From the Guidelines
The recommended dose of remdesivir for COVID-19 treatment is 200 mg intravenously on day 1, followed by 100 mg intravenously once daily for the remaining days of treatment. For hospitalized patients requiring supplemental oxygen, the typical duration is 5 days, though it may be extended to 10 days in patients requiring mechanical ventilation or ECMO 1. Some key points to consider when administering remdesivir include:
- Monitoring for infusion reactions and liver function 1
- Contraindication in patients with severe renal impairment (eGFR <30 mL/min) 1
- Cautious use in patients with hepatic impairment 1
- Potential side effects including elevated liver enzymes, nausea, headache, and rash 1 The medication works as an antiviral by inhibiting viral RNA-dependent RNA polymerase, thereby disrupting SARS-CoV-2 replication 1. Treatment should be initiated as soon as possible after diagnosis, ideally within 7 days of symptom onset for optimal effectiveness 1. It is essential to weigh the benefits and risks of remdesivir treatment, considering factors such as symptom duration, baseline respiratory support requirements, and potential adverse events 1. Overall, the use of remdesivir in COVID-19 treatment should be guided by the most recent and highest-quality evidence, with consideration of individual patient factors and clinical judgment 1.
From the FDA Drug Label
The multiple dose PK parameters of remdesivir and metabolites in pediatric patients with COVID-19 in Cohorts 1–4 and 8 are provided in Table 20. Table 20 Multiple Dose PK Parameters* of Remdesivir and Metabolites (GS-441524 and GS-704277) Following Intravenous Administration of VEKLURY 100 mg (Cohorts 1 and 8) or 2. 5 mg/kg (Cohorts 2–4) to Pediatric Patients with COVID-19
The recommended dose of remdesivir for COVID-19 is:
- 100 mg for patients ≥12 years and weighing ≥40 kg
- 2.5 mg/kg for patients 28 days to <18 years and weighing 3 to <40 kg 2
From the Research
Remdesivir Dose in COVID-19
- The recommended dose of remdesivir for the treatment of COVID-19 is an intravenous loading dose of 200 mg on day 1, followed by daily intravenous maintenance doses of 100 mg for 5-10 days 3, 4, 5.
- A study published in the New England Journal of Medicine found that a 5-day course of remdesivir was as effective as a 10-day course in patients with severe COVID-19 4.
- Another study published in the AAPS Journal suggested that a combination of intravenous and pulmonary delivery of remdesivir may offer additional benefits in the treatment of COVID-19 5.
- The use of remdesivir has been studied in several clinical trials, and the results have shown that it can reduce the duration of hospitalization and improve clinical outcomes in patients with COVID-19 6, 7.
- However, the impact of remdesivir on mortality remains uncertain, and further studies are needed to fully understand its benefits and risks 7.
Clinical Trials and Studies
- A systematic review and meta-analysis of four randomized controlled trials (RCTs) and two case series found that remdesivir was associated with a reduced time to recovery and improved clinical outcomes in patients with COVID-19 3.
- A phase 3 trial published in the New England Journal of Medicine found that remdesivir was effective in reducing the duration of hospitalization and improving clinical outcomes in patients with severe COVID-19 4.
- A retrospective cohort study published in the Annals of Internal Medicine found that remdesivir was used in 21.2% of patients hospitalized with COVID-19 in the United States, and its use varied substantially across health systems 6.
- A systematic review published in the International Journal of General Medicine found that remdesivir had some potential benefits for hospitalized COVID-19 patients, including faster recovery time and fewer respiratory side effects 7.