What is the recommended dose of remdesivir (Veklury) for the treatment of COVID-19?

Recommended Dosage of Remdesivir (Veklury) for COVID-19 Treatment

The recommended dosage of remdesivir for adults is a 200 mg intravenous (IV) loading dose on day 1, followed by 100 mg IV daily for subsequent days, with treatment duration based on disease severity: 5 days for hospitalized patients not requiring mechanical ventilation/ECMO, 10 days for those requiring mechanical ventilation/ECMO, and 3 days for non-hospitalized high-risk patients. 1, 2

Adult Dosing Regimen

• For hospitalized adults: 200 mg IV on day 1, followed by 100 mg IV daily for a total of 5 days (5 doses) 1
• For hospitalized adults requiring mechanical ventilation or extracorporeal membrane oxygenation (ECMO): Treatment may be extended to 10 days (10 doses) 2
• For non-hospitalized adults with mild-to-moderate COVID-19 at high risk for progression: 200 mg IV on day 1, followed by 100 mg IV daily for a total of 3 days 2, 3

Pediatric Dosing Regimen

• For pediatric patients weighing at least 40 kg: Same as adult dosing (200 mg IV on day 1, followed by 100 mg IV daily) 2
• For pediatric patients weighing 3 kg to less than 40 kg: 5 mg/kg IV on day 1, followed by 2.5 mg/kg IV once daily from day 2 2
• For neonates (less than 28 days old) weighing at least 1.5 kg: 2.5 mg/kg IV on day 1, followed by 1.25 mg/kg IV once daily from day 2 2
• For infants at least 28 days old weighing 1.5 kg to less than 3 kg: 2.5 mg/kg IV on day 1, followed by 1.25 mg/kg IV once daily from day 2 2

Treatment Duration Considerations

• Treatment should be initiated as soon as possible after diagnosis of symptomatic COVID-19 2
• For hospitalized patients not requiring mechanical ventilation/ECMO: 5-day course 1
• For hospitalized patients requiring mechanical ventilation/ECMO: 10-day course 2
• For non-hospitalized high-risk patients: 3-day course (must be initiated within 7 days of symptom onset) 2, 3
• For patients whose condition worsens during a 5-day course to require supplemental oxygen but not mechanical ventilation, extending treatment beyond 5 days should be based on clinical judgment 1

Administration Requirements

• Remdesivir must be administered by IV infusion only in settings where healthcare providers have immediate access to medications to treat severe infusion or hypersensitivity reactions 2
• The drug must be diluted prior to IV administration 2
• Two formulations are available:
  • Lyophilized powder (100 mg) requiring reconstitution with Sterile Water for Injection 2
  • Solution (100 mg/20 mL) requiring dilution in 0.9% sodium chloride 2

Monitoring and Precautions

• Perform hepatic laboratory testing in all patients before starting and during treatment 2
• Determine prothrombin time before starting and monitor during treatment 2
• Do not use remdesivir in patients with eGFR <30 mL/min/1.73 m² 1
• Discontinue remdesivir if ALT increases to >10 times the upper limit of normal or if ALT elevation is accompanied by signs or symptoms of liver inflammation 1
• Monitor for hypersensitivity reactions, including infusion-related and anaphylactic reactions 1
• Common adverse events include metabolic (hyperglycemia), hepatic (increased ALT/AST), and renal events 1

Special Populations

• The guidelines do not apply to pregnant women or patients with severe renal or hepatic dysfunction as they were excluded from studies 1
• Remdesivir has low potential for drug-drug interactions 4, 3
• Effectiveness may not vary by age, sex, or race 1

Remdesivir has shown clinical benefit in reducing time to recovery and decreasing risk of clinical worsening, though its effect on mortality remains less clear 3, 5. Early initiation of treatment appears to be associated with better outcomes, particularly in patients treated within 10 days of symptom onset 1.