Evusheld
Evusheld is a medication used to prevent infection from COVID-19 before exposure to the virus, but it's not a vaccine. Evusheld is made up of two monoclonal antibodies (tixagevimab and cilgavimab) that are given as separate injections into the muscles, one right after the other. Evusheld originally received an emergency use authorization (EUA) from the FDA for certain people ages 12 years and older. But the FDA removed the EUA in 2023 because more recent findings show Evusheld has limited protection against the newer COVID-19 variants that make up a majority of COVID-19 infections in the United States.
What is Evusheld?
What is Evusheld used for?
- Prevention of COVID-19 infections in certain people who aren't infected with COVID-19 and who haven't been exposed to anyone with COVID-19 (pre-exposure prevention, or PrEP)
How Evusheld works
Evusheld is made up of two separate monoclonal antibodies, tixagevimab and cilgavimab. They find and attach to different parts of the spike protein of the COVID-19 virus. The virus uses its spike protein to enter and infect your cells. When tixagevimab and cilgavimab bind to the spike protein, it blocks the COVID-19 virus from getting into your cells and causing further infection.
Drug facts
| Common Brands | Evusheld |
|---|---|
| Drug Class | Monoclonal antibody |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Not FDA-approved yet |
Side effects of Evusheld
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Headache (6%)
- Tiredness (4%)
- Cough (3%)
Less Common Side Effects
- Bleeding at injection site
Evusheld serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain or discomfort, heartburn, difficulty breathing, clammy skin, sweating, dizziness, tiredness, anxiety
- Heart failure: difficulty breathing, swelling in the hands and feet, bloating, weight gain, dizziness, tiredness
- Heart rhythm problems: fast or slow heartbeat, chest pain, difficulty breathing, fainting, dizziness, lightheadedness
- Serious allergic reaction: wheezing, fast breathing, swelling under the skin, rash, hives, tightening of your throat, lightheadedness, fainting
Pros and cons of Evusheld
Pros
- Provides protection from the COVID-19 virus for at least 6 months
- Can be used in children as young as 12 years old
- Few side effects
Cons
- Need to get 2 injections, one right after the other
- Might need a repeat dose after 6 months
- Not much research in pregnancy, breastfeeding, people with liver problems, and children under 12 years old weighing less than 88 lbs
Pharmacist tips for Evusheld
- Evusheld is no longer available or authorized in the United States. If you're concerned about COVID-19 and curious about your options for vaccines, prevention, or treatment, talk with your provider.
- Some people have developed rare, but serious allergic reactions after receiving Evusheld. Because of this, your provider will ask you to stay at the clinic for at least 1 hour after your injections to monitor you for any serious allergic reactions. Symptoms can include wheezing, fast breathing, swelling under the skin, rash, hives, tightening of your throat, lightheadedness, and fainting. Please plan for this time when you go to your appointment.
- This medication might put you at higher risk for serious heart problems, such as heart attacks and heart failure. Get medical attention right away if you experience chest pain or discomfort, difficulty breathing, swelling in your hands or feet, dizziness, or tiredness.
Risks and warnings for Evusheld
Evusheld can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious allergic reactions
- Risk factors: Past allergic reaction to COVID-19 vaccines | Allergy to polysorbate 80 or polyethylene glycol (PEG)
Some people have experienced very serious allergic reactions after receiving Evusheld. To be safe, your provider will ask you to stay at the clinic for at least an hour after your injections. They'll monitor you for possible allergic reactions like trouble breathing, fast heart beat, dizziness, and fainting. If needed, they'll provide prompt medical treatment.
In addition, Evusheld contains an inactive ingredient called polysorbate 80, which is also found in some COVID-19 vaccines. If you've had a reaction to a COVID-19 vaccine in the past or if you have a known allergy to polysorbate 80 or polyethylene glycol (PEG), let your provider know before you receive this medication.
Poor protection against certain COVID-19 variants
Evusheld isn't able to provide protection against all COVID-19 variants. You might get sick from COVID even after receiving this medication. Get medical help right away if you think you might have COVID or if you experience COVID symptoms like fever, chills, body aches, or lost of taste or smell.
Bleeding problems
- Risk factors: Low platelets | History of bleeding problems
As with any injections that are given into the muscles, Evusheld can cause bleeding problems. Let your provider know if you have low platelets or a history of bleeding problems, they'll monitor you for serious bleeds after your injection.
Serious heart problems
- Risk factors: History of heart problems, such as heart attack or stroke | High blood pressure | High cholesterol | High blood sugar (diabetes) | Obesity
Though rare, more people who received Evusheld reported serious heart problems, such as heart attack and heart failure, compared to people who didn't receive treatment in early studies. The link between serious heart problems and Evusheld use is still unclear. But the people who developed these problems after receiving the medication already had a history of or had risk factors for heart problems. Make sure your provider knows your full medical history before starting Evusheld. Get medical help right away if you experience symptoms of heart problems, such as chest pain or discomfort, difficulty breathing, swelling in your hands or feet, dizziness, or tiredness.
Evusheld dosage
Typical dosage for Evusheld
- People ages 12 years and older (at least 88 lbs): The full dose of Evusheld is made up of one injection (300 mg) of tixagevimab and one injection (300 mg) of cilgavimab. They're injected into the muscles one right after the other (preferably one in each buttock), by a healthcare provider. The dose is repeated every 6 months.
