Remdesivir is an antiviral medicine originally developed as a treatment for Ebola virus infection. The drug also demonstrates activity against Paramyxoviridae (the family of viruses responsible for measles and mumps), Pneumoviridae (respiratory syncytial virus), and others. But it was its activity against the Coronaviridae family of viruses that led to considerable interest in remdesivir as a potential treatment for COVID-19.¹ ²
Following its confirmation as an effective treatment for SARS-CoV-2 infection, a type of coronavirus, remdesivir is now approved for treating COVID-19. Essentially, remdesivir interrupts the production of coronavirus. As with many other viruses, SARS-CoV-2 replicates and spreads using its genetic information, in this case, ribonucleic acid (RNA). Viral RNA contains the instructions for replicating itself. The virus then uses the cell’s production line to create the building blocks of new viruses and assemble them. Remdesivir disrupts the creation of an enzyme the RNA uses to make copies of the viral genetic material, and the virus can no longer multiply.³ ⁴ ⁵ ⁶
Remdesivir, also known by its brand name, Veklury, is approved by the US Food and Drug Administration (FDA) for the treatment of COVID-19 infection. It helps prevent more severe symptoms and improves survival.⁷ ⁸
The specific indications defined by the US FDA for treatment with remdesivir are the following:⁹
Adults, children, and infants ≥ 28 days of age and weighing a minimum of 3kg
Hospitalized with COVID-19
If not hospitalized, a patient must have mild-to-moderate COVID-19 and be at high risk for progressing into severe disease.
Patients should receive the medication as an intravenous (IV) infusion immediately after testing positive for COVID-19. Nonhospitalized patients should be treated within seven days of the symptoms starting. They can receive remdesivir at a local infusion center or hospital and are given daily doses for three days. However, patients are eligible for the drug only if they are in the following high-risk groups (according to the most updated National Institutes of Health (NIH) clinical treatment guidelines):¹⁰ ¹¹
Over age 50, and even higher risk at 65 and above
Immunocompromising medical condition
Taking immunosuppressant medication
Other patients at increased risk include those with any of the following:
Lapsed vaccination status or unvaccinated
Poor access to therapy due to disparities in care
The recommendation for hospitalized patients is that they receive treatment as soon as the diagnosis is made. The drug should be continued for 5–10 days, depending on the patient’s need for ventilatory support, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO).
Initial studies demonstrated the drug’s effectiveness in treating earlier forms of SARS-CoV-2, such as the ancestral, beta, and delta variants. Although more recent trials have confirmed remdesivir maintains activity against omicron and its newer subvariant forms.¹² ¹³
If you test positive for coronavirus and are eligible for the treatment, call your doctor for an assessment to see if the remdesivir is suitable in your case. If it is appropriate, your doctor will inform you where the treatment can be administered.
Remdesivir is available as a concentrated solution or a powder to be reconstituted with sterile water. Doses are given by IV infusion either in the hospital or an outpatient medical facility, so you would not be taking remdesivir at home.
The available forms of remdesivir include the following:¹⁴
Lyophilized powder for reconstitution: 100mg single-dose vial
Concentrated solution: 100mg/20mL (5mg/mL) single-dose vial
Dosing guidelines set by the US FDA are based on the patient’s age and weight, whether or not they are hospitalized, their need for ventilatory support, level of kidney function, and response to treatment.¹⁵
Remdesivir is administered as an infusion into a vein. It is given in a medical setting by a healthcare professional per your doctor's prescription, and the dosing is based on the most recent prescribing guidelines. Administering the infusion takes between 30 minutes and two hours, and the duration of treatment depends on the severity of your condition and how you respond to the medication.¹⁶
Remdesivir begins working quickly after you receive the infusion. But the drug is most effective if you receive it immediately after testing positive for COVID-19 and within a week of your symptoms starting. Patients differ in their experiences after treatment with remdesivir for COVID-19 infection, particularly if they have risk factors for severe illness. However, many who receive remdesivir will recover faster after receiving this drug, with a lower risk of progression to severe disease.¹⁷
Remdesivir is contraindicated for people with known hypersensitivity to any of the medication’s active or inactive ingredients. It’s also not recommended for people with kidney impairment who have an estimated glomerular filtration rate (eGFR) less than 30mL/min. The US FDA has not approved the drug for children younger than 28 days or weighing less than 3kg.¹⁸ ¹⁹
Additionally, people with liver disease or failure may need a dose adjustment or a different drug to treat their infection.
