharmacist or health care provider how to get rid of this medicine safely.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

They need to know if you have any of these conditions:

• cancer
• diabetes (high blood sugar)
• heart disease
• hepatitis B or history of hepatitis B infection
• high blood pressure
• high cholesterol
• immune system problems
• infection especially a viral infection such as chickenpox, cold sores, or herpes
• infection such as tuberculosis (TB) or other bacterial, fungal or viral infections
• liver disease
• low blood counts, like low white cell, platelet, or red cell counts
• multiple sclerosis
• recent or upcoming vaccine
• stomach or intestine problems
• stroke
• an unusual or allergic reaction to tocilizumab, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

Do not take this medicine with any of the following medications:

• live virus vaccines

This medicine may also interact with the following medications:

• biologic medicines such as abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, secukinumab, ustekinumab
• birth control pills
• certain medicines for cholesterol like atorvastatin, lovastatin, and simvastatin
• cyclosporine
• omeprazole
• steroid medicines like prednisone or cortisone
• theophylline
• vaccines
• warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

It is important not to miss your dose. Call your health care provider if you are unable to keep an appointment.

If you give yourself the medicine at home and you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses. Call your health care provider with questions.

Your condition will be monitored carefully while you are receiving this medicine. Tell your health care provider if your symptoms do not start to get better or if they get worse. You may need blood work done while you are taking this medicine.

You will be tested for tuberculosis (TB) before you start this medicine. If your doctor prescribes any medicine for TB, you should start taking the TB medicine before starting this medicine. Make sure to finish the full course of TB medicine.

This medicine may increase your risk of getting an infection. Call your health care provider for advice if you get a fever, chills, sore throat, or other symptoms of a cold or flu. Do not treat yourself. Try to avoid being around people who are sick.

Talk to your health care provider about your risk of cancer. You may be more at risk for certain types of cancers if you take this medicine.