Tecovirimat can be used to treat human smallpox disease in adult and pediatric patients who weigh at least 13 kg. The drug specifically targets orthopoxvirus VP37 envelope wrapping protein. The World Health Organisation (WHO) has certified smallpox as a globally eradicated disease.
Tecovirimat has been given a fast track status and approved by FDA as it has a high level of specificity and selectivity against orthopoxvirus, a specific virus responsible for causing the disease.
It works by preventing the virus from leaving the infected cell and thereby arrests the spread of the virus within the body.
Smallpox is mainly caused by variola major and variola minor among which variola major is a severe and most common form that produces more rashes and a high fever.
Tecovirimat should not be used in patients who are-
Allergic to tecovirimat
Children under 17 years of age
With a weak immune system
Caution is required while using tecovirimat in-
Pregnant and breastfeeding women
Men on fertility treatment
The dose of tecovirimat is calculated based on the body weight of the patients who are selected for smallpox treatment.
The recommended dose of tecovirimat in adult and pediatric patients who weigh-
Above 13 kg to below 25 kg: One capsule (200 mg) two times daily
Above 25 kg to below 40 kg: Two capsules (400 mg) twice daily
40 kg and above: Three capsules (600 mg) two times daily
Dose adjustment of tecovirimat is not necessary while treating patients with a kidney or liver disease.
Tecovirimat comes in a capsule form and should be taken by mouth with food for 14 days.
Tecovirimat should be taken within 30 minutes after eating a full meal comprised of moderate to high fat that amounts to at least 25 gm of fat.
Patients with swallowing difficulties can carefully open the capsule contents and mix it with either 30 ml of milk or sprinkle it over soft food such as applesauce or yogurt.
The whole mixture should be consumed immediately or at least within 30 minutes of its preparation time.
Men of reproductive potential should be informed that tecovirimat can cause sperm abnormalities and decrease sperm motility.
Resistance to tecovirimat by orthopoxviruses should be considered in patients who show a failed response to tecovirimat therapy or recurrence of disease symptoms.
Elderly patients above the age of 65 should be carefully observed during the treatment with tecovirimat as the occurrence of side effects are high which can affect the patients quality of life.
Gastrointestinal: Nausea, vomiting, indigestion, pain in the stomach, taste disturbances
Nervous system: Headache, dizziness, attention difficulties, depression, anxiety, mood irritation
Respiratory system: Throat pain with airway disorders
Skin: Rashes, itching, redness, swelling of the face
Others: Fever, weakness, chills, pain in the joints, heart rhythm abnormalities, low hemoglobin level
Treatment with tecovirimat can be discontinued permanently if some serious side effects such as a severe headache, diarrhea, or abnormal changes in ECG are reported.
Make sure to complete the entire course of the treatment schedule without missing or skipping a dose of tecovirimat.
Tecovirimat should not be recommended to other people without a doctors approval even if they have similar symptoms, because it may harm them.
Tecovirimat should not be taken with repaglinide, an anti-diabetic drug as it may increase the concentration of repaglinide resulting in low blood sugar levels.
Patients must be monitored closely for their blood sugar level and the symptoms associated with low blood sugar or hypoglycemia while taking tecovirimat and repaglinide together.
Tecovirimat reduces the effectiveness of midazolam, a brain depressant drug and giving an extra dose of midazolam to counteract the effect of tecovirimat can harm the patient; therefore this combination should be avoided.
Patients should inform the doctor about their consumption of prescription, non-prescription, or herbal supplements before taking tecovirimat to avoid unexpected side effects.
Store tecovirimat capsules in the original bottle at room temperature between 20°C and 25°C.
Keep away from children.
Protect from excess moisture and heat.
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