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SOTROVIMAB injection, solution

PRESCRIBING HIGHLIGHTS:  Please see package insert for additional information and possible updates to ensure safe and effective use of this medication. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. Please read the disclaimer carefully BEFORE accessing or using this site. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.  

Drug UPDATES:   [Drug information (pdf)]  
PACKAGE INSERT -Dosing:  Click (+) next to Dosage and Administration section (drug info link)

 

Usual Diluents top of page

NS,  D5W

Standard Dilutions   [Amt of drug] [Infusion vol] [Infusion rate] top of page

[ 500mg ]   [50 ml ]  [15 minutes]
[ 500mg ]   [100 ml ]  [30 minutes]

Use of a 0.2 micron polyethersulfone (PES) filter is strongly recommended.  Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.

The dosage in adults and pediatric patients (12 years of age and older weighing at least 40 kg) is 500 mg of sotrovimab administered as a single IV infusion. Sotrovimab should be given as soon as possible after positive results of direct SARS-CoV-2 viral testing and within 7 days of symptom onset.

Sotrovimab is available as a concentrated solution and must be diluted prior to IV infusion.    Administer 500 mg of sotrovimab by IV infusion over 15 minutes for 50-mL infusion bag or 30 minutes for 100-mL infusion bag.  Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.

Remove one vial of sotrovimab from refrigerated storage and allow to equilibrate to room temperature, protected from light, for approximately 15 minutes.    Inspect the vial of sotrovimab visually for particulate matter and discoloration prior to administration. Should either be observed, the solution must be discarded and fresh solution prepared. Sotrovimab is a clear, colorless or yellow to brown solution.

Gently swirl the vial several times before use without creating air bubbles. Do not shake the vial. Withdraw 8 mL of sotrovimab from one vial and inject into the prefilled infusion bag. Discard any product remaining in the vial.  Prior to the infusion, gently rock the infusion bag back and forth by hand 3 to 5 times. Do not invert the infusion bag. Avoid forming air bubbles.  This product is preservative-free; therefore, the diluted infusion solution should be administered immediately. If immediate administration is not possible, store the diluted solution of sotrovimab up to 6 hours at room temperature (up to 25°C [up to 77°F]) or refrigerated up to 24 hours (2°C to 8°C [36°F to 46°F]).

Administration

Sotrovimab infusion solution should be administered by a qualified healthcare professional.

Sotrovimab may only be administered in settings in which healthcare providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary [see Warnings and Precautions (5.1)].

Gather the materials for infusion via infusion pump or gravity:
Polyvinyl chloride (PVC) or polyolefin (PO) infusion set, and Use of a 0.2 micron polyethersulfone (PES) filter is strongly recommended.

Attach the infusion set to the IV bag using standard bore tubing.  Prime the infusion set.  Administer the entire infusion solution in the bag over 15 minutes for 50-mL infusion bag or 30 minutes for 100-mL infusion bag. Due to potential overfill of prefilled saline bags, the entire infusion solution in the bag should be administered to avoid underdosage.

Do not administer as an IV push or bolus. The prepared infusion solution should not be administered simultaneously with any other medication. The compatibility of sotrovimab with IV solutions and medications other than 0.9% Sodium Chloride Injection and 5% Dextrose Injection is not known.

Once infusion is complete, flush the tubing with 0.9% Sodium Chloride or 5% Dextrose to ensure delivery of the required dose. If the infusion must be discontinued due to an infusion reaction, discard unused product.

Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.

 

 

WARNINGS  top of page

See warnings and precautions below.

Unapproved drug:

AUTHORIZED USE
Sotrovimab is authorized for use under an Emergency Use Authorization (EUA) for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death [see Clinical Trial Results and Supporting Data for EUA

DESCRIPTION  top of page

Description:
Sotrovimab is a human immunoglobulin G-1 (IgG1-kappa) monoclonal antibody consisting of 2 identical light chain (LC) polypeptides composed of 214 amino acids each and 2 identical heavy chain (HC) polypeptides, each composed of 457 amino acids. Sotrovimab is produced by a Chinese Hamster Ovary cell line and has a molecular weight of approximately 149 kDa.

Sotrovimab injection is a sterile, preservative-free, clear, colorless or yellow to brown solution supplied in a single-dose vial for IV infusion after dilution.

