COVID 19 Preparedness Document:
9th June 2020
***Experimental therapies:
At present, use of these therapies is based on a limited available evidence
As the situation evolves, and when more data become available, the evidence will be accordingly incorporated,
and recommendation upgraded
Further, use of these drugs is subjected to limited availability in the country as of now
Currently, these drugs should only be used in a defined subgroup of patients:
.
Remdesivir may be considered in patients with moderate disease (those on oxygen) (Under Emergency Use
Authorization only) with none of the following contraindications
O AST/ALT >5 times Upper limit of normal (ULN)
o Severe renal impairment (.e., eGFR <30ml/min/m'or need for hemodialysis)
o Pregnancy or lactating females
Children (< 12 years of age)
Dose: 200 mg IV on day 1 followed by 100 mg IV daily for 5 days
Convalescent plasma may be considered in patients with moderate disease Off label use) who are not
improving (oxygen requirement is
ment is progressively increasing) despite use of steroids. Special prerequisites
while considering convalescent plasma include
o ABO compatibility and cross matching of the donor plasma
o Neutralizing titer of donor plasma should be above the specific threshold
o Recipient should be closely monitored for several hours post transfusion for any
transfusion related adverse events
o Use should be avoided in patients with IgA deficiency or immunoglobulin allergy
Dose: Dose is variable ranging from 4 to 13 ml/kg (usually 200 ml single dose given slowly over
not less than 2 hours)
Tocilizumab may be considered in patients with moderate disease Off label use with progressively
increasing oxygen requirements and in mechanically ventilated patients not improving despite use of steroids.
Special considerations before its use include
o Presence of raised inflammatory markers (e.g., CRP, Ferritin, IL-6)
o Long term safety data in COVID 19 remains largely unknown
Patients should be carefully monitored post Tocilizumab for secondary infections and
neutropenia
Dose: 8mg/kg (maximum 800 mg at one time) given slowly in 100 ml NS over 1 hour; dose can be
repeated once after 24 hours if needed
#COVID 19 Preparedness Document #
9th June 2020
**Other repurposed or off-label therapies:
(1) Hydroxychloroquine: This drug has demonstrated in vitro activity against SARS-CoV2 and was shown to be
clinically beneficial in several small single center studies though with significant limitations. Nonetheless, several large
observational studies with severe methodologic limitations have shown effect on mortality or other clinically
meaningful outcomes. As such, the evidence base behind its use remains limited as with other drugs and should only be
used after shared decision making with the patients while awaiting the results of ongoing studies. As is the case with other
antivirals, this drug should be used as early in the disease course as possible to achieve any meaningful effects and should
be avoided in patients with severe disease.
Dose: 400 mg BD on day 1 followed by 400mg daily for next 4 days
(2) Corticosteroids: The use of steroids is largely extrapolated from its use in non-COVID 19 ARDS along with several
observational studies in COVID 19; one of these studies demonstrated beneficial outcomes if given early in patients with
moderate disease. Thus, the evidence behind its use remains limited and potential adverse events use should be carefully
weighted before administration,
Dose: In moderate disease - 0.5 to 1mg/kg for 3 days in two divided doses
In severe disease-1to 2mg/kg for 5 to 7 days in two divided doses, if not already given.
Disclaimer:
This is a living document that will be updated in real time as more data emerge. The
document contains some potential off label/experimental use of medications and is based on
a consensus of experts along with the available evidence. An informed and shared decision
making is essential before prescribing any of these therapies.
