Shortages of tocilizumab (Actemra) mean you'll see more orders for other COVID-19 treatments.
Tocilizumab has been the go-to add-on to steroids (dexamethasone, etc) for COVID-19. It's because this "IL-6 inhibitor" has the strongest evidence for reducing mortality.
But tocilizumab supplies are low. And it may need to be reserved for other uses where tocilizumab is the only treatment.
Anticipate that your pharmacy will come up with creative ways to optimize tocilizumab supplies for COVID-19 patients.
For example, you may have to prep IV doses using prefilled syringes labeled for subcutaneous injection. If needed, ensure nurses have an appropriate filter for administration.
Don't be surprised to get orders for sarilumab (Kevzara). This IL-6 inhibitor may be another option for certain COVID-19 patients, such as those in ICU.
Like tocilizumab, it's a one-time IV infusion. And you'll have to use the subcutaneous formulation of sarilumab to prep IV doses...400 mg in 100 mL of normal saline.
Assign these a beyond-use date of 4 hours...and help ensure nurses have a 0.2 micron filter for administration.
Expect to dispense the oral Janus kinase (JAK) inhibitor baricitinib (Olumiant) as an alternative to tocilizumab in many cases.
Check whether you should earmark a supply of baricitinib for a COVID-19 patient when it's started...to ensure they can be treated for a full 14-day course, or until discharge, whichever comes first.
Be aware that tofacitinib (Xeljanz) may be ordered for non-ICU patients if baricitinib is short. When handling either of these meds, take precautions if required by your hazardous meds policy.
Access our chart, Treatments of Interest for COVID-19, to learn about other alternatives you may see.
- www.covid19treatmentguidelines.nih.gov/ (10-1-21)
- JAMA 2021;326(6):499-518
- Lancet Respir Med Published online Aug 31, 2021; doi:10.1016/S2213-2600(21)00331-3
- N Engl J Med 2021;385(5):406-15
- medRxiv Published online Jun 25, 2021; doi:10.1101/2021.06.18.21259133