Supply Disruption Alert: Remsdesivir
Due to increased demand against available supply, clinicians are now asked to apply the full, eligibility criteria for remdesivir as set out within the Central Alerting System (CAS) alert here and summarised below.
Actions for clinicians:
- Ensure only patients with COVID-19 infection are treated with remdesivir. Patients should normally have a confirmed positive polymerase chain reaction (PCR) test but may otherwise be treated where a COVID-19 PCR test is negative but there is a very strong index of suspicion of it being a false negative based on CT Chest showing typical COVID features, a positive antibody test with no previous history suggestive of COVID-19 prior to this admission (will only occur 7-14 days minimum after onset) or classical case definition symptoms for COVID-19 and contacts making pre-test probability high.
- Prescribe remdesivir only to patients with the following criteria (this includes the additional criteria to be applied given the limited supply scenario):
- Hospitalised with COVID-19
- Pneumonia requiring supplemental oxygen
- Adults, and adolescents ≥ 12 years of age and ≥ 40 kg
- eGFR≥30ml/min/1.73m2
- Alanine Aminotransferase (ALT) below 5 times the upper limit of normal at baseline
- Not receiving ongoing mechanical ventilation or ECMO at the time of decision to treat with remdesivir. (Patients who present with an initial rapid deterioration can, however, be considered for treatment with remdesivir).
- Multidisciplinary team assessment should determine if patients not suitable for escalation would benefit from initiation of treatment with remdesivir.
- If patients on remdesivir require escalation, continuation of the drug should be considered by multidisciplinary team assessment.
- Prescribe a maximum treatment course of 5 days. Further expert clinical advice is currently being taken to clarify the circumstances in which an extended course of up to a total of 10 days might be clinically indicated
- Information on the dose and administration of remdesivir can be found in the NHSGGC Therapeutic Handbook or on www.medicines.org.uk
- Information on how to order remdesivir has recently been circulated to clinical staff
- Please cascade across your medical and nursing teams.
Published 02/10/2020
Medicines Update blogs are correct at the time of publication