• Remdesivir is a nucleotide analogue.
• Intravenous infusions between 3 mg and 225 mg were well-tolerated
without any evidence of liver or kidney toxicity.
• <40 kg: IV: 5 mg/kg/dose as a single dose on day 1, followed by 2.5
mg/kg/dose once daily for a total duration of 5 to 10 days
• ≥40 kg: IV: 200 mg as a single dose on day 1, followed by 100 mg once daily
for a total duration of 5 to 10 days
• Renal impairment: not recommended for GFR<30
• There are no known significant interactions.
• Renal impairment: No dose adjustment
• Drug interaction:
• CYP2C8 inhibitor
• Monoclonal antibody IL-6 receptor antagonist.
• Infants, Children, and Adolescents:
• IV: 8 mg/kg/dose once; an additional dose may be given 12 hours after the
first if clinical symptoms worsen or show no improvement
• maximum dose: 800 mg/dose
• Renal impairment: no dose adjustment
• The rationale for the use of corticosteroids is to decrease the host
inflammatory responses in the lungs, which may lead to ARDS.
• This benefit may be outweighed by adverse effects, including delayed
viral clearance and increased risk of secondary infection..
• Observational studies in patients with SARS and MERS reported no
associations of corticosteroids with improved survival, but
demonstrated an association with delayed viral clearance from the
respiratory tract and blood
Compared with placebo, corticosteroids were associated with higher
mortality (risk ratio [RR] 1.75, 95% confidence interval [CI] 1.30 ~ 2.36, Z
= 3.71, P = 0.0002), longer ICU LOS (mean difference [MD] 2.14, 95% CI
1.17 ~ 3.10, Z = 4.35, P < 0.0001), and a higher rate of secondary
infection (RR 1.98, 95% CI 1.04 ~ 3.78, Z = 2.08, P = 0.04) but not MV
days (MD 0.81, 95% CI − 1.23 ~ 2.84, Z = 0.78, P = 0.44) in patients with
• SARS-CoV-2 uses the ACE2 receptor for entry into the host cell.
• These drugs upregulate ACE2 receptors, which could theoretically
lead to worse outcomes if viral entry is enhanced.
• In contrast, ARBs could theoretically provide clinical benefit via
blockade of ACE2 receptors.