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Treatment of Monkeypox (MPV): TPOXX & Supportive Care

Tecovirimat (also known as TPOXX) is FDA-approved for the treatment of human smallpox disease (which is similar to MPV) in adults and children. Since it does not have FDA approval specific to MPV, CDC holds a non-research expanded access Investigational New Drug (EA-IND) protocol (called “compassionate use”) that allows for use of TPOXX for treatment of MPV in adults and children of all ages.

Types of Treatment

Most people with MPV that have intact immune systems just need supportive care and pain control rather than antivirals. This should be enough to help control pain while MPV symptoms heal.

TPOXX may be considered in some cases based on multiple factors (i.e., initial health status, concurrent illnesses, previous vaccination history, other medical conditions).

Effectiveness of TPOXX

Data on the effectiveness of TPOXX in treating people with MPV is not yet available, but CDC data has shown that it is safe and well tolerated in people.

Studies using a variety of animal species have shown that TPOXX is effective in treating disease caused by orthopoxviruses (viruses like MPV) and has been shown to decrease the chance of dying from infections with orthopoxviruses when given early in the disease course.

TPOXX Administration

Oral Capsule

Must be taken concurrently with a full, fatty meal.

Intravenous (IV)

Should NOT be used if patient has severe kidney problems, or with pediatric patients <2 years of age.

Considerations for Treatment

Pain management strategies should be individualized and patient-centered, tailored to the needs and context of each patient.

  • Over-the-counter medications (e.g., acetaminophen, NSAIDs) are recommended for general pain control for patients with MPV.
  • Topical steroids and anesthetics such as lidocaine can be considered for local pain relief. Topical lidocaine or other topical anesthetics should be used with caution on broken skin or open or draining wounds.
  • To minimize the risk of autoinoculation (i.e., transferring virus from a lesion to another site on the body), persons with MPV or their caregivers should use disposable gloves when applying topical medications to lesions, then dispose of the gloves and practice hand hygiene.
  • In some circumstances, prescription pain medications such as gabapentin and opioids have been used for short-term management of severe pain not controlled with other treatments. Use of opioids for pain control should be balanced against the risk of side effects such as constipation, and other risks of unintended long-term use of opioids, such as development of an opioid use disorder or overdose.

How can I get TPOXX?

Speak with your health care provider, or contact the MPV Hotline: 1-800-889-3931