Tecovirimat (TPOXX) photo
Photo source: Siga.com
KEY POINTS
- Tecovirimat (TPOXX) is an inhibitor of the orthopoxvirus VP37 envelope wrapping protein
- Tecovirimat targets and inhibits the activity of the orthopoxvirus VP37 protein (encoded by and highly conserved in all members of the orthopoxvirus genus) and blocks its interaction with cellular Rab9 GTPase and TIP47, which prevents the formation of egress-competent enveloped virions necessary for cell-to-cell and long-range dissemination of virus.
- Tecovirimat was approved in 2018 for the treatment of human smallpox disease caused by variola virus in adults and pediatric patients weighing at least 13 kg.
- Efficacy for smallpox treatment in humans is not known, as well controlled trials have not been feasible
- Efficacy may be reduced in immunocompromised persons
- May have a role in the treatment of human monkeypox
- Adult dose is 600 mg oral BID x14 days
- Should be taken within 30 minutes after a full meal of moderate or high fat
- Pediatric dosing is weight-based, detailed in the package insert
- No dose adjustment needed for renal or hepatic dysfunction
- Holds a warning/precaution for hypoglycemia when administered with repaglinide
- Side effects can include headache, nausea, abdominal pain, and vomiting
- In the United States there is a slew of paperwork required for using tecovirimat (see here)
RESOURCES
- Tecovirimat (TPOXX) Package Insert
- CDC Guidance for Tecovirimat Use Under Expanded Access Investigational New Drug Protocol during 2022 U.S. Monkeypox Cases
- CDC: Obtaining and Using TPOXX (Tecovirimat)
- SIGA TPOXX Fact Sheet
- Monkeypox in 2022—What Clinicians Need to Know (JAMA)
- What to Know About Monkeypox (JAMA 2022)
- Monkeypox Genital Lesions (NEJM 2022)
- Monkeypox: What You Need to Know (IDSA 2022)
