Remdesivir is an IV, broad-spectrum antiviral used in selected patients with COVID-19, usually early in the hospital course and alongside standard care.

Mode of action

Prodrug converted intracellularly to an adenosine nucleotide analogue that inhibits the viral RNA-dependent RNA polymerase, leading to premature termination of viral RNA.

When to use

Hospital patients at higher risk of progression, typically started as soon as possible after admission and preferably within 10 days of symptom onset (follow local guideline).

Indication/Dose (adults ≥40 kg)

Loading: 200 mg IV on day 1.
Maintenance: 100 mg IV once daily to complete a 5-day course (consider up to 10 days if no improvement per local protocol).
Infuse over 30–120 minutes. Dilute in 0.9% sodium chloride.
Paediatric dosing and dosing for lower body weight: see BNF/SmPC.

Dose range: You must check with BNF or drug datasheet

Name	Starting Dose	Frequency	Route
Remdesivir	200 mg (Day 1)	Loading dose	IV infusion (30–120 min)
Remdesivir	100 mg daily (Days 2–5; consider up to 10)	Once daily	IV infusion

Practical prescribing notes

Use according to your local COVID-19 treatment pathway (often with dexamethasone if oxygen is required).
Earlier initiation is associated with better outcomes.
Do not combine with chloroquine or hydroxychloroquine.

Renal/hepatic considerations

Renal: Avoid if eGFR < 30 mL/min/1.73 m² unless local policy advises otherwise.
Liver: Check LFTs before and during therapy. Stop if ALT ≥10× ULN or if ALT elevation is accompanied by signs/symptoms of liver inflammation.

Interactions

Avoid chloroquine/hydroxychloroquine (antagonistic effect).
CYP/P-gp inducers (e.g., rifampicin, carbamazepine, phenytoin, phenobarbital, St John’s wort) may reduce exposure-avoid or seek advice.
Potent P-gp/OATP inhibitors may increase exposure-monitor LFTs and tolerability.

Contraindications

Refer to BNF/SmPC and local policy (e.g., severe hepatic dysfunction, known hypersensitivity).

Adverse effects & monitoring

Common: Nausea, raised transaminases.
Infusion-related: Hypotension, flushing-observe during and after infusion.
Less common: Bradycardia, increased PT (usually without bleeding).
Monitor LFTs and renal function; review clinical response daily.

When to reconsider or stop

No clinical improvement by day 5 and patient now ventilated/ECMO: discuss extension to 10 days versus stopping as per local pathway.
Significant ALT rise or hypersensitivity: stop and seek senior/microbiology advice.

References

BNF: Remdesivir (indications, cautions, interactions).
Product information (SmPC) for administration and hepatic stopping thresholds.
Local/National COVID-19 treatment guideline for eligibility and course duration.

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Remdesvir (Veklury)

About: Always check the BNF link here

What it is