Each mL contains sotrovimab (62.5 mg), L-histidine (1.51 mg), L-histidine monohydrochloride (2.15 mg), L-methionine (0.75 mg), polysorbate 80 (0.4 mg), and sucrose (70 mg). The solution of sotrovimab has a pH of 6.0.

CLINICAL PHARMACOLOGY: top of page

Mechanism of Action:

Sotrovimab is a recombinant human IgG1-kappa mAb that binds to a conserved epitope on the spike protein receptor binding domain of SARS-CoV-2 with a dissociation constant KD = 0.21 nM) but does not compete with human ACE2 receptor binding (IC50 value >33.6 nM [5 µg/mL]). Sotrovimab inhibits an undefined step that occurs after virus attachment and prior to fusion of the viral and cell membranes. The Fc domain of sotrovimab includes M428L and N434S amino acid substitutions (LS modification) that extend antibody half-life, but do not impact wild-type Fc-mediated effector functions in cell culture.

INDICATIONS AND USAGE  top of page

INDICATIONS AND USAGE:
 

LIMITATIONS OF AUTHORIZED USE

Sotrovimab is not authorized for treatment of mild-to-moderate COVID-19 in geographic regions where infection is likely to have been caused by a non-susceptible SARS-CoV-2 variant based on available information including variant susceptibility to these drugs and regional variant frequency.

•FDA’s determination and any updates will be available at: HTTPS://WWW.FDA.GOV/EMERGENCY-PREPAREDNESS-AND-RESPONSE/MCM-LEGAL-REGULATORY-AND-POLICY-FRAMEWORK/EMERGENCY-USE-AUTHORIZATION#COVIDDRUGS1

Sotrovimab is not authorized for use in the following patient populations:
• Adults or pediatric patients who are hospitalized due to COVID-19, OR
•Adults or pediatric patients who require oxygen therapy and/or respiratory support due to COVID-19, OR
•Adults or pediatric patients who require an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 in those patients on chronic oxygen.

•Benefit of treatment with sotrovimab has not been observed in patients hospitalized due to COVID‑19. SARS-CoV-2 monoclonal antibodies may be associated with worse clinical outcomes when administered to hospitalized patients with COVID‑19 requiring high flow oxygen or mechanical ventilation.

RECENT MAJOR CHANGES

Microbiology/Resistance Information, Antiviral Resistance (Section 15): addition of information on susceptibility of SARS-CoV-2 variants to sotrovimab
Limitations of Authorized Use – updated Limitations of Authorized Use for treatment

Revised 03/2022

Revised 02/2022

Dosage and Administration (Box and Sections 2.2 and 2.4): updated intravenous infusion time

Revised 02/2022

Overall Safety Summary, Clinical Trials Experience (Section 6.1, 14.2 and 18): addition of COMET-TAIL safety, PK, and efficacy data

Revised 02/2022

Overall Safety Summary, Post-Authorization Experience (Section 6.2): addition of anaphylaxis

Revised 11/2021

Dosage and Administration, Dose Preparation and Administration (Section 2.4): addition of 5% Dextrose injection and updated storage of diluted solution of sotrovimab

Revised 09/2021

Clinical Trial Results and Supporting Data for EUA (Section 18): updated with efficacy results for the full population

Revised 09/2021

Sotrovimab has been authorized by FDA for the emergency use described above.

Sotrovimab is not FDA-approved for this use.

Sotrovimab is authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of sotrovimab under section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.

This EUA is for the use of the unapproved product sotrovimab for the treatment of mild-to-moderate COVID‑19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-COV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death [see LIMITATIONS OF AUTHORIZED USE].

