Remdesivir in organ failures

 Q: Remdesivir should be given to patients with caution in? (select one)

A) Liver insufficiency

B) Kidney insufficiency

C) Both liver and kidney insufficiencies

D) Irrespectively all COVID 19 patients should get it

Answer: C

Remdesivir has become one of the mainstays of the treatment in COVID-19. Remdesivir's contraindication in liver insufficiency is well-known. The objective of this question is to highlight its effect with renal insufficiency. Remdesivir itself is not harmful to the kidney. Actually, the vehicle in which it is prepared i.e., cyclodextrin can accumulate in renal insufficiency and may become toxic for the body. So far there is no established quantification. At this point, it is recommended to be avoided in patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min per 1.73 m2. Said that a decision should be made clinically per individual patient. 

If a clinician decides to use Remdesivir in a patient on continuous renal replacement therapy (CRRT), hemodialysis (HD), or extracorporeal membrane oxygenation (ECMO), no dose adjustment is required. In fact, it may require a higher dose due to its potential of removal or sequestration. A pharmacist should be consulted. Moreover, Remdesivir should not be prescribed with hydroxychloroquine or chloroquine. It may cause a fatal drug interaction.

#pharmacology

#COVID-19

#nephrology

References:

1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/214787Orig1s000lbl.pdf (Accessed on May 23, 2021). 

2. Chaijamorn W, Rungkitwattanakul D, Nuchtavorn N, et al. Antiviral Dosing Modification for Coronavirus Disease 2019-Infected Patients Receiving Extracorporeal Therapy. Crit Care Explor. 2020;2(10):e0242. Published 2020 Oct 1. doi:10.1097/CCE.0000000000000242

3. Adamsick ML, Gandhi RG, Bidell MR, et al. Remdesivir in Patients with Acute or Chronic Kidney Disease and COVID-19. J Am Soc Nephrol 2020; 31:1384. 

4. Thakare S, Gandhi C, Modi T, et al. Safety of Remdesivir in Patients With Acute Kidney Injury or CKD. Kidney Int Rep 2021; 6:206.