The Roma captain was harshly sent off in last weekend's 2-0 win over Lecce for a minor spat with Ruben Olivera but he was so angry about skipping the derby that he charged after Olivera on the sidelines and had to be rugby-tackled by several officials.
Totti, 34, has played for Roma all his career and is always hyped up for the derby.
"I'm so sorry about missing the game I care about the most. Lazio will definitely win now," Totti joked after netting a penalty in Wednesday's 3-2 Champions League win at Basel.
In a 1979 derby, a Lazio fan was killed after being hit by a flare while one of last year's matches was held up for several minutes because of fireworks on the pitch.
Defender Giuseppe Biava was sent off in Sunday's 1-0 win at Palermo so he misses the derby while goalkeeper Fernando Muslera is facing a race against time to be fit after a thigh strain.
Second-placed Inter Milan have even worse injury problems for Saturday's visit of Brescia following Tuesday's 3-1 Champions League defeat at Tottenham Hotspur.
Sampdoria look poised to again leave out striker Antonio Cassano, who swore at the club president last week, when they entertain Catania despite fellow striker Nicola Pozzi being suspended for blaspheming after last weekend's win at Cesena.
