Table 3e. Dosing Regimens for the Drugs Recommended for the Treatment of MIS-C

Last Updated: July 21, 2023

Table 3e. Dosing Regimens for the Drugs Recommended for the Treatment of MIS-C
	Dosing Regimens For infants, children, and adolescents unless otherwise specified. The doses listed are for FDA-approved indications for other diseases or from reported experiences or clinical trials.	Adverse Events	Monitoring Parameters
Intravenous Immunoglobulin	IVIG 2 g/kg IBW (up to a maximum total dose of 100 g) IV In the event of cardiac dysfunction or fluid overload, consider administering IVIG in divided doses (1 g/kg IBW per dose IV every 24 hours for 2 doses).	Hypersensitivity Fever Chills Flushing Hemolytic anemia	Renal function Urine output CBC with differential Infusion or injection-related AE Anaphylaxis Signs and symptoms of hemolysis
Methylprednisolone	Methylprednisolone 1–2 mg/kg IV every 12 hours If the patient does not respond to 1–2 mg/kg IV every 12 hours, increase the dose to 10–30 mg/kg/day (up to maximum of 1,000 mg/day) IV for 1–3 days.	Adrenal suppression Hyperglycemia Sodium retention Fluid retention Leukocytosis Immune suppression	Blood pressure CBC with differential BMP
Anakinra	Anakinra 5–10 mg/kg/day IV (preferred) or SUBQ in 1 to 4 divided doses	Headache Fever Hypersensitivity Immune suppression Transaminitis	CBC with differential LFTs SCr
Infliximab	Infliximab 5–10 mg/kg IV for 1 dose	Infusion-related reaction Headache Immune suppression	Monitor vital signs every 2–10 minutes during infusion. CBC with differential
Aspirin	Aspirin 3–5 mg/kg (up to maximum of 81 mg) PO once daily	Gastrointestinal ulcers Hypersensitivity Renal dysfunction	Signs or symptoms of bleeding Renal function
Enoxaparin	Enoxaparin Prophylaxis Aged >2 Months to <18 Years 0.5 mg/kg (up to maximum of 30 mg) SUBQ every 12 hours Enoxaparin Treatment Aged >2 Months to <18 Years 1 mg/kg SUBQ every 12 hours Monitor antifactor Xa activity (treatment goal: 0.5 to 1).	Increased risk of bleeding Thrombocytopenia	CBC with differential Renal function
Key: AE = adverse effect; BMP = blood mineral panel; CBC = complete blood count; FDA = Food and Drug Administration; IBW = ideal body weight; IV = intravenous; IVIG = intravenous immunoglobulin; LFT = liver function test; MIS-C = multisystem inflammatory syndrome in children; PO = oral; SCr = serum creatinine; SUBQ = subcutaneous