Prevention and Treatment of Monkeypox https://doi.org/10.

1007/s40265-022-01742-y
Table: Summary of therapies for the management of monkeypox
Treatments Route Dosing Mode of action Common Contraindications (US Major drug interactions Use in specific
adverse labeling) populations
events
Tecovirimat PO, IV Adults: 600 mg twice daily Orthopoxvirus VP37 Headache, None Repaglinide (hypo- glycemia), PO: Hepatic/renal adjust-
(approved in for 14 days; pediatrics (13 envelope wrapping nausea, Midazolam (decreased ment not required. IV:
May 2022) kg or more), if 13 kg to protein inhibitor abdominal pain, effectiveness of midazolam) ` should not be admin-
less than 25 kg: 200 mg vomiting. Note: Co-administration with istered to patients with
BID for 14 days, if 25 kg Infusion-site repaglinide may cause severe renal impairment
to less than 40 kg: 400 mg reactions may hypoglycemia. Monitor blood
twice daily for 14 days, if occur with IV glucose and monitor for hypo-
40 kg or more: 600 mg form glycemic symptoms during co-
twice daily for 14 days administration

Brincidofovir PO (tablets, Adults weighing ≥ 48 kg: Phosphorylated to Diarrhea, None OATP1B1 and 1B3 inhibitors Not recommended in
oral 200 mg once weekly for active metabolite, nausea, increase Brincidofovir exposure pregnant and breast-
suspension) two doses; adults and cidofovir diphosphate, vomiting, and which may increase Brincidofovir feeding women (perform
pediatric patients weighing which selectively abdominal pain -associated adverse reactions. pregnancy test in women of
≥10 kg to less than 48 kg: inhibits orthopoxvirus Consider alternative medication childbearing poten- tial
4 mg/kg of the oral DNA polymerase- that are not OATP1B1 or 1B3 before treatment). Perform
suspension once weekly mediated viral DNA inhibitors liver function tests before
for two doses; pediatrics synthesis and during treatment as
weighing less than 10 kg, brincidofo- vir may cause
the dose is 6 mg/kg of the increases in serum
oral suspension once transaminases and serum
weekly for 2 doses bilirubin

Cidofovir IV 5 mg/kg once weekly for 2 Undergoes cellular Decreased serum Hypersensitivity to cidofovir Probenecid, agents of Dose adjustment based on
weeks, followed by 5 phosphorylation, then bicarbonate, or any component of the nephrotoxic potential renal function is necessary:
mg/kg IV once every other selectively inhibits proteinuria, formulation; history of Serum creatinine
week orthopoxvirus DNA neutropenia, clinically-severe > 1.5 mg/dL, CrCl ≤ 55
polymerase-mediated infection, hypersensitivity to mL/minute, or urine
viral DNA synthesis hypotony of eye, probenecid or other sulfa- protein ≥ 100 mg/dL
iritis, uveitis, containing medications; (≥ 2+ proteinuria)
nephrotoxicity, serum creatinine > 1.5 mg/
fever dL; CrCl ≤ 55 mL/ minute;
urine protein ≥ 100 mg/dL
(≥ 2+ proteinuria); use with
or within 7 days of
nephrotoxic agents; direct
intraocular
 injection
Vaccinia IV 6000 U/kg as soon as Antibodies obtained Headache, Isolated vaccinia Contains maltose: may No human or animal data
symptoms appear; from pooled human nausea, keratitis, history of result in elevated in pregnant women; use
immune may repeated based on plasma of individuals rigors, dizziness anaphylactic or severe glucose readings that only if clearly needed.
globulin severity of symptoms immunized with the systemic reaction can lead to untreated Use caution in patients
and response to treatment; smallpox vaccine to human globulins, hypoglycemia or with renal insufficiency
9000 U/kg may provides passive IgA deficiency with inappropriate insulin (Minimum infusion rate)
be considered if patient immunity antibodies against IgA administration; may
does not respond to and a history of IgA impair efficacy of live
initial dose hypersensitivity attenuated virus vaccines:
revaccination
may be necessary; may
interfere with some
serological tests