The following medical conditions or other factors may place adults and pediatric patients (12 to 17 years of age weighing at least 40 kg) at higher risk for progression to severe COVID-19:

•Older age (for example ≥65 years of age)
•Obesity or being overweight (for example, adults with BMI >25 kg/m2, or if 12 to 17 years of age, have BMI ≥85th percentile for their age and gender based on CDC growth charts, HTTPS://WWW.CDC.GOV/GROWTHCHARTS/CLINICAL_CHARTS.HTM)
•Pregnancy
•Chronic kidney disease
•Diabetes
•Immunosuppressive disease or immunosuppressive treatment
•Cardiovascular disease (including congenital heart disease) or hypertension
•Chronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis and pulmonary hypertension)
•Sickle cell disease
•Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies)
•Having a medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation [not related to COVID-19])

Other medical conditions or factors (for example, race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19, and authorization of sotrovimab under the EUA is not limited to the medical conditions or factors listed above. For additional information on medical conditions and factors associated with increased risk for progression to severe COVID-19, see the CDC website: HTTPS://WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/NEED-EXTRA-PRECAUTIONS/PEOPLE-WITH-MEDICAL-CONDITIONS.HTML. Healthcare providers should consider the benefit-risk for an individual patient.

For additional information on all products authorized for treatment or prevention of COVID-19, please see HTTPS://WWW.FDA.GOV/EMERGENCY-PREPAREDNESS-AND-RESPONSE/MCM-LEGAL-REGULATORY-AND-POLICY-FRAMEWORK/EMERGENCY-USE-AUTHORIZATION.

Sotrovimab must be administered after dilution by intravenous (IV) infusion. See the FULL EUA PRESCRIBING INFORMATION for complete dosage, administration, and preparation instructions.

•The authorized dosage for sotrovimab is 500 mg administered as a single IV infusion as soon as possible after a positive viral test for SARS-CoV-2 and within 7 days of symptom onset [see Dosage and Administration (2.2) and Clinical Trial Results and Supporting Data for EUA (18)].
•Sotrovimab is available as a concentrated solution and must be diluted prior to IV infusion.
•Administer 500 mg of sotrovimab by IV infusion over 15 minutes for 50-mL infusion bag or 30 minutes for 100-mL infusion bag.
•Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.

Sotrovimab may only be administered in settings in which healthcare providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary.

The prescribing healthcare provider and/or the provider’s designee is/are responsible for mandatory reporting of all SERIOUS ADVERSE EVENTS and MEDICATION ERRORS potentially related to sotrovimab within 7 calendar days from the healthcare provider’s awareness of the event. See Sections 8 and 9 of the Full EUA Fact Sheet for reporting requirements.

Patients treated with sotrovimab should continue to self-isolate and use infection control measures (e.g., wear mask, isolate, social distance, avoid sharing personal items, clean and disinfect “high touch” surfaces, and frequent handwashing) according to CDC guidelines.

The authorized dosage may be updated as additional data from clinical trials becomes available.

For information on clinical trials that are testing the use of sotrovimab in COVID-19, please see WWW.CLINICALTRIALS.GOV.


1
FDA will monitor conditions to determine whether use in a geographic region is consistent with this scope of authorization, referring to available information, including information on variant susceptibility [see Microbiology/Resistance Information (15)], and CDC regional variant frequency data available at: HTTPS://COVID.CDC.GOV/COVID-DATA-TRACKER/#VARIANT-PROPORTIONS.

MANDATORY REQUIREMENTS FOR ADMINISTRATION OF SOTROVIMAB UNDER EMERGENCY USE AUTHORIZATION

In order to mitigate the risks of using this unapproved product under the EUA and to optimize the potential benefit of sotrovimab, the following steps are required. Use of sotrovimab under this EUA is limited to the following (all requirements must be met):

