Q: 48 years old male is admitted to ICU with newly diagnosed COVID-19. Remdesivir has been initiated. On Day 3 his liver enzymes appears to be elevated. What is the usual recommended point where remdesivir should be discontinued if liver enzymes continue to rise?
Answer: About 10 folds
Remdesivir has become a mainstay of treatment in COVID-19 hospitalized patients. FDA now approved its use for any inpatient above the age of 12 irrespective of disease severity. It is recommended to be stopped if a patient get discharged before the completion of the course. The dose is 200 mg IV on day one followed by 100 mg for a total of 5 days. A clinician may decide to continue it beyond 5 days if the patient is still sick.
Its side effect includes renal and hepatic insufficiencies. Some elevation in liver enzymes is expected but the drug should be stopped if alanine aminotransferase (ALT) rises more than 10 times above the normal lab limit.
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#pharmacology
#hepatology
References:
1. Zampino R, Mele F, Florio LL, et al. Liver injury in remdesivir-treated COVID-19 patients. Hepatol Int. 2020;14(5):881-883. doi:10.1007/s12072-020-10077-3
2. van Laar SA, de Boer MGJ, Gombert-Handoko KB, Guchelaar HJ, Zwaveling J; LUMC-Covid-19 research group. Liver and kidney function in patients with Covid-19 treated with remdesivir. Br J Clin Pharmacol. 2021 Nov;87(11):4450-4454. doi: 10.1111/bcp.14831. Epub 2021 May 4. PMID: 33763917; PMCID: PMC8251044.
3. Montastruc F, Thuriot S, Durrieu G. Hepatic Disorders With the Use of Remdesivir for Coronavirus 2019. Clin Gastroenterol Hepatol. 2020 Nov;18(12):2835-2836. doi: 10.1016/j.cgh.2020.07.050. Epub 2020 Jul 25. PMID: 32721580; PMCID: PMC7381904.
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