Tocilizumab is Formulary-Restricted at Legacy Health.  Approved for use when indicated for cytokine release syndrome (CRS).

For patients with COVID-19: Restricted to Infectious Disease approval 8am-5pm. ID consult team will assess the patient for appropriate inclusion/exclusion criteria. 

Inclusion Criteria

• • Laboratory confirmed COVID-19
  • Age ≥ 18 years old
  • Receiving concomitant corticosteroid therapy (at least dexamethasone 6mg daily or equivalent)
  • Recent hospitalization (within 3 days) and/or ICU admission within 24 hours
  • Rapidly increasing oxygen needs (e.g. requiring high flow oxygen >0.4 FiO2/30 L/min O2 flow or non-invasive ventilation)
  • CRP ≥ 75 mg/L (ONE time value only at time of decompensation, do not recheck)
  • Limit to ONE dose only

Exclusion Criteria

• • Severely immunocompromised (AIDS, cancer undergoing chemo, solid or bone marrow transplant, neutropenia, serious congenital immunodeficiency)
  • On biologic immunomodulator such as etanercept, infliximab, rituximab, adalimumab, anakinra, golimumab
  • On chronic oral steroids (≥20 mg) for >2 weeks
  • Uncontrolled bacterial, fungal or non-SARS-CoV-2 viral infection
  • History of untreated latent tuberculosis or active tuberculosis infection
  • Patient at risk for GI perforation
  • ALT > 5 upper limit of normal
  • ANC < 500 cells/µL
  • Platelets < 50,000 cells/µL

• Micromedex
• CareNotes
• UpToDate
• Facts & Comparisons
• MedLinePlus (Patient Information)