Select a medication above to begin.
Tpoxx
tecovirimat
Adult Dosing .
Dosage forms: CAP: 200 mg; INJ: various
Restricted Distribution in US
- [distributed directly to CDC and US Department of Defense]
smallpox
- [PO route, 40-119 kg]
- Dose: 600 mg PO bid x14 days; Info: give within 30min after full moderate-high fat meal
- [PO route, >120 kg]
- Dose: 600 mg PO tid x14 days; Info: give within 30min after full moderate-high fat meal
- [IV route, 35-119 kg]
- Dose: 200 mg IV q12h for up to 14 days; Info: switch to PO regimen ASAP to complete course
- [IV route, >120 kg]
- Dose: 300 mg IV q12h for up to 14 days; Info: switch to PO regimen ASAP to complete course
mpox
- [PO route, 40-119 kg]
- Dose: 600 mg PO bid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [PO route, >120 kg]
- Dose: 600 mg PO tid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [IV route, 35-119 kg]
- Dose: 200 mg IV q12h x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; switch to PO regimen ASAP to complete course; may extend duration based on clinical response
- [IV route, >120 kg]
- Dose: 300 mg IV q12h x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; switch to PO regimen ASAP to complete course; may extend duration based on clinical response
renal dosing
- [PO route]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
- [IV route]
- CrCl <30: contraindicated; Info: risk of IV vehicle accumulation
- HD/PD: contraindicated
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: CAP: 200 mg; INJ: various
Restricted Distribution in US
- [distributed directly to CDC and US Department of Defense]
smallpox
- [PO route, 13-24 kg]
- Dose: 200 mg PO bid x14 days; Info: give within 30min after full moderate-high fat meal
- [PO route, 25-39 kg]
- Dose: 400 mg PO bid x14 days; Info: give within 30min after full moderate-high fat meal
- [PO route, 40-119 kg]
- Dose: 600 mg PO bid x14 days; Info: give within 30min after full moderate-high fat meal
- [PO route, >120 kg]
- Dose: 600 mg PO tid x14 days; Info: give within 30min after full moderate-high fat meal
- [IV route, 3-34 kg]
- Dose: 6 mg/kg/dose IV q12h for up to 14 days; Info: switch to PO regimen ASAP to complete course
- [IV route, 35-119 kg]
- Dose: 200 mg IV q12h for up to 14 days; Info: switch to PO regimen ASAP to complete course
- [IV route, >120 kg]
- Dose: 300 mg IV q12h for up to 14 days; Info: switch to PO regimen ASAP to complete course
mpox
- [PO route, <6 kg]
- Dose: 50 mg PO bid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [PO route, 6-12 kg]
- Dose: 100 mg PO bid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [PO route, 13-24 kg]
- Dose: 200 mg PO bid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [PO route, 25-39 kg]
- Dose: 400 mg PO bid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [PO route, 40-119 kg]
- Dose: 600 mg PO bid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [PO route, >120 kg]
- Dose: 600 mg PO tid x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; may extend duration based on clinical response; give within 30min after full moderate-high fat meal
- [IV route, <35 kg]
- Dose: 6 mg/kg/dose IV q12h x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; switch to PO regimen ASAP to complete course; may extend duration based on clinical response
- [IV route, 35-119 kg]
- Dose: 200 mg IV q12h x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; switch to PO regimen ASAP to complete course; may extend duration based on clinical response
- [IV route, >120 kg]
- Dose: 300 mg IV q12h x14 days; Info: for patients with severe disease or aberrant infection, or at high risk for severe disease; consider giving with cidofovir or brincidofovir; switch to PO regimen ASAP to complete course; may extend duration based on clinical response
renal dosing
- [PO route]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
- [IV route]
- CrCl <30: contraindicated; Info: risk of IV vehicle accumulation
- HD/PD: contraindicated
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- CrCl <30 (INJ form)
- avoid: breastfeeding (smallpox use)
- avoid: breastfeeding (patients with active mpox lesion)
- caution: patients <2 yo (IV use)
- caution: immunocompromised patients
Drug Interactions .