1.
Treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death [see LIMITATIONS OF AUTHORIZED USE].
2.
As the healthcare provider, communicate to your patient or parent/caregiver information consistent with the “Fact Sheet for Patients, Parents, and Caregivers” prior to the patient receiving sotrovimab. Healthcare providers (to the extent practicable given the circumstances of the emergency) must document in the patient’s medical record that the patient/caregiver has been:
a. Given the “Fact Sheet for Patients, Parents, and Caregivers”,
b. Informed of alternatives to receiving authorized sotrovimab, and
c. Informed that sotrovimab is an unapproved drug that is authorized for use under this Emergency Use Authorization.
3.
Patients with known hypersensitivity to any ingredient of sotrovimab must not receive sotrovimab.
4.
The prescribing healthcare provider and/or the provider’s designee is/are responsible for mandatory reporting of all serious adverse events* and medication errors potentially related to sotrovimab within 7 calendar days from the healthcare provider’s awareness of the event, using FDA Form 3500 (for information on how to access this form, see below). The FDA requires that such reports, using FDA Form 3500, include the following:
Patient demographics and baseline characteristics (e.g., patient identifier, age or date of birth, gender, weight, ethnicity, and race)
A statement "Sotrovimab use for COVID-19 under Emergency Use Authorization (EUA)” under the “Describe Event, Problem, or Product Use/Medication Error” heading
Information about the serious adverse event or medication error (e.g., signs and symptoms, test/laboratory data, complications, timing of drug initiation in relation to the occurrence of the event, duration of the event, treatments required to mitigate the event, evidence of event improvement/disappearance after stopping or reducing the dosage, evidence of event reappearance after reintroduction, clinical outcomes)
Patient’s preexisting medical conditions and use of concomitant products
Information about the product (e.g., dosage, route of administration, NDC #)
5.
Submit adverse event and medication error reports, using Form 3500, to FDA MedWatch using one of the following methods:
Complete and submit the report online: WWW.FDA.GOV/MEDWATCH/REPORT.HTM
Complete and submit a postage-paid FDA Form 3500 (HTTPS://WWW.FDA.GOV/MEDIA/76299/DOWNLOAD) and return by:

o
Mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787, or
o
Fax to 1-800-FDA-0178, or
Call 1-800-FDA-1088 to request a reporting form
In addition, please provide a copy of all FDA MedWatch forms to:

GlaxoSmithKline, Global Safety

Fax: 919-287-2902

Email: [email protected]

Or call the GSK COVID Contact Center at 1-866-GSK-COVID (866-475-2684) to report

adverse events.

6.
The prescribing healthcare provider and/or the provider’s designee is/are responsible for mandatory responses to requests from FDA for information about adverse events and medication errors following receipt of sotrovimab.

*Serious Adverse Events are defined as:

•death;
•a life-threatening adverse event;
•inpatient hospitalization or prolongation of existing hospitalization;
•a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions;
•a congenital anomaly/birth defect;
•other important medical event, which may require a medical or surgical intervention to prevent death, a life-threatening event, hospitalization, disability, or congenital anomaly.
7.
OTHER REPORTING REQUIREMENTS

•Healthcare facilities and providers will report therapeutics information and utilization data as directed by the U.S. Department of Health and Human Services.

CONTRAINDICATIONS top of page

Contraindications:

Sotrovimab is contraindicated in patients who have a history of anaphylaxis to sotrovimab or to any of the excipients in the formulation..

PRECAUTIONS top of page

WARNINGS AND PRECAUTIONS:

There are limited clinical data available for sotrovimab. Serious and unexpected adverse events may occur that have not been previously reported with sotrovimab use.

5.1 Hypersensitivity Including Anaphylaxis and Infusion-Related Reactions

Serious hypersensitivity reactions, including anaphylaxis, have been observed with administration of sotrovimab [see Overall Safety Summary (6.1)]. If signs and symptoms of a clinically significant hypersensitivity reaction or anaphylaxis occur, immediately discontinue administration and initiate appropriate medications and/or supportive care.

Infusion-related reactions, occurring during the infusion and up to 24 hours after the infusion, have been observed with administration of sotrovimab. These reactions may be severe or life threatening.

Signs and symptoms of infusion‑related reactions may include [see Overall Safety Summary (6.1)]:

•fever, difficulty breathing, reduced oxygen saturation, chills, fatigue, arrhythmia (e.g., atrial fibrillation, sinus tachycardia, bradycardia), chest pain or discomfort, weakness, altered mental status, nausea, headache, bronchospasm, hypotension, hypertension, angioedema, throat irritation, rash including urticaria, pruritus, myalgia, vaso-vagal reactions (e.g., pre-syncope, syncope), dizziness, and diaphoresis.

If an infusion-related reaction occurs, consider slowing or stopping the infusion and administer appropriate medications and/or supportive care. Clinically monitor patients for at least 1 hour after completion of the infusion for signs and symptoms of hypersensitivity.

Hypersensitivity reactions occurring more than 24 hours after the infusion have also been reported with the use of SARS-CoV-2 monoclonal antibodies under Emergency Use Authorization.

