What are the side effects of Tocilizumab (Actemra), specifically dizziness?

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Last updated: April 29, 2025View editorial policy

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From the Guidelines

Tocilizumab can cause dizziness as a side effect, and patients experiencing this symptom should consult their healthcare provider for guidance on managing it. When considering the management of tocilizumab side effects, particularly dizziness, it's crucial to weigh the benefits of the medication against its potential risks. Tocilizumab is a valuable treatment option for conditions like rheumatoid arthritis, and its efficacy in improving symptoms and quality of life should not be overlooked 1. However, the safety profile of tocilizumab, including the risk of dizziness, must be carefully monitored. Some key points to consider in managing tocilizumab-induced dizziness include:

  • Reporting any instances of dizziness to the healthcare provider to determine the best course of action.
  • Avoiding sudden position changes and staying hydrated to minimize the risk of dizziness.
  • Potential dose adjustments or alternative treatments may be considered if the dizziness is severe or persistent. The exact mechanism behind tocilizumab-induced dizziness is not fully understood but may relate to its immunomodulatory effects and the subsequent influence on blood pressure and neurological function 1. Given the potential for dizziness and other side effects, regular follow-up with a healthcare provider is essential for patients taking tocilizumab to ensure that the benefits of treatment outweigh the risks and to adjust the treatment plan as needed.

From the FDA Drug Label

Adverse reactions occurring in 2% or more of patients on 4 or 8 mg per kg ACTEMRA-IV plus DMARD and at least 1% greater than that observed in patients on placebo plus DMARD are summarized in Table 2 (%) (%) (%) (%) (%) 3 ... Dizziness31232 Other infrequent and medically relevant adverse reactions occurring at an incidence less than 2% in rheumatoid arthritis patients treated with ACTEMRA-IV in controlled trials were: ... The most common side effects of ACTEMRA include: ... dizziness or fainting

Dizziness is a reported side effect of Tocilizumab, with an incidence of 3% in patients receiving 4 mg per kg ACTEMRA-IV plus DMARD, and 2% in patients receiving 8 mg per kg ACTEMRA-IV plus DMARD, compared to 1% in patients on placebo plus DMARD 2. Additionally, dizziness or fainting is listed as a common side effect of ACTEMRA 2.

From the Research

Tocilizumab Side Effects: Dizziness

  • There is no direct mention of dizziness as a side effect of Tocilizumab in the provided studies 3, 4, 5, 6, 7.
  • However, the studies do report on various adverse events associated with Tocilizumab treatment, including:
    • Increased risk of any adverse event 3, 4
    • Elevated cholesterol levels 3, 4, 6
    • Increased risk of neutropenia 6
    • Increased risk of liver enzyme elevations 6
  • It is essential to note that the studies focused on the efficacy and safety of Tocilizumab in patients with rheumatoid arthritis, and dizziness may not have been a reported or studied side effect in these specific trials.
  • Further research or clinical trials may be necessary to determine the potential relationship between Tocilizumab and dizziness 3, 4, 5, 6, 7.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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