Remdesivir may cause liver and kidney injury: ICMR tells states to use it cautiously

States have been told to use remdesivir and tocilizumab with extreme caution, as their "indiscriminate use or use in conditions for which they are not desirable may cause more harm than good".

By: Longjam Dineshwori | | Updated: July 13, 2020 8:42 am

Indian pharma major Cipla has launched the generic version of remdesivir under the brand name Cipremi .

As there is no vaccine for COVID-19 yet, doctors and researchers around the world are testing some of the existing drugs to treat the viral disease. One of the much-touted drugs is remdesivir, the antiviral drug originally designed to treat Ebola. Some studies have suggested that remdesivir may decrease the time needed for clinical improvement in moderate to severe cases. Based on these studies, the Drug Controller General of India (DCGI) has approved remdesivir for “restricted emergency use” on severely ill hospitalised coronavirus patients. Three pharma companies – Cipla, Hetero and Mylan NV – have also been given approval by the drug authority to manufacture and sell generic versions of remdesivir in India. Also Read - It is ‘unrealistic’ that COVID-19 pandemic would be over by 2021 end: WHO expert

Now, the government has sounded caution on the use of remdesivir injectable formulation. The Indian Council of Medical Research (ICMR) and the All India Institute of Medical Sciences (AIIMS) have asked states to use remdesivir with extreme caution, as their “indiscriminate use or use in conditions for which they are not desirable may cause more harm than good”. The two bodies also cautioned against use of Tocilizumab, which is also permitted for the treatment of Covid patients with poor oxygen indicators. Also Read - COVID-19 vaccine for variants: Pfizer, Moderna test a third ‘booster’ dose for efficacy

Remdesivir may cause adverse side effects

During a video conference with the states on Friday, the ICMR told states that Remdesivir and Tocilizumab, mentioned as investigational therapies, should be used strictly as per the laid down protocol due to their potential to cause adverse side effects, including liver and kidney injury. Also Read - Co-WIN glitches leave citizens in quandary: 92 per cent unable to register for COVID-19 vaccine

Available evidence for Remdesivir suggests that it may decrease the time needed for clinical improvement in moderate to severe cases, but there have been no benefits in terms of reduced mortality. Similarly, studies have not shown any benefits for tocilizumab in mortality reduction, the health ministry said in a statement on Saturday.

The ministry further noted that all ‘investigational therapies’ should be carried out only in proper health care facilities where close monitoring of patients is possible so that potential complications can be managed.

Guidelines on clinical management

Since there is no cure for COVID-19 as yet, the treatment approach for the disease is largely based on supportive care.

The ICMR said that the focus of clinical management should continue to remain on oxygen therapy, steroids (which are widely available and inexpensive), and timely administration of anti-coagulants and high-quality supportive care, including mental health counseling for patients and families, management of pre-existing illness and palliation of symptoms.

During the video conference, ICMR and AIIMS told the states to follow the standard of care treatment for mild, moderate, and severe cases as described in the Clinical Management Protocol of the health ministry.

For moderate and severe cases, adequate oxygen support, appropriate and timely administration of anti-coagulants and widely available and inexpensive corticosteroids can be considered to be the mainstay of COVID-19 therapy, they said. For mild cases, which constitute nearly 80 per cent of the total cases, doctors have been recommended to use of Hydroxychloroquine (HCQ).

According to the health ministry, the standard of care treatment strategies has shown to yield positive results.

Published : July 12, 2020 4:45 pm | Updated:July 13, 2020 8:42 am

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