Sarilumab belongs to the class of medications called biological response modifiers. It is used to treat moderate-to-severe rheumatoid arthritis (RA) for people for whom other disease-modifying anti-rheumatic drugs have not provided enough benefit or for whom the effects are not tolerable. It is often used together with other disease-modifying anti-rheumatic drugs (e.g., methotrexate).

Sarilumab works by blocking a protein called Interleukin-6 (IL-6), which is found at high levels in people with rheumatoid arthritis. By blocking IL-6, this medication can reduce inflammation in the affected joints.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended adult dose of this medication is 200 mg injected as a subcutaneous (under the skin) injection, once every 2 weeks. Depending on blood tests and how well you tolerate this medication, your doctor may reduce the dose.

Sarilumab is used with the guidance and supervision of a doctor. Your doctor or nurse will help you prepare and inject your first dose (or first few doses). Do not attempt to inject this medication on your own until you completely understand how to inject a dose. If you are having difficulty giving yourself injections, ask a family member or other caregiver for help if they are willing to become involved with your treatment and are willing to learn how to give you your injections.

Before injecting the medication, carefully inspect the medication. Do not inject any solution that has changed colour or contains particles. The syringe should be allowed to warm to room temperature for 30 minutes prior to injection. The pen should be allowed to warm to room temperature for 60 minutes prior to injection.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor.

If you miss a dose, and it is less than 3 days since the missed dose, take it as soon as possible and continue with your regular schedule. If it has been 4 days or more, contact your doctor for directions. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication in the refrigerator at 2°C to 8°C, protect it from light, and keep it out of the reach of children. Do not freeze it. This medication may also be stored at room temperature (up to a maximum of 25°C) for a single period of 14 days. If it is stored at room temperature and is not used within 14 days, it must be discarded.

150 mg
Each prefilled syringe or prefilled pen containing 1.14 mL of sterile, colourless-to-pale-yellow, preservative-free liquid delivers 150 mg of sarilumab. Nonmedicinal ingredients: arginine (45 mM), histidine (21 mM), polysorbate 20 (0.2% w/v), sucrose (5% w/v), and water for injection.

200 mg
Each prefilled syringe or prefilled pen containing 1.14 mL of sterile, colourless-to-pale-yellow, preservative-free liquid delivers 200 mg of sarilumab. Nonmedicinal ingredients: arginine (45 mM), histidine (21 mM), polysorbate 20 (0.2% w/v), sucrose (5% w/v), and water for injection.

Do not take this medication if you are allergic to sarilumab or any ingredients of the medication.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• cold sores
• redness at the injection site

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• increased frequency of colds (e.g., nasal congestion, sore throat, runny nose)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• symptoms of diverticulitis (inflammation in the digestive system; e.g., abdominal pain, fever, nausea, vomiting, constipation, and more rarely, diarrhea)
• symptoms of a urinary tract infection (e.g., pain when urinating, urinating more often than usual, low back or flank pain)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Bleeding: Sarilumab may cause a reduced number of platelets in the blood, which can make it difficult to stop cuts from bleeding. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Cholesterol: Some people experience increased levels of cholesterol in the blood when they use sarilumab. If you have high cholesterol levels, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Gastrointestinal perforation: There have been rare reports of gastrointestinal perforation occurring with the use of sarilumab. A gastrointestinal perforation is a hole that forms through a wall in the digestive tract. If you have a condition that increases the risk of gastrointestinal perforation, such as diverticulitis, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Infections: This medication can increase the risk of developing an infection, including serious infections such as sepsis (blood infection), pneumonia, and tuberculosis. Before starting treatment with sarilumab, your doctor may test to see if you have tuberculosis. If you notice signs of an infection such as fever, chills, pain, swelling, coughing, or pus, contact your doctor as soon as possible. This medication should also not be started while you have an active infection.

Tell your doctor if you have a history of infections that keep coming back, or other conditions that might increase your risk of infections (e.g., diabetes), or if you have visited or lived in areas where there is a greater risk of certain kinds of fungal infection (e.g., blastomycosis). While you are taking sarilumab, your doctor will monitor you for signs of infection.

Kidney function: The safety and effectiveness of using this medication have not been determined for people with reduced kidney function. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: People taking sarilumab may have changes in liver function that produce abnormal liver test results. Your doctor will recommend regular liver tests while you are taking this medication. If you have severe changes in liver function, your doctor may recommend that you take a lower dose of this medication or stop taking it altogether. This medication is generally not recommended for people with reduced liver function.

Vaccines: The safety of receiving certain vaccines (e.g., yellow fever, BCG, cholera, typhoid, varicella, meningococcal, diphtheria) when using sarilumab has not been determined. These vaccines should not be given while you are taking sarilumab.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you are able to become pregnant, you should use effective birth control while using this medication and for 3 months after the last dose. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if sarilumab passes into breast milk. If you are breast-feeding and taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Seniors who use this medication may be more likely to experience a serious infection. Report any symptoms of infection, such as fever, chills, unusual fatigue, aches, cough, or difficulty breathing, to your doctor as soon as possible.

There may be an interaction between sarilumab and any of the following:

• abatacept
• abrocitinib
• adalimumab
• anakinra
• baricitinib
• belimumab
• certolizumab
• cyclosporine
• denosumab
• deucravacitinib
• estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
• etanercept
• golimumab
• infliximab
• leflunomide
• natalizumab
• ocrelizumab
• ofatumumab
• pimecrolimus
• progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
• ruxolitinib
• sirolimus
• sphingosine 1-phosphate (S1P) receptor inhibitors (e.g., fingolimod, ponesimod, siponimod)
• "statin" anti-cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)
• tacrolimus
• theophylline
• tocilizumab
• tofacitinib
• ubrogepant
• upadacitinib
• warfarin
• vaccines (e.g., BCG, cholera, meningococcal)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.