Adult

Remdesivir for in-patients

General Information

Antiviral

Remdesivir is an adenosine nucleotide prodrug which is metabolised intracellularly to the active substrate remdesivir triphosphate.

Discharge letters to primary care should explicitly record the treatment that has been given, together with the dose and dates of administration.

A BlueTeq form must be completed. This should be completed by the clinical team or Micro/ID. This can be completed retrospectively.

Restricted: Formulary. In-line with NICE TA971 or recommendation by Micro/ID.

Remdesivir is recommended as an option for adults for treating COVID‑19 in hospitals in patients only if they have a high risk of serious illness (risk factors as defined in section 5 of NICE's technology appraisal guidance on nirmatrelvir plus ritonavir and tocilizumab for treating COVID-19)

The groups of clinical conditions are as below and details of the risk factors for progression to severe COVID-19 in adults can be found HERE.

  • Down's syndrome and other genetic disorders
  • Solid cancer
  • Haematological diseases and recipients of haematological stem cell transplant (HSCT)
  • Renal disease 
  • Liver diseases 
  • Solid organ transplant recipients
  • Immune-mediated inflammatory disorders (diseases in which autoimmune or autoinflammation-based pathways are implicated in disease, for example, inflammatory arthritis, connective tissue diseases, inflammatory skin diseases, inflammatory gastrointestinal disease)
  • Respiratory
  • Immune deficiencies
  • HIV/AIDS
  • Neurological disorders

 

Note: There is an EPR powerplan associated with this drug. 

Dosage for ADULTS

Dose:

Day 1: 200mg remdesivir as a single dose iv

Day 2 onwards: 100mg remdesivir iv OD 

 

Duration for treatment of COVID-19 with pneumonia and requiring supplemental oxygen:

The usual total duration of treatment is 5 days, but it may be extended up to 10 days for severely immunocompromised patients (MDT decision only).

Use in patients who do not require supplemental oxygen and are at increased risk for progression to severe COVID-19

Discuss with Micro/ID. If used then this would be for 3 days starting as soon as possible after diagnosis of COVID-19 and within 7 days of the onset of symptoms.

 

Consider stopping remdesivir if:- 

  • Patient clinically improves and no longer requires supplemental oxygen 72 hours after commencement of treatment; 
  • Patient continues to deteriorate despite 48 hours of sustained mechanical ventilation.

Renal and hepatic impairment

Renal impairment

  • No dose adjustment required. Patient should be monitored for side effects.
  • HD/HDF/High flux: Dialysed
  • PD: Unknown dialysability

 

Hepatic impairment

  • No dose adjustment required.
  • Monitor LFTs closely. Treatment should not be started if ALT is 5 or more times the upper limit of normal. If ALT increases during treatment, remdesivir may need to be withheld. 

Interactions

All interactions should be checked using The Liverpool COVID-19 Drug Interaction Checker and Summary of Product Characteristics.

Contraception, pregnancy and breastfeeding

See BNF and Summary of Product Characteristics

Additional information

  • Monitoring: the use of remdesivir should be reassessed daily. Daily LFTs and U&Es should be performed.
  • Discontinuation: Remdesivir should be discontinued in patients who develop:
    • ALT 5 times or more the upper limit of normal during treatment with remdesivir, or, ALT elevation accompanied by signs or symptoms of liver inflammation or increasing conjugated bilirubin, alkaline phosphatase or INR
    • Bradycardia
    • Adverse reactions thought to be hypersensitivity
    • Other adverse reactions thought to be due to remdesivir (complete yellow card, found here)

References

  1. National Institute for Health and Care Excellence. Technology appraisal guidance 971. Remdesivir and tixagevimab plus cilgavimab for treating COVID-19. Last updated 8/5/24. Accessed via: www.nice.org.uk. Accessed 1/5/26.
  2. National Institute for Health and Care Excellence. Technology appraisal guidance 878. Nirmatrelvir plus ritonavir and tocilizumab for treating COVID-19. Last updated 16/2/26. Accessed via: www.nice.org.uk. Accessed 1/5/26.
  3. Gilead Sciences Ltd. Veklury 100 mg powder for concentrate for solution for infusion summary of product characteristics. Electronic medicines compendium. Last revision of the text 2/4/26. Accessed via www.medicines.org.uk Accessed 1/5/26.
  4. British National Formulary. Remdesivir. BNF online accessed via www.medicinescomplete.com Accessed 1/5/26.
  5. The Renal Drug Database. Remdesivir. Last updated 10/4/26. Accessed via https://renaldrugdatabase.com Accessed 1/5/26.

Editorial Information

Last reviewed: 01 May 2026

Next review date: 01 May 2029

Author(s): AMST.