Tocilizumab for arthritis

Sounds like 'TOE-si-LIZ-ue-mab'

Key points about tocilizumab for arthritis

  • Tocilizumab is used to treat moderate-to-severe forms of rheumatoid arthritis and giant cell arteritis.
  • Tocilizumab is also called Actemra.
  • Find out how it is given and possible side effects.
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Tocilizumab belongs to a group of medicines known as biologic medicines(external link). These are medicines that target specific chemicals in your body involved in the inflammatory response that causes arthritis. 

Note: Tocilizumab is also used to treat some people who are in hospital with COVID-19. Read more about tocilizumab for COVID-19.

Tocilizumab can be given in 2 ways.

  • As a slow injection into a vein in your arm, once every 4 weeks. This is called an intravenous infusion, and it usually takes about one hour. It's given in hospital and you will be monitored afterwards for at least 30 minutes.
  • As an injection under your skin once weekly. This is a subcutaneous injection. The injection can be given in your thigh, abdomen (tummy) or upper arm and the site of injection should be rotated for each injection. Don't inject into moles or scars or an area that is bruised, red, hard or tender.

Your doctor will decide what dose is right for you, based on your body weight. For most people, tocilizumab will work within 3 to 6 months. You may feel better as early as 2 weeks after starting treatment.

Here are some things to know when you're taking tocilizumab. Other things may be important as well, so ask your healthcare provider what you should know about.

Taking other medicines and supplements

Tocilizumab can interact with some medicines, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting tocilizumab and before starting any new products.

You may need regular blood tests

While you're taking tocilizumab you'll need to have regular blood tests to check the treatment is working and to monitor for side effects. 

Get the flu vaccine every year

Keep your flu vaccination up to date to reduce your risk of getting the flu. It's safe for you to have the annual flu vaccine. Some vaccines shouldn't be taken if you are taking tocilizumab. Always check with your healthcare provider first.

Tell your healthcare providers

Make sure you tell anyone providing you with health, dental or medical care that you are taking tocilizumab.

Pregnancy and breastfeeding

It's not advisable to get pregnant while taking tocilizumab. If you plan to become pregnant, or find you are pregnant, talk to your doctor. Tell your doctor if you are breastfeeding.

Like all medicines, tocilizumab can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects What should I do?
  • During an intravenous infusion, you may experience low blood pressure, where you feel faint or dizzy. Your blood pressure will be monitored when you have the infusion and for a short while after
  • Let your nurse know if you feel very faint or dizzy. 
  • Allergic reaction such as a skin rash, itching, swelling of your lips, face and mouth or difficulty breathing
  • If you're in hospital when you have your dose, you will be monitored closely for these side effects. If you are at home tell your doctor immediately or ring Healthline on 0800 611 116.
  • Pain, inflammation and itching at the injection site
  • These are usually mild but if they bother you let your doctor know. For subcutaneous injections, remember to rotate the site of injection.
  • Flu-like symptoms such as fever, chills, shivering, a runny nose or sneezing 
  • Headache
  • Dizziness
  • Mouth ulcers
  • You may experience these symptoms during the dose or anytime up to 2 weeks after having your dose.
  • Contact your doctor if these side effects are bothering you.  
  • Problems with your tummy (stomach) such as tummy pain, cramps, dark-coloured stools (poo), bleeding, fever or changes in your bowel habits such as constipation 
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
  • Weight gain
  • Increased blood pressure
  • Increased cholesterol
  • Cough
  • Tell your doctor if you are concerned.
  • Signs of an infections such as fever, cough, sore throat, diarrhoea (runny poo) or generally feeling weak and unwell 
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
  • Signs of liver problems such as tiredness or less energy than usual, dark coloured urine, yellow skin and eyes
  • Tell your doctor immediately or ring Healthline on 0800 611 116.
For more information on side effects, see the Medsafe consumer information leaflet Actemra(external link).

Did you know that you can report a medicine side effect to the Centre for Adverse Reactions Monitoring (CARM)? Report a side effect to a product.(external link)


The following links have more information on tocilizumab.

Actemra(external link) Medsafe Consumer Information Sheet, NZ
Tocilizumab(external link) Australian Rheumatology Association, Australia
Tocilizumab(external link) Rheuminfo, US


  1. Tocilizumab(external link) NZ Formulary, NZ
  2. Actemra data sheet(external link), Medsafe, NZ
  3. Biologic medicines for the treatment of inflammatory conditions – what does primary care need to know?(external link) BPAC, NZ, 2013
  4. Tocilizumab – supply issue(external link). Pharmac, NZ, 2021

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Credits: Sandra Ponen, Pharmacist, Healthify He Puna Waiora. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Angela Lambie, Pharmacist, Auckland

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