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Covid 19 drug

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COVID-19 Infection Medications In Renal Disease

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Covid 19 drug

  1. 1. COVID-19 Infection Medications In Renal Disease Fahimeh Asgarian TUMS
  2. 2. Hydroxychloroquine/chloroquine • Tablet: 200 mg • Day 1: 6.5 mg/kg/dose twice daily(max: 400 mg/dose) • Day 2-5: 3.25mg/kg/dose twice daily (max: 200mg/dose) • Renal impairment: no dosage adjustment; not dialyzable • Drug interaction: may increase cyclosporine level • Monitoring parameters: • Baseline ECG, renal and hepatic function • Electrolytes: Mg, Ca, K
  3. 3. Lopinavir/Ritonavir (kaletra) • inhibitors of 3-chymotrypsin-like protease • Tab: Lopinavir 100 mg and ritonavir 25 mg Lopinavir 200 mg and ritonavir 50 mg • Lopinavir 230 mg/m2/dose (max: 400 mg/dose) twice daily up to 14d • Renal impairment: no dosage adjustment; not dialyzable
  4. 4. Lopinavir/Ritonavir (kaletra)… • Drug interaction: • may increase serum concentration of: • Amlodipine • Atorvastatin • Cyclosporine • Tacrolimus • Digoxin
  5. 5. Remdesivir (Gilead) • Remdesivir is a nucleotide analogue. • Intravenous infusions between 3 mg and 225 mg were well-tolerated without any evidence of liver or kidney toxicity. Dosing: • <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
  6. 6. Remdesivir (Gilead)… • Renal impairment: not recommended for GFR<30 • There are no known significant interactions.
  7. 7. Favipiravir • RNA polymerase inhibito .Tab: 200 mg
  8. 8. Favipiravir … • Renal impairment: No dose adjustment • Drug interaction: • CYP2C8 inhibitor
  9. 9. Tucilizumab(Actemra) • 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
  10. 10. Corticosteroids • 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..
  11. 11. • 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
  12. 12. 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 influenza pneumonia
  13. 13. Managing chronic medications
  14. 14. ACE inhibitors/ARBs • 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.
  15. 15. Treat Worsen
  16. 16. ACE inhibitors/ARBs • Patients receiving ACE inhibitors or ARBs should continue treatment with these agents if there is no other reason for discontinuation (eg, hypotension, AKI)
  17. 17. COVID 19 and kidney transplant recipients

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