Remdesivir for COVID-19: Treatment Protocol & Guidelines

Remdesivir for COVID-19: Clinical Guidance

Indication: For hospitalized adults with severe COVID-19 requiring supplemental oxygen, but not mechanical ventilation.

Patient Selection: Initiate treatment if any of the following are present:

• Oxygen saturation ≤94% on room air
• Requiring supplemental oxygen (low-flow or high-flow)
• Respiratory rate >30 breaths/minute
• Respiratory distress with pulmonary infiltrates

Contraindications: Do not initiate in patients:

• Already on mechanical ventilation or ECMO.
• With eGFR ≥10 times upper limit of normal.
• With ALT elevation accompanied by signs/symptoms of liver inflammation.
• Who are pregnant.
• With severe hepatic dysfunction.
• With severe renal impairment (eGFR <30 mL/min/1.73m²).

Dosing (Adults ≥40 kg):

• Day 1: 200 mg IV loading dose
• Days 2-5: 100 mg IV daily
• Infusion Time: 30-120 minutes

Duration:

• 5 days: For patients not requiring mechanical ventilation/ECMO.
• 10 days: For patients requiring mechanical ventilation/ECMO.
• Extension to 10 days: Consider extending beyond 5 days based on clinical judgment if the patient worsens and requires supplemental oxygen (but not mechanical ventilation).

Timing: Initiate as soon as possible after diagnosis. Early treatment (within 2 days of admission) may reduce 30-day in-hospital mortality, particularly in patients needing high-flow oxygen.

Monitoring: Monitor for potential adverse events:

• Metabolic: Hyperglycemia, hypokalemia, hyponatremia
• Hepatic: Increased ALT/AST, increased bilirubin
• Renal: Acute kidney injury, increased blood urea nitrogen
• Gastrointestinal: Nausea, vomiting, constipation
• Hematologic: Anemia, thrombocytopenia

Important Note: Reassess renal function if clinical deterioration occurs due to risk of COVID-19 associated acute kidney injury.

References: 1, 2, 3, 5, 6 (original document references retained)