COVID-19 Hospital (Inpatient) Tocilizumab Orders
Tocilizumab ("Actemra") may be used to treat hospitalized patients with severe acute COVID-19 pneumonia if specific conditions are met.
The patient was admitted to hospital due to COVID-19 seven or fewer days prior OR developed symptoms due to hospital-acquired COVID-19 seven or fewer days prior.
The patient is experiencing significant progressive respiratory failure, due to COVID-19 pneumonia, characterized by:
Invasive or non-invasive ventilation (e.g. Continuous Positive Airway Pressure or Bilevel Positive Airway Pressure) OR
Supplemental oxygen to achieve a minimal SpO2 of 90%, in the form of one of the following:
Heated high flow oxygen with FiO2 > 0.5 (e.g. Optiflow, Airvo)
Oxygen delivered via nasal prong at a rate > 6 L/minute
Mask delivered oxygen with FiO2 > 0.5 (e.g. non-rebreather or Venturi mask)
Mechanically ventilated patients
Administer tocilizumab no more than 24 hours after initiation of mechanical ventilation.
All other patients
Consider administration of tocilizumab as soon as possible once the above clinical criteria have been met in a context concerning for progressive respiratory failure.
Use is restricted to a SINGLE DOSE per patient per hospitalization, based on the following weight-based dosing:
40 or less kg: 8 mg/kg
Greater than 40 kg: 400 mg
Specialist consultation (e.g., internal medicine, infectious disease, critical care) is recommended prior to starting therapy if the ordering clinician is not familiar with tocilizumab use.