remdesivir: clinical use

Prescribing considerations

• Confirm that the patient meets a licensed COVID-19 indication and the product's age and weight criteria.
• Administer where severe hypersensitivity, including anaphylaxis, can be recognised and treated.
• Evidence in immunocompromised patients remains limited, with potential concern about prolonged viral shedding and resistance.
• The product contains betadex sulfobutyl ether sodium and a clinically relevant sodium content.

Contraindications and cautions

• Hypersensitivity to remdesivir or any formulation excipient.
• Safety and efficacy are not established below 4 weeks of age or below 3 kg.
• Use additional caution and surveillance in severe renal impairment, end-stage renal disease or severe hepatic impairment because clinical safety data are limited.

Monitoring

• Observe during and after administration for hypersensitivity or infusion-related reactions.
• Determine eGFR before treatment and during treatment when clinically appropriate; monitor people with severe renal impairment or end-stage renal disease closely for adverse events.
• Review liver enzymes and coagulation results where clinically appropriate because raised transaminases and prolonged prothrombin time are recognised effects.
• Assess unexplained bradycardia or clinical deterioration.

Clinical pharmacology

Remdesivir is an adenosine nucleotide prodrug converted intracellularly to an active triphosphate metabolite. It competes with ATP for incorporation by SARS-CoV-2 RNA-dependent RNA polymerase, causing delayed RNA-chain termination and impaired viral RNA synthesis.

Formulation and product differences

• The selected product is a preservative-free powder requiring aseptic reconstitution with sterile water and further dilution in sodium chloride solution before intravenous infusion.
• It is supplied in a single-use vial; unused contents must be discarded.
• The prepared solution should be visually checked for particles and discolouration and should not be given intramuscularly.

Solution for infusion

Route: Intravenous

Strengths: 100 mg