Remdesivir (Veklury) is an antiviral medication that’s infused into your vein at a healthcare facility. It can treat COVID-19 regardless of whether you’re in the hospital.
Remdesivir is generally well-tolerated. But some of its more common side effects are nausea and mild elevations in your liver enzyme (protein) levels.
Serious side effects are also possible, such as infusion reactions, allergic reactions, and kidney injury. If you’ve left your clinic or hospital and developed serious side effects like these, contact your healthcare provider right away.
For the past couple of years, you’ve heard all about the risks of COVID-19. You’ve heard about its ability to spread easily, the complications it can cause, and how viral variants are making preventing and treating it all the more complex.
Fast forward to the present day, and redeliver (Veklury) is one of the three available COVID-19 treatment options if you’re experiencing mild-to-moderate symptoms. It’s used in hospitals for more severe COVID-19, too. And since the beginning, remdesivir has held up against all of the COVID-19 variants.
However, since remdesivir has been approved and recommended for use, we’ve learned more about its possible risks and side effects. So, if the time has come for you or a loved one to receive it, what do you need to know?
Here, we’ll talk about remdesivir side effects — what’s common, what can be severe, and what you can do to navigate these risks.
What is remdesivir?
Remdesivir is an antiviral medication that’s infused into your vein. It can treat confirmed cases of COVID-19 regardless of whether you’re in the hospital. It can be used by certain children and adults.
If you have mild-to-moderate COVID-19 and aren’t in the hospital, you’ll typically receive one infusion daily at a clinic for up to 3 days. Ideally, you should receive it within a week of developing symptoms for it to be most effective. But if you’re in the hospital with severe COVID-19, you’d likely receive it daily for 5 to 10 days.
If your healthcare provider decides you’re a good candidate to get remdesivir, the specific dose and length of time you’ll receive it is variable. It’ll depend on your body weight, symptoms, and other health conditions you may have.
remdesivir is made by Gilead Sciences, a California-based company.
How does remdesivir work?
As mentioned, remdesivir is an antiviral medication. It works by stopping SARS-CoV-2 (the virus that causes COVID-19) from replicating inside of your cells. It slows down an enzyme (protein) that the virus needs in order to make copies of itself. When viruses like SARS-CoV-2 are no longer able to replicate inside your cells, they begin to die off.
Common side effects of remdesivir
Remdesivir is generally well-tolerated. It hasn’t been linked to too many side effects, but specific risks vary by person and situation.
The most common side effect is nausea. But it’s also common to see elevated liver enzymes (proteins) in your lab work.
These liver effects are usually mild, asymptomatic, and go away on their own. But your healthcare provider should monitor your liver health prior to and during your remdesivir infusions to make sure that everything is OK. However, it’s not always clear if this effect on liver enzymes is due to remdesivir, COVID-19 itself, or both.
Mild-to-moderate infusion reactions are also possible. Not everyone experiences them. But if you do, they usually happen within 1 hour of your infusion. Some of these reactions happen close to where the medication is injected, and others happen throughout your body. Possible symptoms include:
- Pain or swelling where remdesivir was injected
- Skin rashes
- Changes in blood pressure
- Changes in heart rate
If you experience any worrisome or bothersome side effects like these after you leave the clinic or hospital, make sure to contact your healthcare provider.
Serious side effects of remdesivir
In addition to what’s mentioned above, rare but serious side effects are also possible. If you experience any serious symptoms, as described below, make sure to seek medical attention right away.
Keep in mind: The list below isn’t an exhaustive list of possible side effects. Other rare side effects have also been reported, and since remdesivir is still relatively new, we’re still learning more about it.
Hypersensitivity reactions — including allergic reactions and severe infusion reactions — can happen during or after your infusions. Allergic reactions can vary in severity, but anaphylaxis is possible. Severe infusion reactions may include angioedema (severe facial swelling) and difficulty breathing.
As mentioned, remdesivir can affect your liver. In most cases, it mostly has a mild effect on your liver enzymes. But in rare cases, it can lead to liver injury or intense liver inflammation. This risk is generally highest if you’re critically sick with COVID-19.
Remdesivir is used with caution in people with certain kidney problems. It’s generally recommended to run lab tests before getting remdesivir. This helps make sure that your kidneys are healthy enough to receive it.
But why is this? Remdesivir has the potential to cause kidney issues. The main reason is that remdesivir infusions also contain an ingredient called betadex sulfonyl ether sodium. This ingredient can build up in your kidneys and cause harm if they’re not working efficiently enough.
However, the specific way that remdesivir impacts your kidneys is still being studied. Your risk of developing kidney problems also depends on your situation.
