Tocilizumab (Actemra )

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1 Tocilizumab (Actemra ) How does it works? Actemra is a biologic medicine that helps keep the immune system from attacking healthy tissues in the body by blocking the protein IL-6 (interleukin-6). Actemra is used to treat Rheumatoid Arthritis (RA). In people with RA, the body s immune system mistakes certain normal cells in the body as foreign invaders. The immune cells get turned on and begin attacking healthy body tissues causing pain and swelling (inflammation) of joints and other tissues. Damage to the joints and tissues will occur if this is not treated. Why take it? How quickly does it work?: Actemra has been ordered by the doctor to help manage your arthritis. Actemra is generally used after someone has tried other DMARDs and biologic medicines. Actemra is used alone or in combination with other medications to help - reduce pain in your joints - reduce the number of swollen & tender joints you have - reduce how long you have stiffness in the morning - reduce your level of tiredness (fatigue) - increase ability to move your body & do daily activities - slow or even prevent damage to your joints and tissues Decreased swelling, pain and stiffness, increased energy and ability to move may be felt as early as 2 weeks after starting Actemra. This can take longer in some people. How do I take it? You will go to a clinic once every 4 weeks. A nurse will place a needle in a vein in your arm and you will receive an IV (intravenous) infusion over one hour. The preparation, infusion and waiting period after the infusion may take as long as 2 hours 1

2 Dosage: - How much Actemra you receive is based on your body weight. You will receive 4 to 8 mg/kg to control the swelling and pain of your arthritis. Methotrexate or another DMARD (Disease Modifying Anti- Rheumatic Drug) may also be taken with Actemra to increase the benefit of the medicine. Take your medicine as advised by your doctor. Work with your doctor to decide how much medication you need to control your condition. Taking more medication than is needed increases your risk of side effects. Skipping doses of medication will reduce how well it will work in your body to control your condition. Once you are feeling better on Actemra, you must continue to take your other medications, unless advised otherwise by your rheumatologist. Develop a plan for having your infusions: Mark your infusion dates on a calender ahead of time. Do your blood work one week before the infusion. Ensure the medication is ordered a week prior. Ensure you have transportation to the clinic. Wear comfortable clothing, bring a snack and a book. If you forget to go to your appointment, feel unwell or have any concerns before the infusion, contact the nurse. What tests are needed? Prior to startingactemra, the following tests are done: Blood tests TB skin test Chest x-ray Blood Tests: Do blood tests (CBC, platelets, AST, ALT, albumin, creatinine, CRP) as ordered by your doctor one week before each infusion. 2

3 A hepatitis blood screening test is done prior to starting Actemra A cholesterol blood test is done before starting Actemra, repeated 6 8 weeks after starting Actemra and then repeated every 6 12 months. What are the possible side effects? Like all medicines that effect the immune system, Actemra may cause side effects, some of which may be serious. Possible side effects: upper respiratory infection colds sinus infection headache increase or decreasein blood pressure changes in blood tests such as increased liver enzymes or cholesterol levels, or decreased neutrophils or platelets Potentially serious side effects: Infusion reaction: an allergic reaction such an itching, rash, or trouble breathing, swelling of the lips, tongue, or face, chest pain, feeling dizzy or faint. Serious Infection: fever, chills, mouth or skin blisters, stomach ache or persistent headaches that caused by viruses, bacteria, fungi or TB (tuberculosis) Bowel Injury: holes in the lining of the bowel usually as a result of diverticulitis (inflammation of the large intestine) Cancer: Very rare cases of cancer have developed in people with RA and taking Actemra. Nervous system disorder: numbness or tingling, or feeling unbalanced What if I have a side effect? : Contact your doctor or nurse if you develop any symptoms: These symptoms can occur any time while taking Actemra and often don t last long. If needed until symptoms go away, Actemra may be stopped or the dosage reduced. An increase in blood & other tests may be done. 3

4 Infusion reactions: If reactions occur, your symptoms will be treated immediately with medications such as Benadryl, Acetaminophen and sometimes Cortisone as needed. Treat delayed allergic type reactions (itching, rash, flushing): Take Benadryl mg every 4 to 6 hours as needed. Anti-itch creams (Benadryl, Alveeno or Hydrocortisone.05%) are also available. Go to the emergency department if you have: shortness of breath chest tightness/pressure swelling of your lips, tongue or throat or any other serious concern What if I get sick? Infections: There is an increased risk of serious infections associated with the use of Actemra. Any infections or fevers should be taken seriously & reviewed by your doctor. Do not have the Actemra infusion if you suspect you an infection or are being treated for an infection. have What if I need surgery? Surgery, dental work or other procedures: Develop a plan with your doctor on upcoming procedures. Procedures should be done midway between infusions, & not within 14 days before or after receiving Actemra. Actemra is not restarted after the surgery until the incision is healed and there are no open wounds or signs of infection. Precautions? Actemra should not be taken if you : have an infection or if you often get infections have untreated tuberculosis (T.B.) or have been in close contact with someone who has T.B. recently have any disease of the liver such as hepatitis have had any type of cancer are pregnant or breast feeding. 4

5 Vaccines: No live vaccines should be taken while on Actemra Take flu & pneumovax vaccines midway between infusions, & not within 14 days before or after receiving Actemra. How do I store it? How often will I see my doctor? Refrigerate Actemra at 2-8ºC. Do not freeze. Carry Actemra in a case with an icepack when travelling. 1. See your rheumatologist after starting Actremra every 3 to 6 months. These visits allow you & your doctor to assess how well your medications are working to control your arthritis and any changes needed in your medications.. 2. Keep a diary. Record when you take your medications, any side effects & any reasons for changes or withdrawal of medications. 3. Keep a medication list in your wallet. Record all medications, vitamin/mineral & herbal supplements you are presently taking & any allergies you may have. Bring this list to all medical appointments with your doctor, nurse etc. Actemra Support Line: Jointeffort Program: A service that helps you find a way to cover the cost of Actemra & helps with the planning of your infusions. Clinic Contact: Name Phone Disclaimer: This information does not replace medical advice. Specific questions about medications should be discussed with your doctor, nurse or pharmacist. v Developed: December 2010 Jane Prince RN, BScN, Christine Fitzsimmons, RN, Clinical Resourse Nurses MPAP, Vancouver Arthritis Centre, VCHA 5