5.2 Clinical Worsening After SARS-CoV-2 Monoclonal Antibody Administration

Clinical worsening of COVID‑19 after administration of SARS-CoV-2 monoclonal antibody treatment has been reported and may include signs or symptoms of fever, hypoxia or increased respiratory difficulty, arrhythmia (e.g., atrial fibrillation, tachycardia, bradycardia), fatigue, and altered mental status. Some of these events required hospitalization. It is not known if these events were related to SARS-CoV-2 monoclonal antibody use or were due to progression of COVID‑19.

5.3 Limitations of Benefit and Potential for Risk in Patients with Severe COVID-19

Benefit of treatment with sotrovimab has not been observed in patients hospitalized due to COVID‑19. SARS-CoV-2 monoclonal antibodies may be associated with worse clinical outcomes when administered to hospitalized patients with COVID‑19 requiring high flow oxygen or mechanical ventilation. Therefore, sotrovimab is not authorized for use in the following patient populations [see LIMITATIONS OF AUTHORIZED USE]:

•Adults or pediatric patients who are hospitalized due to COVID‑19, OR
•Adults or pediatric patients who require oxygen therapy and/or respiratory support due to COVID‑19, OR
•Adults or pediatric patients who require an increase in baseline oxygen flow rate and/or respiratory support due to COVID‑19 in those patients on chronic oxygen.

ADVERSE REACTIONS top of page

ADVERSE REACTIONS:

Clinical trials evaluating the safety of sotrovimab are ongoing [see Overall Safety Summary (6)].

The prescribing healthcare provider and/or the provider’s designee is/are responsible for the mandatory reporting of all serious adverse events* and medication errors potentially related to sotrovimab within 7 calendar days from the healthcare provider’s awareness of the event, using FDA Form 3500 (for information on how to access this form, see below). The FDA requires that such reports, using FDA Form 3500, include the following:

•Patient demographics and baseline characteristics (e.g., patient identifier, age or date of birth, gender, weight, ethnicity, and race)
•A statement "Sotrovimab use for COVID-19 under Emergency Use Authorization (EUA)” under the “Describe Event, Problem, or Product Use/Medication Error” heading
•Information about the serious adverse event or medication error (e.g., signs and symptoms, test/laboratory data, complications, timing of drug initiation in relation to the occurrence of the event, duration of the event, treatments required to mitigate the event, evidence of event improvement/disappearance after stopping or reducing the dosage, evidence of event reappearance after reintroduction, clinical outcomes)
•Patient’s preexisting medical conditions and use of concomitant products
•Information about the product (e.g., dosage, route of administration, NDC #)

Submit adverse event and medication error reports, using Form 3500, to FDA MedWatch using one of the following methods:

•Complete and submit the report online at WWW.FDA.GOV/MEDWATCH/REPORT.HTM, or
•Complete and submit a postage-paid FDA Form 3500 (HTTPS://WWW.FDA.GOV/MEDIA/76299/DOWNLOAD) and return by:
 

Mail to MedWatch, 5600 Fishers Lane, Rockville, MD 20852-9787, or
Fax (1-800-FDA-0178), or
•Call 1-800-FDA-1088 to request a reporting form.
•In addition, please provide a copy of all FDA MedWatch forms to:

GlaxoSmithKline, Global Safety

Fax: 919-287-2902

Email: [email protected]

Or call the GSK COVID Contact Center at 1-866-GSK-COVID (866-475-2684) to report adverse events.

The prescribing healthcare provider and/or the provider’s designee is/are responsible for mandatory responses to requests from FDA for information about adverse events and medication errors following receipt of sotrovimab.

*Serious Adverse Events are defined as:

•death;
•a life-threatening adverse event;
•inpatient hospitalization or prolongation of existing hospitalization;
•a persistent or significant incapacity or substantial disruption of the ability to conduct normal life functions;
•a congenital anomaly/birth defect;
•other important medical event, which may require a medical or surgical intervention to prevent death, a life-threatening event, hospitalization, disability, or congenital anomaly.

IMPORTANT: When reporting adverse events or medication errors to MedWatch, please complete the entire form with detailed information. It is important that the information reported to FDA be as detailed and complete as possible. Information to include:

•Patient demographics (e.g., patient initials, date of birth)
•Pertinent medical history
•Pertinent details regarding admission and course of illness
•Concomitant medications
•Timing of adverse event(s) in relationship to administration of sotrovimab
•Pertinent laboratory and virology information
•Outcome of the event and any additional follow-up information if it is available at the time of the MedWatch report. Subsequent reporting of follow-up information should be completed if additional details become available.

