With the surge in Covid-19 cases seeing across India, there is a huge increasing demand for antiviral Remdesivir drugs. Broad spectrum Remdesivir was initially manufactured by Gilead Science Biotechnology in 2014. This drug was manufactured for the treatment of Hepatitis C and MERS (Middle East Respiratory Syndrome). With the outbreak of Covid-19, the drug was found to be effective in fighting Corona Virus.

National Institute of Health (NIH) Adaptive Covid-19 Treatment Trail (ACTT) results found that severe patients who were hospitalized with little lung infection receiving Remdesivir have a faster recovery than those who received placebo. Doctors feel that the drug helps in treating moderate to severe Covid-19 patients with the combination of other drugs that includes vitamin supplements, steroids, oxygen, blood thinner when given in a suitable stage, helps in recovering faster. The effectiveness of the Remdesivir drug depends on the time when it was administered to the patient. Doctors treating Covid-19 patients in India have different opinions about the drug. Some doctors feel that this drug should be given within the first 9 days from the onset of symptoms and should be used only for 5 days and not more than it. While other feels that young patients having no comorbidities with milder symptoms do not require oxygen can be treated without Remdesivir.

Mechanism of action – Remdesivir is given intravenously which hinders the replication of the virus by interfering with one of the key enzymes the virus needs to replicate RNA. The active metabolite of Remdesivir interferes with the action of viral RNA – dependent RNA polymerase and evades proofreading by viral exoribonuclease, causing a decrease in viral RNA production. For RNA - dependent RNA polymerase of SARS – CoV – 2 RNA synthesis stops, after incorporation of three additional nucleotides. Hence, Remdesivir is classified as a direct acting antiviral agent. 

As per Gilead Sciences July 2020, Remdesivir can cause GI symptoms (nausea), increases Transaminase levels, and hypersensitivity reaction. Before administering Remdesivir, a liver function test and prothrombin time should be tested. 

There is no drug interaction with dexamethasone however, hydroxychloroquine might decrease the antiviral properties of Remdesivir. Hence, coadministration of these drugs is not recommended.

Pregnant ladies were excluded from clinical trials. Post-partum hospitalized women who have received Remdesivir with severe Covid-19, the therapy was well tolerated with lesser adverse effect.

The safety and effectiveness of using Remdesivir to treat children have not been evaluated. Although FDA has given Emergency Use Authorization (EUA) of Remdesivir for the treatment of Covid-19 in hospitalized pediatric patients aging below 12 years of 3.5 – 40 kg.