Update 31 August 2021
This guidance applies only to patients with COVID-19 who are managed as an inpatient in a physical hospital. It includes evidence-based recommendations, as well as guidance and resources supporting therapeutic decision-making, drug access, governance and utilisation in hospital.
As evidence emerges from clinical trials, recommendations regarding the use of some disease-modifying medicines in COVID-19 can now be made, while the use of other disease-modifying medicines remains best limited to a clinical trial setting. Recommendations can also be made where the use of some medicines should not occur. The
Australian guidelines for the clinical care of people with COVID-19 is the nationally recognised source for specific, patient-focused recommendations on management and care of people with suspected or confirmed COVID-19.
The tables below summarise the recommendations regarding specific disease-modifying medicines, as of August 31, 2021, with guidance on access, governance and resources to support use in hospital. Additional Summary Guidances for Pharmacological Management of Hospitalised Patients with COVID-19- adults, pregnant and breastfeeding women and children and adolescents- can be found on the NSW Therapeutic Advisory Group website - see
Medicines use in the treatment of COVID-19. A verbal consent form/guide for one or more COVID-specific medicines (remdesivir, baricitinib, tocilizumab) can be found at
Medicines use in the treatment of COVID-19
Critical Shortage: ONLY use when not possible to use baricitinib.
Via Prescribing Declaration or Streamlined IPU*
Conditional recommendation for commencing in adults, who require high-flow oxygen, non-invasive ventilation or invasive mechanical ventilation&
Give with dexamethasone unless there is a specific contraindication.¥
If stock available, only use when not possible to use baricitinib or tocilizumab.
Via Streamlined IPU*
Contact NSW TAG for drug guidance (requires local DTC endorsement); patient information; patient consent form; IPU* application form#; outcomes reporting form.
Requires SAS form to be completed.
Currently eligible for TGA evaluation for provisional registration. Stock currently unavailable.
When/if available, see NSW TAG drug guidance (requires local DTC endorsement); patient information; patient consent form; IPU* application form#; outcomes reporting form.
Requires SAS form..
See also ACI Model of Care
Via Prescribing Declaration/ Streamlined IPU*
Do not commence for the
treament of COVID-19.
NSW Health does not endorse any specific antiviral or immunomodulatory therapy for patients with COVID-19, outside those treatments recommended by the national COVID-19 clinical guidelines. Currently there are few circumstances where this might be considered (e.g. remdesivir slightly outside current criteria). In these rare circumstances, the following process should be followed.
Clinical decision making must align with the criteria for Off-Label Use of Medicines for “Exceptional/Individual Use” and “Conditional Use, with Evidence Development”, outlined in the Council of Australian Therapeutic Advisory Groups’ (CATAG)Guiding principles. Institutional governance is through the Individual Patient Use procedure, with shared decision making and informed consent involving the patient or carer, and entry of patient data into a registry for evidence development. Rigorous monitoring for adverse drug events and reporting of these is essential. Use of a registry will inform safer future use of treatments for COVID-19. Currently local sites are responsible for their own registry with collated information regarding IPUs reported through the usual process – refer to Approval process of Medicines for Use in NSW Hospitals. State-wide registries are being established to facilitate the collection of information on use and outcomes for all NSW patients with COVID-19 who are given specific COVID-19 medicines outside a clinical trial. Further information is available at
NSW TAG COVID-19 resources.
There are other approved studies of therapies for prevention of COVID-19 as well as studies of other therapies for treatment, currently under ethics review and applications for funding.
This guidance will be updated regularly as new information becomes available.
[back to top]
Drug and therapeutics Advisory Community of Practice.
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.
31 August 2021.
communities of practice.