The following steps are highlighted to provide the necessary information for safety tracking:

In section A, box 1, provide the patient’s initials in the Patient Identifier
In section A, box 2, provide the patient’s date of birth
In section B, box 5, description of the event:

Write “Sotrovimab use for COVID-19 under Emergency Use Authorization (EUA)” as the first line
Provide a detailed report of medication error and/or adverse event. It is important to provide detailed information regarding the patient and adverse event/medication error for ongoing safety evaluation of this unapproved drug. Please see information to include listed above.
In section G, box 1, name and address:

Provide the name and contact information of the prescribing healthcare provider or institutional designee who is responsible for the report.
Provide the address of the treating institution (NOT the healthcare provider’s office address).

See PACKAGE INSERT for PATIENT COUNSELING INFORMATION and Medication Guide. Drug information (pdf)

DOSAGE AND ADMINISTRATION  top of page

DOSAGE AND ADMINISTRATION:

2.1 Patient Selection

Sotrovimab should be administered as soon as possible after a positive viral test for SARS-CoV-2 and within 7 days of symptom onset in adults and pediatric patients (12 years of age and older weighing at least 40 kg) who are at high risk for progression to severe COVID-19, including hospitalization or death [see Authorized Use (1) and Clinical Trial Results and Supporting Data for EUA (18)].

The following medical conditions or other factors may place adults and pediatric patients (12 to 17 years of age weighing at least 40 kg) at higher risk for progression to severe COVID-19:

•Older age (for example, ≥65 years of age)
•Obesity or being overweight (for example, adults with BMI >25 kg/m2, or if 12 to 17, have BMI ≥85th percentile for their age and gender based on CDC growth charts, HTTPS://WWW.CDC.GOV/GROWTHCHARTS/CLINICAL_CHARTS.HTM)
•Pregnancy
•Chronic kidney disease
•Diabetes
•Immunosuppressive disease or immunosuppressive treatment
•Cardiovascular disease (including congenital heart disease) or hypertension
•Chronic lung diseases (for example, chronic obstructive pulmonary disease, asthma [moderate-to-severe], interstitial lung disease, cystic fibrosis, and pulmonary hypertension)
•Sickle cell disease
•Neurodevelopmental disorders (for example, cerebral palsy) or other conditions that confer medical complexity (for example, genetic or metabolic syndromes and severe congenital anomalies)
•Having a medical-related technological dependence (for example, tracheostomy, gastrostomy, or positive pressure ventilation [not related to COVID-19])

Other medical conditions or factors (for example, race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19, and authorization of sotrovimab under the EUA is not limited to the medical conditions or factors listed above. For additional information on medical conditions and factors associated with increased risk for progression to severe COVID-19, see the CDC website: HTTPS://WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/NEED-EXTRA-PRECAUTIONS/PEOPLE-WITH-MEDICAL-CONDITIONS.HTML

Healthcare providers should consider the benefit-risk for an individual patient.

2.2 Dosage

The dosage in adults and pediatric patients (12 years of age and older weighing at least 40 kg) is 500 mg of sotrovimab administered as a single IV infusion. Sotrovimab should be given as soon as possible after positive results of direct SARS-CoV-2 viral testing and within 7 days of symptom onset.

•Sotrovimab is available as a concentrated solution and must be diluted prior to IV infusion.
•Administer 500 mg of sotrovimab by IV infusion over 15 minutes for 50-mL infusion bag or 30 minutes for 100-mL infusion bag.
•Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.
2.3 Dosage Adjustment in Specific Populations

Pregnancy or Lactation

No dosage adjustment is recommended in pregnant or lactating women [see Use in Specific Populations (11.1, 11.2)].

Pediatric Use

No dosage adjustment is recommended in pediatric patients who weigh at least 40 kg and are 12 years of age and older. Sotrovimab is not authorized for patients under 12 years of age or pediatric patients weighing less than 40 kg [see Use in Specific Populations (11.3)].

Geriatric Use

No dosage adjustment is recommended in geriatric patients [see Use in Specific Populations (11.4)].

Renal Impairment

No dosage adjustment is recommended in patients with renal impairment [see Use in Specific Populations (11.5)].

