Tocilizumab interactions
Tocilizumab (Actemra), an immunosuppressant has 80 documented interactions across the FDA labels and fact sheets we index: 26 major, 34 moderate, 19 minor, and 1 where a label reports no significant interaction. Each entry below quotes the sentence behind it. This drug page is a starting point, not a verdict for your situation.
Major interactions (26)
It is uncertain whether the occurrence of HSTCL is related to use of a TNF blocker or a TNF blocker in combination with these other immunosuppressants [see Warnings and Precautions (5.2) ] . (Adalimumab label, Boxed warning)
- BeclomethasonecorticosteroidMajor
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- BetamethasonecorticosteroidMajor
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- Budesonide and formoterolcorticosteroidMajor
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- CaptoprilACE inhibitorMajor
About 13 percent of the cases of neutropenia have ended fatally, but almost all fatalities were in patients with serious illness, having collagen vascular disease, renal failure, heart failure or immunosuppressant therapy, or a combination of these complicating factors. (Captopril label, Warnings)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- CyclosporineimmunosuppressantMajor
In kidney, liver, and heart transplant patients Neoral may be administered with other immunosuppressive agents. (Cyclosporine label, Boxed warning)
- DesonidecorticosteroidMajor
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- FludrocortisonecorticosteroidMajor
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- FluocinonidecorticosteroidMajor
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- HalobetasolcorticosteroidMajor
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
- InfliximabimmunosuppressantMajor
The concomitant use of tocilizumab with biological DMARDs such as TNF antagonists, including RENFLEXIS, should be avoided because of the possibility of increased immunosuppression and increased risk of infection. (Infliximab label, Drug interactions)
Immunosuppressants Everolimus Sirolimus Temsirolimus (IV) Not recommended during and 2 weeks after TOLSURA treatment. (Itraconazole label, Drug interactions)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
…IN TRANSPLANT PATIENTS; AND INCREASED MORTALITY IN FEMALE LIVER TRANSPLANT PATIENTS • Increased risk for developing serious infections and malignancies with ASTAGRAF XL ® or other immunosuppressants that may lead to hospitalization or death. [see Warnings and Precautions ( 5.1 , 5.2 )] • Increased mortality in female liver transplant patients with ASTAGRAF XL. (Tacrolimus label, Boxed warning)
Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. (Tocilizumab label, Boxed warning)
Moderate interactions (34)
Upon initiation or discontinuation of TOFIDENCE, in patients being treated with these types of medicinal products, perform therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) and the individual dose of the medicinal product adjusted as needed. (Tocilizumab label, Drug interactions)
- Amlodipinedihydropyridine calcium channel blockerModerate
Immunosuppressants Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. (Amlodipine label, Drug interactions)
- AtorvastatinstatinModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- Butalbital, acetaminophen, and caffeinebarbiturateModerate
Upon initiation or discontinuation of TOFIDENCE, in patients being treated with these types of medicinal products, perform therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) and the individual dose of the medicinal product adjusted as needed. (Tocilizumab label, Drug interactions)
- Conjugated estrogensestrogenModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- DenosumabModerate
Other risk factors for the development of ONJ include immunosuppressive therapy, treatment with angiogenesis inhibitors, systemic corticosteroids, diabetes, and gingival infections. (Denosumab label, Warnings and precautions)
- Drospirenone and ethinyl estradioloral contraceptiveModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- EstradiolestrogenModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- EtanerceptimmunosuppressantModerate
Tocilizumab products have not been studied in combination with biological DMARDs such as TNF antagonists [see Dosage and Administration (2.2) ] . (Tocilizumab label, Drug interactions)
- EverolimusimmunosuppressantModerate
