Good afternoon, pharmacists -  

There has been an update to the Remdesivir Criteria for Use. As you may know, remdesivir contains cyclodextran, an excipient that has been considered hepatotoxic at supratherapeutic doses and that may accumulate in the blood of patients with reduced eGFR. For this reason, patients with reduced eGFR or receiving dialysis were excluded from clinical trials. However, case studies have been published looking at the effects of remdesivir in patients with impaired renal function and have shown the benefit of the medication oftentimes outweighs the risk, especially when administered early in the disease course. Additionally, the amount of cyclodextran given over the recommended duration (3-5 days) is below the maximum recommended dose. 

Given this information, ADULT patients with eGFR < 30 mL/min or who are receiving dialysis may receive remdesivir if ordered by an infectious diseases specialist. For dialysis-dependent patients, schedule remdesivir daily with doses falling on dialysis days to be given after dialysis session. Patients < 18 years of age with renal insufficiency will continue to be excluded due to lack of data in this population. This update applies to both the 3-day and 5-day durations. The updated criteria is attached to this email and uploaded on the AMT FormWeb page.

AMT will continue to monitor remdesivir patients daily. Please ensure a CMP is ordered with every remdesivir order so that the necessary labs are available for assessment. 

Please reach out with questions or if further clarification is needed. 

Thank you!

Madeline