Remdesivir can cause side effects in some patients. They do not always occur, but if they do, you may need medical attention, depending on their severity.²⁰
Below are the most common side effects of remdesivir:²¹
Nausea and vomiting
Diarrhea or constipation
Bleeding or pain at the injection site
Abnormal heart rhythm
Low blood pressure
Elevated blood sugar
Elevated liver enzymes
Reduced white blood cells
Less common and more severe adverse effects include the following:
Deep vein thrombosis (blood clot)
Acute kidney injury
Since remdesivir is administered in a medical setting by a healthcare professional, patients are protected from accidentally overdosing. Studies have shown little toxic effect when the drug is used as directed.²²
Remdesivir carries a risk for hypersensitivity reactions such as anaphylaxis, rash, hives, rapid heart rate, sweating, swelling of the lips or tongue, chills, vomiting, wheezing or difficulty breathing, and even loss of consciousness. Your care team will monitor for any signs of an allergic reaction during treatment.²³
Pregnant individuals were excluded from participating in the clinical studies on the use of remdesivir in COVID-19. But more recent data from the compassionate use program did show a high recovery rate and improved obstetric outcomes. Nonclinical animal studies with remdesivir have not demonstrated any adverse effects on embryofetal development when given at significantly higher doses than those given to humans.²⁴ ²⁵
However, remdesivir has not been approved for use in people who are pregnant. It is important to note that having COVID-19 during pregnancy brings an increased risk of progressive disease and negative outcomes. Thus, remdesivir is recommended for use in pregnancy if the benefits outweigh the risk to the fetus and the mother.²⁶ ²⁷
There are no data on the effect of remdesivir in lactation. But animal studies have detected the medicine and its metabolites in nursing mothers. Recent research suggests that remdesivir is not transmitted in high doses via breastmilk, and there is no expectation of adverse effects. This should be a discussion between the patient and physician regarding the risks and benefits in individual cases.²⁸
Patients receiving a remdesivir injection in a clinical setting may sometimes miss a follow-up dose, which would likely impact the effectiveness of their COVID-19 treatment, leaving the patient vulnerable to a worsening infection.
As with most other drugs, remdesivir may interact with other medications. Generally, remdesivir has an exceptionally low risk of interactions since it is metabolized quickly. The following are a few medications known to interact with remdesivir, and their use should be monitored carefully:²⁹
Antibiotics, such as rifapentine (Priftin), rifabutin (Mycobutin), and rifampicin (Rifadin)
Antimalarial drugs like chloroquine (Aralen) and hydroxychloroquine (Plaquenil)
Steroids like dexamethasone (Decadron) and betamethasone
St. John’s wort
Give your doctor a list of all prescription and non-prescription drugs, herbs, or dietary supplements you use regularly or occasionally, to reduce the likelihood of a drug interaction.
Some people taking remdesivir develop elevated liver enzymes, which may indicate liver inflammation. Because alcohol also affects the liver, combining the two may increase the risk of adverse effects and damage to the liver. Speak with your doctor about your alcohol use before starting remdesivir.³⁰
Before taking remdesivir, speak with your doctor about your past and current health conditions and your lifestyle preferences. Be sure to include the following topics:³¹
All current prescription and over-the-counter medications
Any known allergies to other drugs or previous adverse reactions to an infusion
Known complications with your liver or kidneys
Your current and past alcohol or opiate use³²
Diseases that compromise your immune health
Plans to become pregnant (since remdesivir is not currently US FDA approved for use in pregnancy)
Informing your doctor about these health conditions, current medication or drug use, and previous experiences with medical treatment is essential and will help your doctor provide the best care for you. Providing this information can also help you anticipate and possibly avoid negative side effects or drug interactions.
May 2020: Remdesivir received an Emergency Use Authorization (EUA) from the US FDA³³
October 2020: The US FDA issued a standard approval for use in adults and pediatric patients 12 and older³⁴
April 2022: The US FDA revoked the EUA for remdesivir upon the expansion of the drug’s approval to include pediatric patients aged 28 days and older³⁵
Because remdesivir is administered intravenously, you will need to be under a doctor’s supervision to receive the drug. However, there are a few tips you can follow when taking remdesivir:
Your infusion will take 30–120 minutes; bring something to do to pass the time during your session.³⁶
Allot at least one additional hour to remain under the doctor’s supervision after your infusion for monitoring.³⁷
Because remdesivir commonly causes nausea and vomiting, let your doctor know if you experience these symptoms and ask if an anti-nausea medication would be appropriate.
Remdesivir is one of the antiviral medicines used to treat COVID-19. Others include molnupiravir and Paxlovid (ritonavir and nirmatrelvir). A key difference is that remdesivir is administered through an IV infusion, and the others can be taken orally. Since all these drugs are relatively new, there is limited and variable information about which could be better. Your doctor will base the recommendation on several factors, including how long you have had symptoms, your age and health status, and your risk of progression to severe disease. Clinical trials are ongoing in examining the efficacy of these drugs. However, it is important to discuss your health information with your doctor, as some conditions might indicate the use of one drug over another.³⁸ ³⁹
There’s no need to change your diet unless advised otherwise by your healthcare professional. Drinking plenty of fluids will help you remain hydrated while your immune system fights the COVID-19 infection.⁴⁰
Here at HealthMatch, we’ve done our best to ensure that the information provided in this article is helpful, up to date, and, most importantly, accurate.
However, we can’t replace the one-to-one advice of a qualified medical practitioner or outline all of the possible risks associated with this particular drug and your circumstances.
It is therefore important for you to note that the information contained in this article does not constitute professional medical or healthcare advice, diagnosis or recommendation of treatment and is not intended to, nor should be used to, replace professional medical advice. This article may not always be up to date and is not exhaustive of all of the risks and considerations relevant to this particular drug. In no circumstances should this article be relied upon without independent consideration and confirmation by a qualified medical practitioner.
Your doctor will be able to explain all possible uses, dosages, precautions, interactions with other drugs, and other potential adverse effects, and you should always talk to them about any kind of medication you are taking, thinking about taking or wanting to stop taking.