There have been rare instances where remdesivir has been connected to generalized seizures. These are a type of seizure that can affect all parts of your brain.
Blood clotting effects
Remdesivir can delay your ability to form blood clots. More specifically, it can elevate your prothrombin time — which is a reading that can be obtained from a blood test. This hypothetically raises your risk for bleeding-related complications.
When should I contact my healthcare provider about remdesivir side effects?
You can only receive remdesivir at a hospital, clinic, or another similar healthcare facility. You can’t receive it at home. Because of this, your care team will monitor you for side effects while you’re still on site.
However, healthcare providers can only help with symptoms that they know about, can see, or test for. Keep in mind that not all side effects are visually noticeable. Some symptoms, like nausea, may only be obvious to you.
So if you’re at a hospital or clinic and develop these types of side effects, make sure to let your care team know. They can step in and help treat these side effects when possible. And if you develop any concerning or serious side effects once you leave the hospital or clinic, make sure to still let them know right away.
What can I do to manage remdesivir’s side effects?
In most cases, you won’t need to do much to manage remdesivir’s side effects by yourself. This is because the medication is infused at a healthcare setting, and you’re usually monitored for at least 1 hour after your infusion ends. Many of remdesivir’s possible side effects are thought to happen during or shortly after your infusion.
However, some side effects may still affect you after you go home. If you’re experiencing a common side effect like nausea, you can try a few different things to control your symptoms. Here are a few ideas:
- Don’t make yourself eat or drink or anything. Feel free to just eat or drink when you can.
- When you do eat, try to avoid heavy meals. Bland and easy-to-digest food are often ideal when you’re feeling nauseous.
- Consider several small meals throughout the day instead of a few larger meals.
- Stay hydrated throughout the day — small but frequent sips of water are often beneficial.
- Avoid food, drinks, or other things that have strong odors. These can worsen nausea symptoms.
If you’re experiencing nausea or other side effects that are annoying or intolerable, make sure to talk to your healthcare provider. They can help alleviate your discomfort by recommending other treatment ideas that are more personalized for your situation.
Remdesivir is an antiviral medication that can treat COVID-19. It’s a potential option for you to use if you have a confirmed case of COVID-19, but it may cause a few side effects. Relatively common but manageable side effects are nausea and elevated liver enzymes. More serious side effects, like infusion reactions, allergic reactions, and kidney injury, are also possible.
If you have symptoms of a serious or bothersome side effect, make sure to let your care team know about them as soon as you can.
COVID-19 Treatment Guidelines. (2022). Antiviral drugs that are approved, authorized, or under evaluation for the treatment of COVID-19. National Institutes of Health.
COVID-19 Treatment Guidelines. (2022). Remdesivir. National Institutes of Health.
Food and Drug Administration. (2022). Fact sheet for parents and caregivers, emergency use authorization (EUA) of veklury® (remdesivir) for Coronavirus disease 2019 (COVID-19) for children weighing 8 pounds (3.5 kg) to less than 88 pounds (40 kg) or for children less than 12 years of age weighing at least 8 pounds (3.5 kg) who are: Hospitalized, or not hospitalized and have mild to-moderate COVID-19 and are at high risk for progression to severe COVID-19, including hospitalization or death.
Gilead Sciences, Inc. (2022). Veklury [package insert].
Gupte, V., et al. (2022). Safety and clinical outcomes of remdesivir in hospitalised COVID-19 patients: a retrospective analysis of active surveillance database. BMC Infectious Diseases.
Kokic, G., et al. (2021). Mechanism of SARS-CoV-2 polymerase stalling by remdesivir. Nature Communications.
Moon, A. M., et al. (2021). Elevated liver enzymes in patients with COVID-19: Look, but not too hard. Digestive Diseases and Sciences.
National Human Genome Research Institute. (n.d.). Virus.
National Institute of Diabetes and Digestive and Kidney Diseases. (2022). Remdesivir. LiverTox.
Seethapathy, R., et al. (2022). A propensity score–matched observational study of remdesivir in patients with COVID-19 and severe kidney disease. Kidney360.
Tarbox, J. A., et al. (2018). Angioedema. JAMA.
Wu, B., et al. (2022). Acute kidney injury associated with remdesivir: A comprehensive pharmacovigilance analysis of COVID-19 reports in FAERS. Frontiers in Pharmacology.
Yang, R., et al. (2021). Prothrombin time. StatPearls.
Written by Joshua Murdock, PharmD | Reviewed by Alyssa Billingsley, PharmD | Published on April 14, 2022 | Photo by Yehor Milohrodskyi on Unsplash