Lymphomas and Other Malignancies Patients receiving immunosuppressants, including Zortress, are at increased risk of developing lymphomas and other malignancies, particularly of the skin. (Everolimus label, Warnings and precautions)
- Ezetimibe and simvastatinstatinModerate
In vivo studies with omeprazole, metabolized by CYP2C19 and CYP3A4, and simvastatin, metabolized by CYP3A4, showed up to a 28% and 57% decrease in exposure one week following a single dose of tocilizumab, respectively. (Tocilizumab label, Drug interactions)
- Febuxostatxanthine oxidase inhibitorModerate
Upon initiation or discontinuation of TOFIDENCE, in patients being treated with these types of medicinal products, perform therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) and the individual dose of the medicinal product adjusted as needed. (Tocilizumab label, Drug interactions)
- FenofibratefibrateModerate
Immunosuppressants Clinical Impact: Immunosuppressants such as cyclosporine and tacrolimus can produce nephrotoxicity with decreases in creatinine clearance and rises in serum creatinine, and because renal excretion is the primary elimination route of fibrate drugs including fenofibrate, there is a risk that an interaction will lead to deterioration of renal… (Fenofibrate label, Drug interactions)
- Ketoconazoleazole antifungalModerate
Immunosuppressants everolimus, rapamycin (also known as sirolimus), temsirolimus budesonide, ciclesonide, cyclosporine, dexamethasone, fluticasone, methylprednisolone, tacrolimus Rapamycin (sirolimus): Ketoconazole tablets 200 mg daily for 10 days increased the C max and AUC of a single 5 mg dose of sirolimus by 4.3 fold and 10.9 fold, respectively in 23 healthy… (Ketoconazole label, Drug interactions)
- LeflunomideimmunosuppressantModerate
If used with concomitant methotrexate and/or other potential immunosuppressive agents, chronic monitoring should be monthly. (Leflunomide label, Warnings and precautions)
- LevonorgestrelprogestinModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- Levonorgestrel and ethinyl estradioloral contraceptiveModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- LovastatinstatinModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- MedroxyprogesteroneprogestinModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- MegestrolprogestinModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- MycophenolateimmunosuppressantModerate
Lymphoma and Other Malignancies Patients receiving immunosuppressants, including MYHIBBIN, are at increased risk of developing lymphomas and other malignancies, particularly of the skin [see Adverse Reactions ( 6.1 )]. (Mycophenolate label, Warnings and precautions)
- NorethindroneprogestinModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- Norethindrone and ethinyl estradioloral contraceptiveModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- Norgestimate and ethinyl estradioloral contraceptiveModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- Omeprazoleproton pump inhibitorModerate
In vivo studies with omeprazole, metabolized by CYP2C19 and CYP3A4, and simvastatin, metabolized by CYP3A4, showed up to a 28% and 57% decrease in exposure one week following a single dose of tocilizumab, respectively. (Tocilizumab label, Drug interactions)
- PentoxifyllinemethylxanthineModerate
Upon initiation or discontinuation of TOFIDENCE, in patients being treated with these types of medicinal products, perform therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) and the individual dose of the medicinal product adjusted as needed. (Tocilizumab label, Drug interactions)
- ProgesteroneprogestinModerate
Exercise caution when coadministering TOFIDENCE with CYP3A4 substrate drugs where decrease in effectiveness is undesirable, e.g., oral contraceptives, lovastatin, atorvastatin, etc. (Tocilizumab label, Drug interactions)
- RifampinantibioticModerate
Glipizide Decrease exposure Immunosuppressive Agents Cyclosporine Decrease exposure Tacrolimus Prevention or Management: Monitoring of whole blood concentrations and appropriate dosage adjustments of tacrolimus are recommended when rifampin and tacrolimus are used concomitantly. (Rifampin label, Drug interactions)
- SimvastatinstatinModerate
In vivo studies with omeprazole, metabolized by CYP2C19 and CYP3A4, and simvastatin, metabolized by CYP3A4, showed up to a 28% and 57% decrease in exposure one week following a single dose of tocilizumab, respectively. (Tocilizumab label, Drug interactions)
- Sofosbuvir and velpatasvirantiviralModerate
