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High-demand COVID-19 Drug Remdesivir May Not Work in Patients Requiring Ventilation: Experts

Unnecessary use of Remdesivir may cause arrhythmia in Covid-19 patients, warn experts.

A senior PGI doctor has warned that unnecessary use of Remdesivir in Covid-19 patients may worsen renal functions and may cause arrhythmia.

The demand for Remdesivir, an antiviral used for COVID-19 treatment, has surged amid spurt in Covid-19 cases in India. To meet the high demand, the Centre has extended all support to the domestic Remdesivir manufacturers. To boost the production capacity from a current level of 38 lakh vials per month to 74 lakh vials per month as well as approved 20 additional manufacturing sites. In addition, export of the injectable drug has also been banned, according to the Union Health Ministry. Warning against the unnecessary or irrational use of the drug on Covid patients, the ministry in a tweet on Monday clarified that "Remdesivir is an experimental investigational drug that had been granted emergency authorisation for use on moderately sick Covid patients on oxygen support under hospital settings." But it is not effective for patients requiring high oxygen support or ventilation, said a senior doctor with the Postgraduate Institute of Medical Education and Research (PGIMER).

G.D. Puri, HoD of Anaesthesia and Intensive Care, PGIMER, also said that Remdesivir does not have any effect in reducing mortality, as reported by IANS. Earlier, All India Institute of Medical Sciences (AIIMS) Delhi director Dr Randeep Guleria had also said the same thing. "Remdesivir isn't magic bullet and isn't a drug that decreases mortality," he said while addressing the media on Monday.

When to use of Remdesivir?

According to Puri, Remdesivir should be used within the first seven to eight days in Covid-19 patients developing room air hypoxia, meaning oxygen saturation less than 94 per cent.

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"It is not likely to be beneficial after 10 days in patients who are already on ventilator support. It has a potential to worsen renal functions and may cause arrhythmia, so it needs to be used with caution and under strict monitoring. There are very limited indications of using Remdesivir and a very narrow therapeutic window, so it should be used judiciously," IANS quoted him as saying.

Dr Guleria had also cautioned that this antiviral drug should only be given to patients hospitalised with moderate illness, who had a fall in oxygen saturation and have infiltrates on chest X-rays or CT-scan. "It is of no use if given early in mild and asymptomatic patients and also if administered too late," he told media.

In support of Dr Guleria's remark, NITI Aayog member (Health) V K Paul added that remdesivir is not to be used in home settings and not to be procured from chemist shops.

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