Remdesivir intravenous infusion for adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• May only be prescribed as per HSE national guidelines
• Supply MUST be ordered on a named patient basis by pharmacy following initiation by completion of the form attached to this monograph by ward pharmacist.
• See 'Monitoring requirements' below
• Co-administration of remdesivir and chloroquine or hydroxychloroquine is not recommended (possible decreased effect of remdesivir)

Available preparations

Veklury 100mg vial

Reconstitution

Water for injection 19ml per 100mg vial (final concentration upon addition is 5mg/ml i.e. 100mg in 20ml)

• Discard the vial if a vacuum doses not pull the sterile water for injection into the vial
• Immediately shake the vial for 30 seconds
• Allow the contents to settle for 2 to 3 minutes. A clear solution should result
• If the contents of the vial are not completely dissolved, shake the vial again for 30 seconds, and allow the contents to settle for 2 to 3 minutes more
• Dilute further prior to administration

Infusion fluids

Sodium chloride 0.9%

Methods of intravenous administration

Intermittent intravenous infusion

• Withdraw and discard a volume of infusion fluid from the bag equal to the volume of drug solution being added
• Add the required volume of drug solution to the infusion bag
• Gently invert the bag 20 times to mix the solution in the bag
• Do not shake
• Infuse over 30 to 120 minutes as per table below. Slower infusion rates, with a maximum infusion time up to 120 minutes can be considered to potentially prevent hypersensitivity reactions
• After the infusion is complete, flush line with at least 30ml Sodium chloride (at the same rate of infusion as the drug was being given at)
• Extravasation is likely to cause tissue damage due to low pH of remdesivir infusion (particularly when diluted in 100ml) -monitor the infusion site (ref 1)

Infusion bag volume	Infusion time (minutes)
250ml (safer, preferred)	30
	60
	120
100ml (if severe fluid restriction)	30
	60
	120

Dose in adults

Usual dose in patients >40kg

• Day 1: Give a loading dose of 200mg
• Subsequent days: Give 100mg once daily
• Duration of treatment: Usually 3 days (can be used for up to 5 days as per hse guideline e.g. if requiring oxygen). The duration of treatment recommended in national guidelines can be checked in the linked HSE national guideline.

Renal impairment

• No dose adjustment is required in patients with renal impairment, including those on dialysis.

Hepatic impairment

• No dose adjustment is required in patients with mild, moderate or severe hepatic impairment.

Monitoring

Hypersensitivity reactions

• Infusion-related and anaphylactic reactions have been observed
• Slower infusion rates, with a maximum infusion time up to 120 minutes can be considered to potentially prevent hypersensitivity reactions
• If signs and symptoms of a clinically significant hypersensitivity reaction occur, immediately discontinue administration of the drug and initiate appropriate treatment

Transaminase elevations

• Liver function should be determined prior to starting remdesivir and should be monitored throughout treatment.

Further information

• For further information regarding drug interactions see this website
• See HSE guidelines here

Storage

• Store at room temperature or in the fridge
• It is recommended to reconstitute the drug and then prepare the infusion for immediate administration. However, the reconstituted solution is stable for 48 hours in the fridge if necessary

References

SPC April 2022

1. Injectable Medicines guide- downloaded from Medusa 6th Oct 2020

 

Therapeutic classification

Antiviral