Remdesivir Dosage

Medically reviewed by Drugs.com. Last updated on Jan 16, 2025.

Applies to the following strengths: 100 mg; 5 mg/mL

Usual Adult Dose for COVID-19

Loading dose (Day 1): 200 mg IV as a single dose
Maintenance dose (from Day 2): 100 mg IV once a day

Duration of Therapy:

Hospitalized patients requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO): 10 days total
Hospitalized patients not requiring invasive mechanical ventilation and/or ECMO: 5 days; may extend up to 5 additional days (for a total of up to 10 days) if no clinical improvement shown
Nonhospitalized patients: 3 days total

Comments:

This drug should be infused IV over 30 to 120 minutes; the manufacturer product information should be consulted for recommended infusion rates.

Use: For the treatment of COVID-19 in patients who are:

Hospitalized, or
Not hospitalized, have mild to moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death

Usual Pediatric Dose for COVID-19

Less Than 28 Days Old:
Weight at least 1.5 kg:

Loading dose (Day 1): 2.5 mg/kg IV as a single dose
Maintenance dose (from Day 2): 1.25 mg/kg IV once a day

At Least 28 Days Old:
Weight 1.5 to less than 3 kg:

Loading dose (Day 1): 2.5 mg/kg IV as a single dose
Maintenance dose (from Day 2): 1.25 mg/kg IV once a day

Weight 3 to less than 40 kg:

Loading dose (Day 1): 5 mg/kg IV as a single dose
Maintenance dose (from Day 2): 2.5 mg/kg IV once a day

Weight at least 40 kg:

Loading dose (Day 1): 200 mg IV as a single dose
Maintenance dose (from Day 2): 100 mg IV once a day

Duration of Therapy:

Hospitalized patients requiring invasive mechanical ventilation and/or ECMO: 10 days total
Hospitalized patients not requiring invasive mechanical ventilation and/or ECMO: 5 days; may extend up to 5 additional days (for a total of up to 10 days) if no clinical improvement shown
Nonhospitalized patients: 3 days total

Comments:

This drug is recommended for pediatric patients, including term neonates (gestational age greater than 37 weeks) and infants, weighing at least 1.5 kg.
This drug should be infused IV over 30 to 120 minutes.
For patients weighing 1.5 to less than 40 kg: The rate of infusion (mL/min) should be calculated based on total infusion volume and total infusion time.
For patients weighing at least 40 kg: The manufacturer product information should be consulted for recommended infusion rates.
The lyophilized powder formulation is the only approved dosage form for pediatric patients weighing 1.5 to less than 40 kg.

Use: For the treatment of COVID-19 in patients who are:

Hospitalized, or
Not hospitalized, have mild to moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death

Renal Dose Adjustments

Any degree of renal dysfunction: No adjustment recommended

Comments:

Use of this drug in pediatric patients with renal dysfunction is supported by safety data in adults.
Limited data are available regarding safety in pediatric patients with mild or moderate renal dysfunction.
No data are available regarding safety in pediatric patients with severe renal dysfunction.
In clinical studies, exposures of GS-441524 and GS-704277 (the metabolites of this drug) and betadex sulfobutyl ether sodium (SBECD) were increased in subjects with mild to severe renal dysfunction relative to those with normal renal function.
Because this product contains SBECD, which is eliminated through glomerular filtration when administered IV, administration to pediatric patients with renal immaturity or renal dysfunction may result in higher exposure to SBECD.

Liver Dose Adjustments

Mild, moderate, or severe liver dysfunction (Child-Pugh A, B, or C): No adjustment recommended

During therapy:

If ALT levels increase to greater than 10 times the upper limit of normal: Discontinuation of this drug should be considered.
If ALT elevation occurs with signs/symptoms of liver inflammation: This drug should be discontinued.

Comments:

Hepatic laboratory testing should be performed in all patients before starting this drug and while receiving this drug as clinically appropriate.

Precautions

CONTRAINDICATIONS:

History of clinically significant hypersensitivity reactions to the active component or any of the ingredients

Safety and efficacy have not been established in pediatric patients weighing less than 1.5 kg.

Consult WARNINGS section for additional precautions.

Dialysis

No adjustment recommended

Comments:

This drug may be administered without regard to the timing of dialysis.
In clinical studies, exposures of GS-441524, GS-704277, and SBECD were increased in subjects requiring dialysis relative to those with normal renal function.

Other Comments

Administration advice:

Perform hepatic laboratory testing in all patients before starting this drug and during therapy as clinically appropriate.
Determine prothrombin time in all patients before starting this drug and monitor during therapy as clinically appropriate.
Administer only in settings in which health care providers have immediate access to medications to treat a severe infusion or hypersensitivity reaction (e.g., anaphylaxis) and the ability to activate the emergency medical system, as needed.
Start this drug as soon as possible after symptomatic COVID-19 has been diagnosed (hospitalized and nonhospitalized patients) and within 7 days of symptom onset (nonhospitalized patients).
Administer by IV infusion only; do not administer by any other route.
Do not administer the prepared diluted solution simultaneously with any other medication.
Monitor patients during infusion and observe patients for at least 1 hour after infusion is complete for signs/symptoms of hypersensitivity as clinically appropriate.

Storage requirements:

Injection Solution: Store vials in refrigerator (2C to 8C [36F to 46F]) until needed for use.
Before dilution: Equilibrate to room temperature (20C to 25C [68F to 77F]); can store sealed vials up to 12 hours at room temperature before dilution
Lyophilized Powder: Store vials below 30C (86F) until needed for use.
After reconstitution: Use vial immediately to prepare diluted solution.
Diluted Solution in the Infusion Bags: Can store up to 24 hours at room temperature (20C to 25C [68F to 77F]) or 48 hours refrigerated (2C to 8C [36F to 46F]) before administration
Diluted Solution in Syringe: Should be used immediately

Reconstitution/preparation techniques:

The 2 formulations have differences in preparation; the manufacturer product information should be consulted, and the product-specific instructions should be followed carefully.
Injection Solution: Must be diluted before IV infusion
Lyophilized Powder: Must be reconstituted and further diluted before IV infusion
Dilute within the same day as administration.

IV compatibility:

Compatible (injection solution): 0.9% sodium chloride injection, USP
Compatible (lyophilized powder): Sterile Water for Injection; 0.9% sodium chloride injection, USP
Compatibility with other IV solutions and medications is not known.

General:

There are 2 different formulations of this drug, supplied as lyophilized powder in vial and as solution in vial; the manufacturer product information should be consulted.
The lyophilized powder formulation is the only approved dosage form for pediatric patients weighing 1.5 to less than 40 kg.

Monitoring:

Hematologic: Prothrombin time in all patients (before starting and during therapy as clinically appropriate)
Hepatic: Hepatic laboratory testing in all patients (before starting and during therapy as clinically appropriate)
Hypersensitivity: For sign/symptoms of hypersensitivity (during and after infusion as clinically appropriate)

Patient advice:

Read the US FDA-approved patient labeling (Patient Information).
Notify health care provider if any of the following occur: changes in heart rate, fever, shortness of breath/wheezing, swelling of lips/face/throat, rash, nausea, sweating, or shivering.
Notify health care provider immediately if any symptoms of liver inflammation develop.
Patients of childbearing potential: Inform health care provider of pregnancy.