Overview
tecovirimat
viral envelope wrapping protein inhibitor
Interaction Characteristics:
- CYP2C8 inhibitor, weak
- CYP2C19 inhibitor, weak
- CYP3A4 inducer, weak
Contraindicated
- ranolazine
Avoid/Use Alternative
- atazanavir
- codeine
- desogestrel (contraceptive)
- dienogest (contraceptive)
- dolutegravir
- drospirenone (contraceptive)
- estradiol (contraceptive)
- ethinyl estradiol (contraceptive)
- ethynodiol (contraceptive)
- etonogestrel (contraceptive)
- fentanyl
- fosamprenavir
- levonorgestrel (contraceptive)
- levonorgestrel (post-coital contraceptive)
- lopinavir/ritonavir
- lumateperone
- mavacamten
- medroxyprogesterone (contraceptive)
- meperidine
- methadone
- norelgestromin (contraceptive)
- norethindrone (contraceptive)
- norgestimate (contraceptive)
- norgestrel (contraceptive)
- oliceridine
- oxycodone
- rilpivirine
- segesterone (contraceptive)
- tramadol
- ulipristal (post-coital contraceptive)
- zuranolone
Monitor/Modify Tx
- aficamten
- amiodarone
- amlodipine
- atogepant
- buprenorphine
- carbamazepine
- citalopram
- clobazam
- cyclophosphamide
- cyclosporine
- diazepam
- diltiazem
- disopyramide
- everolimus
- fedratinib
- flibanserin
- fosphenytoin
- ifosfamide
- isradipine
- ketoconazole
- mitapivat
- nicardipine
- nimodipine
- nisoldipine
- paclitaxel
- phenytoin
- quinidine (antiarrhythmic)
- repaglinide
- sirolimus
- tacrolimus
- tiagabine
- ubrogepant
- voriconazole
- warfarin
Caution Advised
- abemaciclib
- abrocitinib
- acalabrutinib
- alfentanil
- alprazolam
- aluminum hydroxide
- aprepitant
- artemether/lumefantrine
- atorvastatin
- avacopan
- avapritinib
- axitinib
- bictegravir
- bosutinib
- brigatinib
- budesonide
- buspirone
- cabozantinib
- calcium acetate
- capivasertib
- capmatinib
- carisoprodol
- clarithromycin
- clopidogrel
- cobicistat
- cobimetinib
- crizotinib
- daridorexant
- darunavir
- dasatinib
- defactinib
- deflazacort
- doravirine
- dordaviprone
- dronedarone
- drospirenone (hormone replacement)
- elacestrant
- elbasvir
- elexacaftor/tezacaftor/ivacaftor
- eliglustat
- elvitegravir
- entrectinib
- erdafitinib
- erlotinib
- felodipine
- ferric citrate
- finerenone
- fosaprepitant
- fostamatinib
- fruquintinib
- gepirone
- gilteritinib
- glasdegib
- glecaprevir
- grazoprevir
- guanfacine
- haloperidol
- hydrocortisone
- ibrutinib
- irinotecan
- isavuconazonium
- istradefylline
- itraconazole
- ivacaftor
- lanthanum
- lapatinib
- larotrectinib
- lazertinib
- lefamulin
- lenacapavir
- leniolisib
- letermovir
- levoketoconazole
- levonorgestrel intrauterine device (contraceptive)
- lonafarnib
- lorlatinib
- lurasidone
- macitentan
- maraviroc
- midazolam
- midostaurin
- mobocertinib
- naldemedine
- naloxegol
- nefazodone
- nelfinavir
- neratinib
- netupitant
- nevirapine
- nifedipine
- nilotinib
- nirmatrelvir
- nirogacestat
- olaparib
- olutasidenib
- palbociclib
- pemigatinib
- perampanel
- pimavanserin
- pirtobrutinib
- ponatinib
- praziquantel
- pretomanid
- proguanil
- quetiapine
- quinine
- quizartinib
- repotrectinib
- ribociclib
- ripretinib
- ritonavir
- roflumilast
- rolapitant
- samidorphan
- sebetralstat
- selpercatinib
- selumetinib
- sevelamer
- simvastatin
- sirolimus albumin-bound
- sonidegib
- sucroferric oxyhydroxide
- suzetrigine
- tadalafil
- taletrectinib
- tamoxifen
- tasimelteon
- tazemetostat
- temsirolimus
- tezacaftor/ivacaftor
- ticagrelor
- tipranavir
- tofacitinib
- tolvaptan
- toremifene
- vanzacaftor/tezacaftor/deutivacaftor
- velpatasvir
- venetoclax
- verapamil
- voclosporin
- vonoprazan
- voxilaprevir
- zanubrutinib
- ziftomenib
Adverse Reactions .
Serious Reactions
may occur but none reported
Common Reactions
- infusion site reaction (IV use)
- headache
- nausea (PO use)
- abdominal pain (PO use)
- vomiting (PO use)
- dry mouth (PO use)
- impaired concentration (PO use)
- dysphoria (PO use)
- fever (PO use)
- diarrhea
- facial edema (PO use)
- purpura, palpable (PO use)
- abnormal EEG
- myalgia (IV use)
- arthritis (IV use)
- photophobia (IV use)
Safety/Monitoring .
Monitoring Parameters
Cr at baseline and during tx if using IV
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; no human data available; no known risk of fetal harm based on animal data at 0.4x, 23x, and 24x recommended human dose
Lactation
Clinical Summary
Smallpox Use: avoid breastfeeding; no human data available, though possible risk of postnatal smallpox virus transmission; no human data available to assess effects on milk production
Mpox Use: avoid breastfeeding if active lesions, otherwise weigh risk/benefit while breastfeeding; no human data available, though possible risk of postnatal mpox virus transmission; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for tecovirimat: liver; CYP450: none; UGT: 1A1, 1A4 substrate
Excretion: for tecovirimat: urine 73%, feces 23% (primarily unchanged); Half-life: 20h
Mechanism of Action
for tecovirimat: inhibits orthopoxvirus envelope wrapping protein, preventing extracellular enveloped virus production and cell-to-cell dissemination of variola (smallpox) virus
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.