Drug interactions
Tocilizumab + Ustekinumab
Severity: Major
Tocilizumab and Ustekinumab: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Two biologic immunomodulators acting on different cytokine pathways may add to the risk of serious infections, including tuberculosis and opportunistic infections. Combined use of biologics is not well studied and is generally not recommended.
What this interaction means in plain words
Tocilizumab and Ustekinumab can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Tocilizumab belongs to Musculoskeletal; Ustekinumab belongs to Gastrointestinal Tract.
Why it happens
Additive immunosuppression through IL-12/23 blockade and IL-6 receptor blockade.
What to do
Avoid concurrent use of the two biologics; if switching, monitor for infection during the transition. Screen for latent tuberculosis before therapy.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Ustekinumab
- Bcg vaccine live + Ustekinumab Contraindicated
- Typhoid vaccine live + Ustekinumab Contraindicated
- Adalimumab + Ustekinumab Major
- Adenovirus types 4 and 7 live + Ustekinumab Major
- Alefacept + Ustekinumab Major
- Anakinra + Ustekinumab Major
Other interactions of Tocilizumab
- Bcg vaccine live + Tocilizumab Contraindicated
- Measles mumps and rubella vaccine live + Tocilizumab Contraindicated
- Measles mumps rubella and varicella vaccine live + Tocilizumab Contraindicated
- Measles vaccine + Tocilizumab Contraindicated
- Rubella vaccine + Tocilizumab Contraindicated
- Smallpox vaccine live + Tocilizumab Contraindicated
Frequently asked questions
Can I take Tocilizumab with Ustekinumab?
MediHelp rates the interaction as major. Tocilizumab and Ustekinumab can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Two biologic immunomodulators acting on different cytokine pathways may add to the risk of serious infections, including tuberculosis and opportunistic infections. Combined use of biologics is not well studied and is generally not recommended.
How serious is the interaction between Tocilizumab and Ustekinumab?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid concurrent use of the two biologics; if switching, monitor for infection during the transition. Screen for latent tuberculosis before therapy.
What other medicines interact with Ustekinumab?
MediHelp also lists interactions of Ustekinumab with, for example, Bcg vaccine live, Typhoid vaccine live, Adalimumab. The full list is on the Ustekinumab page.
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