Adult

Baricitinib for in-patients

Baricitinib is a selective and reversible inhibitor of Janus kinase 1 and 2 (JAK 1 and 2).  

Restricted formulary: The decision to initiate treatment with baricitinib MUST be made with Micro/ID. For patient:

  • With COVID-19 infection who requires oxygen, and,
  • Receiving corticosteroids, and,
  • Can not have tocilizumab or have failed to respond to tocilizumab, and,
  • Has no evidence of bacterial or viral infection (other than COVID-19).

See Oxygen requirement for in-patient with COVID-19 pneumonia guidance.

It is good practice to screen for blood borne virus including HIV, hepatitis B and C prior to starting baricitinib. Doses can be given whilst results are pending. In case of positive result discuss with Micro/ID.

Prescribing baricitinib

Baricitinib may be used alone or in combination with an interleukin-6 inhibitor (e.g. tocilizumab).

Cautions

  • The summary of product characteristics (SPC) states not to initiate baricitinib when the Absolute Neutrophil Count (ANC) is less than 1 x 109 cells/L. Use clinical discretion for ANC between 0.5 and 1 x 109 cells/L.
  • The SPC states that where Absolute Lymphocyte Count (ALC) is less than 0.5 x 109 cells/L, treatment should not be initiated or temporarily interrupted but this was not used in the RECOVERY trial. Use clinical judgement as appropriate.
  • When haemoglobin is less than 8 g/dL, treatment should not be initiated or temporarily interrupted.  
  • If increases in ALT or AST are observed and drug-induced liver injury is suspected, treatment should be temporarily interrupted until this diagnosis is excluded.
  • Baricitinib should not be given to patients with active or latent TB.
  • Combination with biological DMARDs, biological immunomodulators or other Janus kinase (JAK) inhibitors has a risk of additive immunosuppression. Clinician should take this into consideration before starting baricitinib. 

There are further cautions which primarily relate to long term use of baricitinib. Consider the risk benefit of short term use in COVID-19, and consult the SPC for information.

Dosage

Treatment course is for 10 days or until discharge (if sooner)

  Baricitinib dose*
Patients who are already taking baricitinib for a licenced indication at the dose of 4mg per day

Should not receive additional baricitinib doses
Patients who are already taking baricitinib at a dose of 2mg per day

Dose may be increased for duration of COVID-19 treatment provided the increased dose is deemed clinically appropriate

Consider renal function and interactions
Co-administration of an Organic Anion Transporter 3 (OAT3) inhibitor with a STRONG inhibition potential e.g. probenecid (Discuss with pharmacy)

2mg once daily
eGFR 60 ml/min/1.73m2 or more

4mg once daily
eGFR 30 up to 60 ml/min/1.73m2 2mg once daily
eGFR 15 up to 30 ml/min/1.73m2 2mg on alternate days
eGFR less than 15 ml/min/1.73m2 Should not receive baricitinib 

*Doses as per the NHS interim commissioning policy.

Prescribers should use clinical judgement and exercise caution with regards to dosing in those with unstable renal function in the context of acute kidney injury.

Unlicensed Use

This is an off-label indication for baricitinib. A routine use unlicensed medicine form has been completed for this use of baricitinib.

Interactions

A useful resource is University of Liverpool COVID-19 Drug Interactions website

Also see the BNF, Summary of Product Characteristics or speak to a pharmacist.

Avoid concurrent use with live and live-attenuated vaccines. 

This is not a complete list. Please see the BNF, summary of product characteristics or speak to a pharmacist.

Contraception, pregnancy or breastfeeding

See BNF and Summary of Product Characteristics.

References

  1. National Institute for Health and Care Excellence. Nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19 [TA878]. 2026 Available from: https://www.nice.org.uk/guidance/ta878 Accessed 14/8/26
  2. Eli Lilly and Company Ltd. Baricitinib Lilly 4mg film-coated tablets summary of product characteristics. Electronic Medicines Compendium. Last revision of the text 15/5/26. Available from: https://www.medicines.org.uk/emc/product/16006/smpc Accessed 11/9/26
  3. University of Liverpool. Covid-19 Drug Interactions [Internet]. Available from: https://www.covid19-druginteractions.org/checker Accessed 14/8/26
  4. Department of Health and Social Care. Rapid Policy statement. Interim Clinical Commissioning Policy: Baricitinib for patients hospitalised due to COVID-19 (adults and children aged 2 years and over) 28th November 2022. Available at: https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103221  Accessed 14/8/26

Editorial Information

Last reviewed: 11 Sept 2026

Next review date: 13 Sept 2029

Author(s): AMST.