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Veklury
remdesivir
Adult Dosing .
Dosage forms: INJ
COVID-19
- [mild-moderate]
- Dose: 200 mg IV x1, then 100 mg IV q24h x2 days; Start: ASAP w/in 7 days of symptom onset; Info: for non-hospitalized patients at high risk for disease progression
- [severe]
- Dose: 200 mg IV x1, then 100 mg IV q24h x4 days; Info: for hospitalized patients >40 kg not requiring mechanical ventilation and/or ECMO; may give w/ baricitinib per baricitinib FDA Emergency Use Authorization; ECMO = extracorporeal membrane oxygenation
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: INJ
COVID-19, mild-moderate
- [0-27 days old, >1.5 kg]
- Dose: 2.5 mg/kg/dose IV x1, then 1.25 mg/kg/dose IV q24h x2 days; Start: ASAP w/in 7 days of symptom onset; Info: for non-hospitalized patients at high risk for disease progression; use IV powder form due to lower IV vehicle amt
- [28 days old and older, 1.5-2.9 kg]
- Dose: 2.5 mg/kg/dose IV x1, then 1.25 mg/kg/dose IV q24h x2 days; Start: ASAP w/in 7 days of symptom onset; Info: for non-hospitalized patients at high risk for disease progression; use IV powder form due to lower IV vehicle amt
- [28 days old and older, 3-39 kg]
- Dose: 5 mg/kg/dose IV x1, then 2.5 mg/kg/dose IV q24h x2 days; Start: ASAP w/in 7 days of symptom onset; Info: for non-hospitalized patients at high risk for disease progression; use IV powder form due to lower IV vehicle amt
- [28 days old and older, >40 kg]
- Dose: 200 mg IV x1, then 100 mg IV q24h x2 days; Start: ASAP w/in 7 days of symptom onset; Info: for non-hospitalized patients at high risk for disease progression
COVID-19, severe
- [0-27 days old, >1.5 kg]
- Dose: 2.5 mg/kg/dose IV x1, then 1.25 mg/kg/dose IV q24h x4 days; Info: for hospitalized patients >40 kg not requiring mechanical ventilation and/or ECMO; may extend tx for up to 5 additional days if no clinical improvement; use IV powder form due to lower IV vehicle amt; ECMO = extracorporeal membrane oxygenation
- [28 days old and older, 1.5-2.9 kg]
- Dose: 2.5 mg/kg/dose IV x1, then 1.25 mg/kg/dose IV q24h x4 days; Info: for hospitalized patients >40 kg not requiring mechanical ventilation and/or ECMO; may give w/ baricitinib per baricitinib FDA EUA in patients 2 yo and older; may extend tx for up to 5 additional days if no clinical improvement; use IV powder form due to lower IV vehicle amt; ECMO = extracorporeal membrane oxygenation
- [28 days old and older, 3-39 kg]
- Dose: 5 mg/kg/dose IV x1, then 2.5 mg/kg/dose IV q24h x4 days; Info: for hospitalized patients >40 kg not requiring mechanical ventilation and/or ECMO; may give w/ baricitinib per baricitinib FDA EUA in patients 2 yo and older; may extend tx for up to 5 additional days if no clinical improvement; use IV powder form due to lower IV vehicle amt; ECMO = extracorporeal membrane oxygenation
- [28 days old and older, >40 kg]
- Dose: 200 mg IV x1, then 100 mg IV q24h x4 days; Info: for hospitalized patients >40 kg not requiring mechanical ventilation and/or ECMO; may give w/ baricitinib per baricitinib FDA EUA in patients 2 yo and older; may extend tx for up to 5 additional days if no clinical improvement; ECMO = extracorporeal membrane oxygenation
renal dosing
- [see below]
- renal impairment: no adjustment
- HD: no adjustment; no supplement; PD: not defined
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- ALT >10x ULN
Drug Interactions .
Overview
remdesivir
viral RNA polymerase inhibitor
- prodrug activated by intracellular phosphorylation
- CYP3A4 inhibitor, weak
Contraindicated
- cisapride
- eliglustat
Avoid/Use Alternative
- alprazolam
- chloroquine
- codeine
- colchicine
- hydrocodone
- hydroxychloroquine
- meperidine
- methadone
- oxycodone
- pimozide
- pralsetinib
- propafenone
- simvastatin
Monitor/Modify Tx
- abemaciclib
- acalabrutinib
- alfentanil
- amiodarone
- avanafil
- avapritinib
- brigatinib
- capivasertib
- carbamazepine
- clozapine
- disopyramide
- docetaxel
- dofetilide
- domperidone
- encorafenib
- entrectinib
- erythromycin
- everolimus
- fedratinib
- felodipine
- fentanyl
- finerenone
- flibanserin
- gepirone
- ibrutinib
- ivabradine
- ivosidenib
- ixabepilone
- lemborexant
- levoketoconazole
- lomitapide
- lonafarnib
- lovastatin
- lumateperone
- lurasidone
- lurbinectedin
- mavacamten
- midazolam
- mobocertinib
- nifedipine
- nimodipine
- nisoldipine
- oliceridine
- pacritinib
- pemigatinib
- quinidine (antiarrhythmic)
- red yeast rice
- ribociclib
- selpercatinib
- selumetinib
- sirolimus
- sirolimus albumin-bound
- sufentanil
- tacrolimus
- tadalafil
- taletrectinib
- temsirolimus
- tolvaptan
- triazolam
- ubrogepant
- vardenafil
- venetoclax
- vinblastine
- vincristine
- vinorelbine
- warfarin
- zanubrutinib
Caution Advised
- cariprazine
- cobimetinib
- conivaptan
- cyclophosphamide
- daridorexant
- dihydroergotamine
- elinzanetant
- eplerenone
- ergotamine
- fexinidazole
- methylergonovine
- palovarotene
- pexidartinib
- repotrectinib
- rilzabrutinib
- roflumilast
- roflumilast topical
- sirolimus topical
- verapamil
Adverse Reactions .
Serious Reactions
- hypersensitivity reaction
- anaphylaxis
- angioedema
- infusion reaction
- ALT or AST elevated
- seizures
- acute kidney injury
Common Reactions
- nausea
- ALT or AST elevated
- hyperglycemia
- PT incr.
Safety/Monitoring .
Monitoring Parameters
LFTs, PT at baseline, then periodically; signs/symptoms of infusion reaction during and for at least 1h after infusion
Pregnancy/Lactation .
Pregnancy
Clinical Summary
benefits outweigh risks in 1st trimester, may use in 2nd and 3rd trimester; inadequate human data available in 1st trimester; no known risk of fetal harm based on human data in 2nd and 3rd trimester; no known risk of fetal harm based on animal data at 4x recommended human dose
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm based on limited human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: intracellular; CYP450: 3A4 substrate; Info: prodrug converted to active metabolite
Excretion: urine 49%; Half-life: 1h (parent drug), >27h (active metabolite)
Subclass: Coronavirus
Mechanism of Action
inhibits RNA-dependent RNA polymerase, preventing viral replication
Formulary .
No Formulary Selected
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