Formulary
Remdesivir: Indications, Dosing, Side Effects and Interactions
Remdesivir is an RNA polymerase inhibitor that disrupts the production of viral RNA, preventing multiplication of SARS-CoV-2.
MedNext Academy | 6 min read
Remdesivir: Indications, Dosing, Side Effects and Interactions
Remdesivir is an RNA polymerase inhibitor that disrupts the production of viral RNA, preventing multiplication of SARS-CoV-2.
Drug action
Remdesivir is an RNA polymerase inhibitor that disrupts the production of viral RNA, preventing multiplication of SARS-CoV-2.
Indications and dose
**COVID-19 in patients hospitalised with pneumonia and requiring low-flow supplemental oxygen (under close medical supervision)**
- **Adult** (By Intravenous Infusion): Loading dose 200 mg for 1 dose, then maintenance 100 mg once daily for up to 5 days in total, treatment should be initiated within 10 days of initial COVID-19 symptoms, consider stopping treatment if continuous deterioration despite 48 hours of mechanical ventilation, course may be repeated if readmitted with COVID-19-consult interim clinical commissioning policy for further details (see Prescribing and dispensing information ).
**COVID-19 in immunocompromised patients hospitalised with pneumonia (under close medical supervision)**
- **Adult** (By Intravenous Infusion): Loading dose 200 mg for 1 dose, then maintenance 100 mg once daily for up to 10 days in total following a multidisciplinary assessment, consider stopping treatment if continuous deterioration despite 48 hours of mechanical ventilation, course may be repeated if readmitted with COVID-19-consult interim clinical commissioning policy for further details (see Prescribing and dispensing information ).
**COVID-19 in patients who do not require oxygen supplementation and are at an increased risk of progression to severe COVID-19 infection (under close medical supervision)**
- **Adult** (By Intravenous Infusion): Loading dose 200 mg for 1 dose, then maintenance 100 mg once daily for 3 days in total, treatment should be initiated within 7 days of initial COVID-19 symptoms.
**COVID-19 in patients hospitalised with pneumonia and requiring low-flow supplemental oxygen (under close medical supervision) for remdesivir**
- **Child (body-weight 3-39 kg)** (By intravenous infusion): Loading dose 5 mg/kg for 1 dose, then maintenance 2.5 mg/kg once daily for up to 5 days in total, treatment should be initiated within 10 days of initial COVID-19 symptoms, consider stopping treatment if continuous deterioration despite 48 hours of mechanical ventilation, course may be repeated if readmitted with COVID-19-consult interim clinical commissioning policy for further details (see Prescribing and dispensing information).
- **Child (body-weight 40 kg and above)** (By intravenous infusion): Loading dose 200 mg for 1 dose, then maintenance 100 mg once daily for up to 5 days in total, treatment should be initiated within 10 days of initial COVID-19 symptoms, consider stopping treatment if continuous deterioration despite 48 hours of mechanical ventilation, course may be repeated if readmitted with COVID-19-consult interim clinical commissioning policy for further details (see Prescribing and dispensing information).
**COVID-19 in immunocompromised patients hospitalised with pneumonia (under close medical supervision) for remdesivir**
- **Child (body-weight 3-39 kg)** (By intravenous infusion): Loading dose 5 mg/kg for 1 dose, then maintenance 2.5 mg/kg once daily for up to 10 days in total following a multidisciplinary assessment, consider stopping treatment if continuous deterioration despite 48 hours of mechanical ventilation, course may be repeated if readmitted with COVID-19-consult interim clinical commissioning policy for further details (see Prescribing and dispensing information).
- **Child (body-weight 40 kg and above)** (By intravenous infusion): Loading dose 200 mg for 1 dose, then maintenance 100 mg once daily for up to 10 days in total following a multidisciplinary assessment, consider stopping treatment if continuous deterioration despite 48 hours of mechanical ventilation, course may be repeated if readmitted with COVID-19-consult interim clinical commissioning policy for further details (see Prescribing and dispensing information).
