UGM Experts Said, Remdesivir Is Only For Emergency Use For COVID-19 Patients

Wisma Atlet Emergency Hospital (Angga Nugraha)

JAKARTA - PT Kalbe Farma Tbk (KLBF) or Kalbe has started distributing Remdesivir antiviral drugs for the treatment of COVID-19 patients in Indonesia. What many people need to know is that Remdesivir is given a distribution permit in the form of 'Emergency Use Authorization (EUA)'.

"This means that permission to use drugs is given in an emergency manner because there is no definitive and approved COVID-19 drug. Not an emergency because the patient is in an emergency," said UGM Pharmacology and Clinical Pharmacy Expert, Prof. Dr. Zullies Ikawati, Apt. as reported from the official UGM website, Tuesday 6 October.

Remdesivir can not be obtained freely in the market or pharmacies. This drug is directly distributed by PT Kalbe Farma to the hospital. Remdesivir is intended for adults or adolescents aged 12 years and over with a minimum body weight of 40 kilograms (kg), who are admitted to hospital with severe conditions.

Remdesivir is a hot topic of conversation in many countries and in recent months being tested by WHO. A number of countries have used the drug and it is showing good results when used in the treatment of COVID-19 patients. Giving Remdesivir was able to shorten the healing period in Covid-19 patients.

"Remdesivir is an antiviral drug. It was developed to treat RNA viruses and was tried during the Ebola and MERS outbreaks," said Prof. Zullies.

The Professor of Pharmacy at UGM explained that Remdesivir is an analog compound (similar) to adenosine and can infiltrate the RNA chain. This drug works by inhibiting viral replication in the body.

Uniquely, the drug will change into an active substance when it is in the patient's body. This form can increase the entry of the drug into the cells and protect the drug from reaching its place of action. Then, an important modification to remdesivir is a carbon nitrogen (CN) group attached to the sugar. Therefore, once remdesivir is incorporated into the RNA growth chain, the presence of the CN group will cause the form of sugar to shrink.

"In the end this stops the production of RNA strands and sabotages viral replication," he explained.

In addition, the change in the CN bonds to CC causes remdesivir to not be released by its target enzyme, namely RNA-dependent RNA Polymerase, which makes it remain in the growing RNA chain and blocks viral replication.

Furthermore, Zullies conveyed that remdesivir should only be used in patients who were confirmed positive for Covid-19 with an age above 12 years and a minimum body weight of 40 Kg. For drug administration is carried out by injection by infusion. The first day as much as 200 milligrams, then on the second day and the next given as much as 100 milligrams / day. The drug administration is carried out for 5 to 10 days.

Although it can help in the treatment of Covid-19, Zullies said remdesivir has a number of side effects. Some of them are nausea and vomiting. In addition, remdesivir can increase the transaminase enzyme in the liver, potentially damaging the liver. Therefore, the use of this drug must be given with caution in patients who are indicated to have impaired liver function.

Then, does remdesivir have drug interactions with other drugs? Zullies said that until now there had not been any reports of drug interactions between remdesivir and other drugs. However, it is possible that the use of other drugs will actually affect the availability of remdesivir in the blood.

"Several antibiotics such as rifampin and clarithromycin have been reported to affect the availability of remdesivir in the blood. However, it is still temporary, maybe there could be more drugs that interact if there is a lot of information about their use, "he said.

Zullies said the safety of using remdesivir for pregnant and breastfeeding women is also unknown. However, in pre-clinical trials in mice and monkeys, it is known that remdesivir use can affect the kidneys in the fetus.