Remdesivir

VEKLURY

What it isNucleotide analog inhibiting viral RNA polymerase; COVID-19.

Why this oneIt shortens recovery in hospitalized patients and is the IV option when oral antivirals are unsuitable.

What limits itIV only, over several days. Transaminase rise; benefit is greatest early and modest in late severe disease.

FDA-approved for

FDA dosing	Population	Start	Target	Max
COVID-19	Adults & peds >=40 kg	200 mg IV loading dose day 1	100 mg IV QD from day 2	100 mg/day maintenance
COVID-19	Peds 1.5 to <40 kg	Weight-based (Table 1)	Weight-based maintenance	Per weight

Renal No adjustment needed (any degree, including dialysis)

Hepatic Monitor LFTs; consider discontinuing if ALT >10x ULN or with signs of liver injury

Total duration 5-10 days by severity

Give by IV infusion (may slow to up to 120 min if hypersensitivity risk)
Perform hepatic labs and prothrombin time before and during treatment
Duration 5 days (not ventilated) or 10 days (invasive mechanical ventilation/ECMO)
Initiate as soon as possible after diagnosis

Pregnancy No drug-associated risk identified (2nd/3rd trimester); no dose adjustment in pregnancy

Lactation Detected in human milk; no adverse effects reported in breastfed infants (limited data)

NO BOXED WARNINGS

Principal riskIV only; transaminase rise

Cost, est. cash$300–$2,000/month

Generic entry2041 est.

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityAgent-specific renal, hepatic, hematologic, metabolic and drug-interaction toxicity.