Administration of tocilizumab for COVID-19, 16 June 2023

Administration of tocilizumab for COVID-19 Dilution • Wash hands and wear gloves. • Obtain the required number of single-use vials (see table). • Tocilizumab solution should be clear to opalescent, colourless to pale yellow and free of visible particles for administration. • Obtain the correct volume infusion bag containing 0.9% or 0.45% sodium chloride: – For patients ≥ 30 kg, use 100 mL – For patients < 30 kg, use 50 mL. • From the infusion bag, using a syringe, withdraw and discard a volume equivalent to the volume of tocilizumab you will be using. • Withdraw the tocilizumab from each vial using an appropriate syringe. • Transfer the contents of the syringe into the infusion bag. • Gently invert the infusion bag several times to mix the solution. Do not shake. • Dispose any unused medicinal product or waste material in accordance with local procedures. Administration • Connect the tocilizumab infusion to a dedicated intravenous line (do not use the same line for other medications). • Administer over 1 hour via a volumetric pump or closely monitored infusion. • Monitor the patient for signs of infusion reaction according to local protocol. • After the infusion is complete, flush the giving set with 20 mL sodium chloride 0.9% over 15 minutes to ensure the remaining tocilizumab has been administered. • Dispose of any waste material according to local procedures. Stability If unable to administer immediately, the prepared solution is stable for 24 hours at room temperature and if protected from light. Quick reference for practical dosing Patient body weight Dose of tocilizumab 8 mg/kg, maximum dose 800 mg < 45 kg Calculate at 8 mg/kg 46–55 kg 400 mg 56–65 kg 480 mg 66–80 kg 600 mg 81–90 kg 680 mg > 91 kg 800 mg https://www.who.int/teams/health-care- readiness-clinical-unit/covid-19/therapeutics For detailed information, see WHO Therapeutics and COVID-19: living guideline. CA R E C o n f i r m COVID-19 CLINICAL CARE PATHWAY E v a l u a t eR e s p o n dA s s e s s Guidance for health care workers © WHO 2023. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. WHO/2019-nCoV/Therapeutics/Tocilizumab/Poster_B/2023.1S Tocilizumab should be co-administered with corticosteroids (either oral or intravenous) where possible. Tocilizumab should be given with baricitinib (a Janus kinase inhibitor) where possible. Preparation and administration Tocilizumab must be diluted and given by slow infusion. RIGHT ROUTE RIGHT TIME RI GH T D OS E Remember the FIVE RIGHTS of drug administration: RI GH T M EDIC ATION RIGHT PATIENT mg 1 2 3 4 5 ml IIIIIIIIIIIIII III III II II II II I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IIIIIIIIIIIII IV SC 1 2 3 4 5 mlOral 1 2 3 4 5 6 7 8 9 10 m l 50 mL 100 mL 50 mL 100 mL 16 J un e 20 23 . START . . FINISH . hour minute hour minute hour minute hour minute 1 hour 50 mL 100 mL