HBV reactivation has also been reported in patients receiving certain immunosuppressant or chemotherapeutic agents; the risk of HBV reactivation associated with treatment with HCV direct-acting antivirals may be increased in these patients. (Sofosbuvir and velpatasvir label, Warnings and precautions)
- TheophyllinemethylxanthineModerate
Upon initiation or discontinuation of TOFIDENCE, in patients being treated with these types of medicinal products, perform therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) and the individual dose of the medicinal product adjusted as needed. (Tocilizumab label, Drug interactions)
- TinidazoleantibioticModerate
Cyclosporine, tacrolimus: Monitor for toxicities of these immunosuppressive drugs ( 7.1 ) (Tinidazole label, Drug interactions)
- WarfarinanticoagulantModerate
Upon initiation or discontinuation of TOFIDENCE, in patients being treated with these types of medicinal products, perform therapeutic monitoring of effect (e.g., warfarin) or drug concentration (e.g., cyclosporine or theophylline) and the individual dose of the medicinal product adjusted as needed. (Tocilizumab label, Drug interactions)
Minor mentions (19)
- AspirinNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- Aspirin and dipyridamoleantiplatelet agentMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- CelecoxibNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- DiclofenacNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- EtodolacNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- FluvastatinstatinMinor
IMNM is characterized by proximal muscle weakness and elevated serum CK, which persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody, muscle biopsy showing necrotizing myopathy, and improvement with immunosuppressive agents. (Fluvastatin label, Warnings and precautions)
- IbuprofenNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- IndomethacinNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- KetorolacNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- MeloxicamNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- Methimazoleantithyroid drugMinor
In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (Methimazole label, Warnings)
- NabumetoneNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- NaproxenNSAIDMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
- PitavastatinstatinMinor
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Pitavastatin label, Warnings and precautions)
- Posaconazoleazole antifungalMinor
CYP3A Substrates Immunosuppressants that are CYP3A4 Substrates Mechanism and Clinical Effect(s) Posaconazole is a strong CYP3A4 inhibitor. (Posaconazole label, Drug interactions)
- PravastatinstatinMinor
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Pravastatin label, Warnings and precautions)
- Propylthiouracilantithyroid drugMinor
In some cases, vasculitis resolved/improved with drug discontinuation; however, more severe cases required treatment with additional measures including corticosteroids, immunosuppressant therapy, and plasmapheresis. (Propylthiouracil label, Warnings)
- RosuvastatinstatinMinor
IMNM is characterized by proximal muscle weakness and elevated serum creatine kinase that persist despite discontinuation of statin treatment; positive anti-HMG CoA reductase antibody; muscle biopsy showing necrotizing myopathy; and improvement with immunosuppressive agents. (Rosuvastatin label, Warnings and precautions)
- Sumatriptan and naproxentriptanMinor
Concomitant Drugs for Treatment of Adult Indications In RA patients, population pharmacokinetic analyses did not detect any effect of methotrexate (MTX), non-steroidal anti-inflammatory drugs or corticosteroids on tocilizumab clearance. (Tocilizumab label, Drug interactions)
No significant interaction reported (1)
- Clarithromycinmacrolide antibioticNo interaction
…Repaglinide, Rosiglitazone: [See Warnings and Precautions ( 5.4 ) and Adverse Reactions ( 6.2 )] Insulin Insulin: [See Warnings and Precautions ( 5.4 ) and Adverse Reactions ( 6.2 )] Immunosuppressants: Cyclosporine Use With Caution Cyclosporine: There have been spontaneous or published reports of CYP3A based interactions of clarithromycin with cyclosporine. (Clarithromycin label, Drug interactions)
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Open in the checkerNot medical advice. Severity reflects the label's wording, not your circumstances. A "major" flag can be routine under supervision and a "minor" one can matter at high doses. Ask a pharmacist.