Tocilizumab and Axitinib: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Axitinib
Tocilizumab
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced CYP3A4 substrate with NTI exposure and reduced efficacy of CYP3A4 substrate with NTI
Interaction Deep Dive
Concurrent use of tocilizumab and a CYP3A4 substrate with a narrow therapeutic index (NTI) may reduce the exposure of the substrate. In clinical studies, CYP3A4 substrate (omeprazole, simvastatin and dextromethorphan), showed decrease in exposure one week following a single dose of tocilizumab. Monitor therapeutic effect or drug concentrations and adjust the individual dose of the CYP3A4 NTI substrate as needed upon initiation or discontinuation of tocilizumab, in patients being treated with CYP3A4 NTI substrate. The effect of tocilizumab on CYP450 enzyme activity may persist for several weeks after stopping therapy. Use caution when coadministering tocilizumab with CYP3A4 substrate drugs like oral contraceptives, lovastatin, atorvastatin etc. where decrease in effectiveness is undesirable123.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism by tocilizumab
Literature reports
2 reports — tap to read
a) In clinical studies, 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 13.
b) In drug interaction studies, In 13 RA patients receiving 30 mg dextromethorphan (a CYP2D6 and CYP3A4 substrate), exposure to dextromethorphan was comparable to that in healthy subjects. However, exposure to its metabolite, dextrorphan (a CYP3A4 substrate), was a fraction of that observed in healthy subjects. One week following administration of a single infusion of tocilizumab (8 mg per kg), dextromethorphan exposure was decreased by approximately 5%. However, a larger decrease (29%) in dextrorphan levels was noted after tocilizumab infusion 2.
Common questions
Can I take Tocilizumab and Axitinib together?
Reduced CYP3A4 substrate with NTI exposure and reduced efficacy of CYP3A4 substrate with NTI Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tocilizumab and Axitinib interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Tocilizumab or Axitinib need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: AVTOZMA(R) intravenous, subcutanous injection, tocilizumab-anoh intravenous, subcutanous injection. CELLTRION USA, Inc. Jersey City, NJ, 2025. DailyMed
- Product Information: TYENNE(R) intravenous, subcutaneous injection, tocilizumab-aazg intravenous, subcutaneous injection. Fresenius Kabi USA, LLC (Per FDA), Lake Zurich, IL, 2024. DailyMed
- Product Information: TOFIDENCE(TM) intravenous injection, tocilizumab-bavi intravenous injection. Biogen MA Inc (per FDA), Cambridge, MA, 2023. DailyMed
Keep reading about Axitinib
Keep reading about Tocilizumab
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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