Actemra Drug Interactions: What to Avoid and What to Tell Your Doctor

Like all medications, Actemra (tocilizumab) can interact with other drugs, vaccines, and supplements in ways that affect safety or effectiveness. Some interactions are serious and require avoiding certain combinations entirely; others simply require monitoring or dose adjustment. Here's what you need to know.

Interactions to Avoid: Other Biologic Medications

The most important drug interactions for Actemra are with other biologic immunosuppressants. Combining Actemra with another biologic DMARD or targeted therapy significantly increases the risk of serious infections by creating compounded immunosuppression.

Medications to avoid combining with Actemra include:

• Abatacept (Orencia): Contraindicated. This combination is explicitly not recommended.
• TNF inhibitors (adalimumab/Humira, etanercept/Enbrel, infliximab/Remicade, etc.): Avoid concurrent use — greatly increases infection risk
• Rituximab (Rituxan): Avoid combination — increased immunosuppression and infection risk
• JAK inhibitors (baricitinib, tofacitinib, upadacitinib): Not recommended with Actemra — additive immunosuppression
• IL-1 receptor antagonists (anakinra/Kineret): Avoid combination

Important Interaction: CYP3A4 Enzymes and Your Other Medications

One of Actemra's most clinically significant interactions is with medications processed by the CYP3A4 enzyme in the liver. Normally, IL-6 suppresses CYP3A4 activity. When Actemra lowers IL-6 levels, CYP3A4 activity can increase — meaning drugs processed by this enzyme are broken down faster than usual. This can cause some drugs to become less effective.

Drugs affected by this interaction include:

• Statins (atorvastatin/Lipitor, lovastatin, simvastatin): Levels may decrease when starting Actemra; lipid monitoring recommended
• Warfarin (Coumadin): Anticoagulant levels may change — INR monitoring is important when starting or stopping Actemra
• Oral contraceptives: Hormonal contraceptive effectiveness may potentially be affected; consider additional contraceptive methods and discuss with your doctor
• Omeprazole (Prilosec) and other proton pump inhibitors: Levels may change; discuss with your doctor if you use these regularly
• Cyclosporine, calcium channel blockers, and some other drugs processed by CYP3A4 — discuss all your medications with your prescriber and pharmacist when starting Actemra

Vaccines: What You Need to Know

Actemra's immunosuppressive effect has important implications for vaccines:

• Live vaccines: DO NOT receive live vaccines while taking Actemra. Live vaccines include MMR (measles, mumps, rubella), varicella (chickenpox), yellow fever, and certain oral vaccines. Live vaccines given to immunosuppressed patients can cause infection from the vaccine virus.
• Inactivated/killed vaccines: Generally safe to receive, but Actemra may reduce your immune response, making the vaccine less effective than it would be in a fully immunocompetent person
• Zoster vaccine (shingles): The recombinant shingles vaccine (Shingrix) is an inactivated vaccine and may be given per your rheumatologist's guidance. If you haven't had it, discuss with your doctor before starting Actemra.

Interaction With Methotrexate and Corticosteroids

Actemra can be used alone or in combination with conventional DMARDs like methotrexate (Trexall) and corticosteroids. These combinations are clinically approved and commonly used:

• Methotrexate + Actemra: Approved and commonly used for RA. The combination provides additive benefit. Methotrexate monitoring (CBC, LFTs) should continue.
• Corticosteroids + Actemra: Also commonly used. Note that concomitant use of NSAIDs, corticosteroids, or methotrexate increases the risk of GI perforation with Actemra.

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What to Tell Your Doctor and Pharmacist

Before starting Actemra, give your provider a complete list of everything you take, including:

• All prescription medications, including other biologics and DMARDs
• Over-the-counter medications (especially NSAIDs like ibuprofen or naproxen)
• Vitamins and herbal supplements
• Your vaccination history and any upcoming vaccines planned

For a complete overview of Actemra's side effect profile, see our article on Actemra side effects and when to call your doctor. If you're having trouble locating Actemra, medfinder can help find it at pharmacies near you.