**COVID-19 in patients who do not require oxygen supplementation and are at an increased risk of progression to severe COVID-19 infection (under close medical supervision) for remdesivir**
- **Child (body-weight 40 kg and above)** (By intravenous infusion): Loading dose 200 mg for 1 dose, then maintenance 100 mg once daily for 3 days in total, treatment should be initiated within 7 days of initial COVID-19 symptoms.
Side effects
Common or very common Headache; nausea; rash Rare or very rare Hypersensitivity; infusion related reaction Frequency not known Sinus bradycardia Side-effects, further information Manufacturer advises slower infusion rates, with a maximum infusion time of up to 120 minutes, to prevent signs and symptoms of hypersensitivity. If significant hypersensitivity occurs, discontinue immediately.
Interactions
**Severe interactions:**
- In vitro , remdesivir is an inhibitor of UGT1A1, MATE1, OAT3, and OCT1; however no clinically significant drug interactions are expected with remdesivir and substrates of these enzymes or...
- Remdesivir induced CYP1A2 in vitro ; however no clinically significant drug interaction is expected with remdesivir and CYP1A2 substrates.
**Other interactions (15):**
- Pharmacodynamic interactions Due to antagonism observed in vitro , concomitant use of remdesivir with chloroquine phosphate or hydroxychloroquine sulphate is not recommended.
- Pharmacokinetic interactions Effects of other medicinal products on remdesivir In vitro , remdesivir is a substrate for esterases in plasma and tissue, drug metabolizing enzyme CYP3A4 and is a...
- GS704277 (a metabolite of remdesivir) is a substrate for OATP1B1 and OATP1B3.
- A drug-drug interaction study was conducted with remdesivir.
- Table 5 summarises the pharmacokinetic effects of studied drugs on remdesivir and metabolites GS-704277 and GS-441524.
- Table 5: Effect of other drugs on remdesivir and metabolites GS-704277 and GS-441524 Co-administered Drug Dose (mg) Interaction Geometric mean change (%) Recommendation concerning co-administration...
Pregnancy
Important safety information For remdesivir MHRA/CHM advice: COVID-19 antivirals: reporting to the UK COVID-19 Antivirals Pregnancy Registry (February 2022) The safety of COVID-19 antiviral treatment, such as remdesivir, during pregnancy has not been established. The MHRA, in collaboration with the UK Teratology Information Service (UKTIS), is operating the UK COVID-19 Antivirals Pregnancy Registry to collect information about and enable follow-up of reported exposures to COVID-19 antivirals in pregnancy; it is also collecting information on the outcomes of pregnancies, where conception occurred during or shortly after paternal exposure to antiviral treatment. Healthcare professionals in England, Scotland, and Wales (as well as patients and their partners) are advised to report exposure to remdesivir during pregnancy or around the time of conception, or of partners on remdesivir around the time of conception. Healthcare professionals in Northern Ireland cannot currently report on behalf of a pregnant female or their partner but should encourage them to self-report. Since exposure can occur in very early pregnancy before pregnancy is recognised, healthcare professionals are advised to report (or to encourage patients to self-report), even if some time has passed since the end of remdesivir treatment. An exposed pregnancy should be reported by telephone to UKTIS-for more information, see the UKTIS Registry website (available at: ).
Breast feeding
Specialist sources indicate use with caution-limited information. Minimal oral absorption expected, but monitor breast-fed infants for adverse reactions such as diarrhoea, rash, hypotension, liver and renal impairment (increased risk of accumulation due to long half-life).
Hepatic impairment
Manufacturer advises caution (no information available)-treatment should not be started if ALT is 5 times the upper limit of normal. If ALT increases during treatment, remdesivir may need to be withheld, consult product literature for further information.
Renal impairment
Manufacturer advises avoid if eGFR less than 30 mL/minute/1.73 m 2 - Veklury formulation excipient (sulfobutylether beta cyclodextrin sodium) may accumulate. See Prescribing in renal impairment .
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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