Guidelines
Remdesivir

Remdesivir

Background

Use is restricted to the inclusion and exclusion criteria; no longer requires ID approval

  • Now FDA-approved for the treatment of COVID-19; should be considered first-line for those who qualify
  • The benefit of remdesivir was seen in patients on low-flow oxygen
    • For patients requiring high-flow oxygen or mechanical ventilation, the benefit has not been demonstrated
  • Consider close monitoring rather than immediate start of remdesivir for patients requiring minimal oxygen support (e.g. 2 L or intermittent use) and without significant risk factors for progression of disease

FDA-approved for use in COVID-19, no consent or patient hand-out is required

  • Age ≥ 18 years
  • Hospitalized with confirmed COVID or pending test and known contact with confirmed case
  • Symptom onset within 10 days
  • Requiring 2 L per minute (LPM) or more ABOVE any baseline needs (prior to hospitalization)

  • ALT ≥ 10 x upper limit of normal
  • Unlikely to achieve sustainable benefit from medication as deemed by attending and ID provider
  • For patients with CrCL < 30 mL/min, remdesivir can be considered on a case by case basis by ID provider if potential benefit outweighs the potential risk 
  • Bradycardia is a potential serious adverse effect of remdesivir and though not a contraindication, use caution in patients with baseline bradycardia

Remdesivir Use

Ensure patient meets criteria, then order “Pharmacist consult - Remdesivir” within Epic

Baseline and daily CMP

Each dose is in a total volume of 250 mL and is administered over 30 minutes

Dosing

  • 200 mg IV on day 1, then
  • 100 mg IV daily for 4 days OR until stable enough for hospital discharge (whichever comes first)

The benefit of extending treatment past 5 days has not been shown

Treatment Considerations

May be administered to pregnant patients after a risk-benefit discussion with the patient

  • There is limited clinical data available
  • Adverse events may occur that have not been previously reported
  • Reporting of any serious adverse events to the FDA MedWatch database is required

Potential adverse events include:

  • Transaminase elevations
  • Infusion-related reactions (hypotension, nausea, vomiting, diaphoresis, shivering)
  • Bradycardia