TABLE 1.
Drug Dosing Regimens
| Drug | Age | Dose | Duration | Contraindications | Precautions and Comments |
|---|---|---|---|---|---|
| Baricitinib | 2 to <9 y ≥9 y |
2 mg PO daily 4 mg PO daily |
14 d OR until discharged, whichever is first | • Renal impairment (creatinine clearance <15 mL/min/1.73 m2) • Lymphopenia (<2 × 109 cells/L) • Neutropenia (<0.5 × 109 cells/L) • Transaminitis (ALT or AST >5× ULN) • Active TB and other opportunistic infections |
• Due to its immunosuppressive effects should be used with caution in immunocompromised patients • Cytopenia may occur during treatment; cease if lymphocyte count <0.5 × 109 cells/L, hemaglobin <80 g/L or ANC <1 × 109 cells/L • Dose adjustment required in patients with renal impairment |
| Budesonide | ≥4 to 11 y ≥12 y |
400 µg by DPI BD 800 µg by DPI BD |
10 d | • Patients unable to appropriately inhale from a DPI • Patients already on inhaled corticosteroids |
• Rinse mouth following use to minimize risk of oral candidiasis |
| Casirivimab-imdevimab | ≥12 y and ≥40 kg | For treatment single dose based on disease severity: - Mild: 1200 mg IV or SC - Moderate-critical: 8000 mg IV For postexposure prophylaxis: Single dose 1200 mg IV or SC Ongoing 600 mg IV or SC 4 weekly or until no longer required (max 6 doses) |
Not applicable | • No known contraindications | • IV route preferred for 1200 mg due to medication volume• Not recommended for infection with Omicron variant (BA.1) |
| Ciclesonide | ≥6 to 11 y ≥12 y |
160 µg by MDI BD ± spacer 320 µg by MDI BD ± spacer |
10 d | • Patients already on inhaled corticosteroids | • Alternative for patients ≥6 y unable to inhale from a DPI • Rinse mouth following use to minimize the risk of oral candidiasis |
| Dexamethasone | All ages | 0.15 mg/kg (maximum 6 mg) IV or PO daily | Up to 10 d or until discharge (whatever is first) | • Not recommended for infection with Omicron variant (BA.1) | |
| Fluticasone | <5 y | 125 µg BD by MDI + spacer | 10 d | • Patients already on inhaled corticosteroids | • Alternative for patients <5 y unable to inhale from a DPI • Rinse mouth following use to minimize risk of oral candidiasis |
| Nirmatrelvir/ritonavir | ≥12 y and ≥40 kg | 300 mg nirmatrelvir + 100 mg ritonavir BD | 5 d | • Contraindicated in patients receiving drugs highly dependent on CYP3A for clearance* OR potent CYPA3A inducers | • Dose adjustment in renal impairment • No safety or efficacy data for children and adolescents <18 y |
| Remdesivir | ≥12 y and ≥40 kg <12 y and/or <40 kg |
200 mg IV loading dose 100 mg IV daily 5 mg/kg IV loading dose 2.5 mg/kg IV daily |
Day 1 Days 2–5 Day 1 Days 2–5 |
• Known hypersensitivity to the drug, the metabolites or formulation excipient | • Severe bradycardia and mild-moderate increase in AST and ALT reported in patients receiving remdesivir for COVID-19; discontinue if hepatic impairment develops |
| Sotrovimab | ≥12 y and ≥40 kg | 500 mg IV as single dose | Not applicable | • No known contraindications | • No dosage adjustment for hepatic or renal impairment • Monitor for possible anaphylactic or infusion reaction during the infusion and until 1 h post infusion • Not recommended for infection with Omicron variant (BA.2) |
| Tocilizumab | >2 y | Single IV dose: <30 kg: 12 mg/kg 30–40 kg: 8 mg/kg 41–65 kg: 400 mg 66–90 kg: 600 mg >90 kg: 800 mg |
Not applicable | • Known hypersensitivity to tocilizumab • Severe hepatic impairment (AST or ALT >10× ULN) • Severe, active infection (including TB and other opportunistic infections) |
• Due to its immunosuppressive effects should be used with caution in immunocompromised patients • No dose adjustment required in renal impairment |
*See product information statement for full list of contraindicated medications.
ANC, absolute neutrophil count; AST, aspartate aminotransferase; BD, twice daily; DPI, dry powder inhaler; ECMO, extracorporeal membrane oxygenation; MDI, metered dose inhaler; PO, orally; SC, subcutaneous; TB tuberculosis.