Table 4.
List of potential COVID-19 treatments with drug interactions with commonly used immunosuppressants (from Nephjc http://www.nephjc.com/news/covidtx).
| Drug | Dose reported in COVID-19 trials | Dose adjustment in CKD? | Drug Interactions in Transplant | Other considerations |
|---|---|---|---|---|
| Remdesivir | 200 mg x 1 then 100 mg daily | ? None1 | None reported | CrCl < 30 exclusion in most trials1 |
|
Lopinavir/Ritonavir Kaletra |
400 mg / 100 mg twice daily | None | ↑Cyclosporine, tacrolimus levels ↑↑ Sirolimus levels ? Effect on mycophenolate |
Both highly protein bound |
|
Chloroquine/ Hydroxychloroquine Plaquenil |
CQ: 500 – 1000 mg a day (or 10 mg/kg) HCQ: 400 mg x1 then 200 mg two or three times a day |
None3 | ↑Cyclosporine, tacrolimus, sirolimus levels | ~ 50–70% protein bound; high volume of distribution |
|
DarunavirPrezista / RitonavirNorvir |
800 mg / 100 mg daily | None | ↑Cyclosporine, tacrolimus levels ↑↑ Sirolimus levels ? Effect on mycophenolate |
Both highly protein bound |
| Favipiravir | 1200 mg twice daily for 2 days then 600 mg 2–3 times a day | ?Yes | None reported | ~50% protein bound |
| Tocilizumab | 8 mg/kg (up to max 800 mg) | None | ↓Cyclosporine, tacrolimus, sirolimus levels | |
| Colchicine | 0.5 mg twice daily2 | Yes4 | ↑Cyclosporine, tacrolimus levels ? Sirolimus levels Avoid with azathioprine |
High volume of distribution; ~40% protein bound |
Names in italics refer to brand names.
1
This is a common reported exclusion, due to the potential toxicity of the excipient.
2
Dose in gout is usually 0.6 mg, this dose is reported for the COLCORONA trial.
3
These drugs do have some clearance by kidneys, so accumulation with occur with chronic dosing, not relevant in the COVID-19 setting.
4
CrCl < 30 an exclusion in the COLCORONA trial
CQ: chloroquine; HCQ: hydroxychloroquine; CrCl: creatinine clearance.