2.4 Dose Preparation and Administration

Preparation

Sotrovimab is supplied in a single-dose vial and must be diluted prior to IV infusion.

Sotrovimab infusion solution should be prepared by a qualified healthcare professional using aseptic technique.

•Gather the materials for preparation:
 

•Polyvinyl chloride (PVC) or polyolefin (PO), sterile, prefilled 50-mL or 100-mL infusion bag containing 0.9% Sodium Chloride Injection or 5% Dextrose Injection, and
•One vial of sotrovimab (500 mg/8 mL).
•Remove one vial of sotrovimab from refrigerated storage and allow to equilibrate to room temperature, protected from light, for approximately 15 minutes.
•Inspect the vial of sotrovimab visually for particulate matter and discoloration prior to administration. Should either be observed, the solution must be discarded and fresh solution prepared. Sotrovimab is a clear, colorless or yellow to brown solution.
•Gently swirl the vial several times before use without creating air bubbles. Do not shake the vial.
•Withdraw 8 mL of sotrovimab from one vial and inject into the prefilled infusion bag.
•Discard any product remaining in the vial.
•Prior to the infusion, gently rock the infusion bag back and forth by hand 3 to 5 times. Do not invert the infusion bag. Avoid forming air bubbles.
•This product is preservative-free; therefore, the diluted infusion solution should be administered immediately. If immediate administration is not possible, store the diluted solution of sotrovimab up to 6 hours at room temperature (up to 25°C [up to 77°F]) or refrigerated up to 24 hours (2°C to 8°C [36°F to 46°F]).

Administration

Sotrovimab infusion solution should be administered by a qualified healthcare professional [see Warnings and Precautions (5.1)].

Sotrovimab may only be administered in settings in which healthcare providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary [see Warnings and Precautions (5.1)].

•Gather the materials for infusion via infusion pump or gravity:
 

•Polyvinyl chloride (PVC) or polyolefin (PO) infusion set, and
•Use of a 0.2 micron polyethersulfone (PES) filter is strongly recommended.
•Attach the infusion set to the IV bag using standard bore tubing.
•Prime the infusion set.
•Administer the entire infusion solution in the bag over 15 minutes for 50-mL infusion bag or 30 minutes for 100-mL infusion bag. Due to potential overfill of prefilled saline bags, the entire infusion solution in the bag should be administered to avoid underdosage.
•Do not administer as an IV push or bolus.
•The prepared infusion solution should not be administered simultaneously with any other medication. The compatibility of sotrovimab with IV solutions and medications other than 0.9% Sodium Chloride Injection and 5% Dextrose Injection is not known
•Once infusion is complete, flush the tubing with 0.9% Sodium Chloride or 5% Dextrose to ensure delivery of the required dose.
•If the infusion must be discontinued due to an infusion reaction, discard unused product.
•Clinically monitor patients during infusion and observe patients for at least 1 hour after infusion is complete.

HOW SUPPLIED  top of page

DOSAGE FORMS AND STRENGTHS:
Sotrovimab is a sterile, preservative-free, clear, colorless or yellow to brown solution available as:

Injection: 500-mg/8-mL (62.5-mg/mL) solution in a single-dose vial.

Storage and Stability top of page

 How Supplied

Sotrovimab injection 500 mg (62.5 mg/mL) is a sterile, preservative-free, clear, colorless or yellow to brown solution supplied in a carton containing one single-dose glass vial with a rubber vial stopper (not made with natural rubber latex) and a flip-off cap (NDC 0173-0901-86).

Storage and Handling

Sotrovimab is preservative-free. Discard unused portion.

Store unopened vials refrigerated at 2°C to 8°C (36°F to 46°F) in original carton. Do not freeze or shake. Protect from light.

The solution of sotrovimab in the vial is preservative-free and requires dilution prior to IV administration. The diluted infusion solution of sotrovimab should be administered immediately. If immediate administration is not possible, store the diluted infusion solution for up to 24 hours at refrigerated temperature (2°C to 8°C [36°F to 46°F]) or up to 6 hours at room temperature (up to 25°C [up to 77°F]) including transportation and infusion time. If refrigerated, allow the infusion solution to equilibrate to room temperature for approximately 15 minutes prior to administration.

SOTROVIMAB injection, solution