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.

Clinical Requirements

  • 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.