Remdesivir Dosing and Administration for COVID-19

Standard Dosing Regimen

For hospitalized adults and pediatric patients ≥40 kg, the American College of Physicians recommends administering remdesivir 200 mg IV on day 1, followed by 100 mg IV daily for 5 days if not requiring mechanical ventilation/ECMO, or 10 days if requiring mechanical ventilation/ECMO 1, 2
The standard loading dose is 200 mg IV infusion on day 1, followed by a maintenance dose of 100 mg IV daily 1, 2

For hospitalized patients NOT requiring mechanical ventilation/ECMO, a 5-day course is the standard recommendation 1, 2
For hospitalized patients requiring mechanical ventilation/ECMO, a 10-day course is recommended 1, 2
The World Health Organization suggests that if clinical improvement is not demonstrated, treatment may be extended up to 5 additional days (total 10 days) 1

The Infectious Diseases Society of America recommends initiating treatment as soon as possible after diagnosis of symptomatic COVID-19 2
For outpatients, treatment must begin within 7 days of symptom onset, as recommended by the British Medical Association 3, 2
If a patient worsens during the 5-day course to require supplemental oxygen, extending to 10 days should be based on clinical judgment, according to the American College of Physicians 1, 2

The European Society of Clinical Microbiology and Infectious Diseases states that remdesivir is contraindicated in patients with eGFR <30 mL/min/1.73 m² 1, 2
The American College of Physicians also notes that remdesivir is contraindicated in patients with ALT ≥5 times upper limit of normal 2

Before initiating treatment, the American College of Physicians recommends assessing hepatic function (ALT/AST) and renal function (eGFR) 1
During treatment, monitor hepatic function as clinically appropriate and discontinue if ALT increases to >10 times upper limit of normal or if accompanied by signs/symptoms of liver inflammation, as recommended by the Infectious Diseases Society of America 1

The World Health Organization strongly recommends against using remdesivir in patients with non-severe COVID-19 at low risk of hospitalization 3
The American College of Physicians notes that remdesivir is not recommended for patients already on mechanical ventilation/ECMO at baseline, as evidence suggests potential for increased mortality 2
The greatest benefit of remdesivir is observed in hospitalized patients requiring low-flow supplemental oxygen at baseline, according to the European Society of Clinical Microbiology and Infectious Diseases 2
The Infectious Diseases Society of America also notes that the greatest benefit is observed in patients with symptom duration ≤10 days 4, 5