Tocilizumab (ICU — Cytokine Storm / COVID-19)

SCOPE: the dose above is the COVID-19 indication, which is the page's primary one (the page is titled 'Tocilizumab (ICU — Cytokine Storm / COVID-19)'). Verbatim source, US §2.6 Highlights: 'The recommended dosage of TOFIDENCE for adult patients with COVID-19 is 8 mg per kg administered by a 60-minute intravenous infusion.' || ⚠️ CAR-T / CYTOKINE RELEASE SYNDROME IS NOT DOSED ANYWHERE IN THIS BUNDLE. Neither label in this bundle contains a CRS indication or posology, so nothing about CRS is published here; it must be sourced separately. || The retrieved §2.6 text stops at the single Highlights sentence; it neither authorises nor excludes a repeat dose. Do not publish a second-dose rule from here. || BEFORE STARTING, COVID-19-specific thresholds (verbatim, §2.1): 'COVID-19 - It is recommended that TOFIDENCE not be initiated in patients with an absolute neutrophil count (ANC) below 1000 per mm3, platelet count below 50,000 mm3, or ALT or AST above 10 times ULN.' (The corresponding thresholds for RA, GCA, PJIA and SJIA are stricter: ANC below 2000 per mm3, platelets below 100,000 per mm3, ALT or AST above 1.5 times ULN.) 'Obtain and assess baseline complete blood count (CBC) and liver function tests prior to treatment.' || CO-ADMINISTRATION (§2.1): 'Tocilizumab products have not been studied in combination with biological DMARDs such as TNF antagonists, IL-1R antagonists, anti-CD20 monoclonal antibodies and selective co-stimulation modulators because of the possibility of increased immunosuppression and increased risk of infection. Avoid using TOFIDENCE with biological DMARDs.' §5.9/§7.3: 'Live vaccines—Avoid use.' || STRENGTHS (§3): '80 mg/4 mL (20 mg/mL), 200 mg/10 mL (20 mg/mL), 400 mg/20 mL (20 mg/mL) in single-dose vials for further dilution prior to intravenous infusion.' || OTHER INDICATIONS' IV DOSES — RECORDED FOR CONTEXT ONLY, NOT FOR THIS PAGE: RA 4 mg/kg every 4 weeks then 8 mg/kg every 4 weeks based on clinical response (doses above 800 mg per infusion not recommended); GCA 6 mg/kg every 4 weeks with tapering glucocorticoids (doses above 600 mg per infusion not recommended); PJIA every 4 weeks — 10 mg/kg under 30 kg, 8 mg/kg at or above 30 kg; SJIA every 2 weeks — 12 mg/kg under 30 kg, 8 mg/kg at or above 30 kg. These are different indications with different ceilings; do not blend them into the COVID-19 dose. || CYP INTERACTION AFTER DOSING (§7.2): 'Inhibition of IL-6 signaling in RA patients treated with tocilizumab products may restore CYP450 activities to higher levels than those in the absence of tocilizumab products leading to increased metabolism of drugs that are CYP450 substrates', potentially affecting CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4.