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Veklury 100 mg powder for concentrate for solution for infusion

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Remdesivir may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Remdesivir
Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

for

The active substance in Veklury is remdesivir. It is an antiviral medicine used for treating COVID-19. COVID-19 is caused by a virus called a coronavirus. Veklury stops the virus multiplying in cells and this stops the virus multiplying in the body. This can help your body to overcome the virus infection, and may help you get better faster. Veklury will be given to treat COVID-19 in adults and children (who are at least 4 weeks of age and weighing at least 3 kg):  who have pneumonia, and need extra oxygen to help them breathe, but who are not on artificial ventilation (where mechanical means are used to assist or replace spontaneous breathing at start of treatment).  who do not need extra oxygen to help them breathe and are at increased risk for progressing to severe COVID-19. 2.

What you need to know before you take it

Veklury

You will not usually be given Veklury:  if you are allergic to remdesivir, or any of the other ingredients of this medicine (listed in section 6)  Talk to your doctor or nurse as soon as possible, if this applies to you. Warnings and precautions Talk to your doctor or nurse before starting on Veklury:  if you have kidney problems. Your doctor may monitor you if you have kidney problems to ensure your safety.  If you are immunocompromised. Your doctor may monitor you more closely if your immune system is not working properly to ensure the treatment is working.

Reactions following the infusion Veklury can cause allergic reactions following and during the infusion, including anaphylactic reactions (sudden life-threatening allergic reactions). Allergic reactions have been seen rarely. For anaphylactic reactions frequency cannot be estimated from the available data. Symptoms can include:  Changes to blood pressure or heart rate  Low oxygen level in blood  High temperature  Shortness of breath, wheezing  Swelling of the face, lips, tongue or throat (angioedema)  Rash  Feeling sick (nausea)  Being sick (vomiting)  Sweating  Shivering  Tell your doctor or nurse straight away if you notice any of these effects. Blood tests before and during treatment If you are prescribed Veklury, you may be given blood tests before treatment starts. Patients being treated with Veklury may have blood tests during their treatment as determined by their healthcare professional. These tests are to check for kidney problems. Children and adolescents Veklury is not to be given to children under 4 weeks old or to children who weigh less than 3 kg. Not enough is known for it to be given to these children. Other medicines and Veklury Tell your doctor or nurse about any other medicines you are taking, or have recently taken. Do not take chloroquine or hydroxychloroquine at the same time as Veklury.  Tell your doctor if you are taking any of these medicines Pregnancy and breast-feeding Tell your doctor or nurse if you are pregnant, or if you might be. There is not enough information to be sure that Veklury is safe for use in first trimester of pregnancy. Veklury will only be given if the potential benefits of treatment outweigh the potential risks to the mother and the unborn child. Discuss with your doctor the need to use effective contraception during treatment with Veklury. Tell your doctor or nurse if you are breast-feeding. Veklury passes into human breast milk in very small amounts. Because there is limited experience with use during breast-feeding, you should carefully discuss with your doctor whether to continue or interrupt breast-feeding during treatment with Veklury. Driving and using machines Veklury is not expected to have any effect on your ability to drive. Veklury contains a cyclodextrin This medicine contains 3 g betadex sulfobutyl ether sodium in each 100 mg dose of Veklury (6 g in the starting dose). This ingredient is a cyclodextrin emulsifier that helps the medicine to disperse in the body.

Veklury contains sodium This medicine contains 212 mg sodium (main component of cooking/table salt) in each 100 mg dose unit. This is equivalent to 10.6 % of the recommended maximum daily dietary intake of sodium for an adult.

3.

How to take it

to you

Veklury will be given to you by a nurse or doctor, as a drip into a vein (an intravenous infusion) lasting 30 to 120 minutes, once a day. You will be closely monitored during your treatment. Recommended dose for adults and children

Day 1 (single starting dose) Day 2 and onwards (once daily)

Adults

Children (weighing at least 40 kg)

Children at least 4 weeks old (weighing at least 3 kg but less than 40 kg)

200 mg

200 mg

100 mg

100 mg

5 mg per kg of body weight 2.5 mg per kg of body weight

Adults

Children (weighing at least 40 kg)

Daily for at least 5 days. May be extended up to a total of 10 days. Daily for 3 days, starting within 7 days of the onset of COVID-19 symptoms.

Daily for at least 5 days. May be extended up to a total of 10 days. Daily for 3 days, starting within 7 days of the onset of COVID-19 symptoms.

How long treatment lasts

Patients who have pneumonia and need extra oxygen Patients who do not need extra oxygen and are at increased risk for progressing to severe COVID-19

Children at least 4 weeks old (weighing at least 3 kg but less than 40 kg) Daily for up to a total of 10 days. Daily for 3 days, starting within 7 days of the onset of COVID-19 symptoms.

See the Instructions for healthcare professionals which gives details on how the Veklury infusion is given. If you are given more or less Veklury than you should As Veklury is only given to you by a healthcare professional, it is unlikely that you will be given too much or too little. If you have been given an extra dose, or missed one, tell your nurse or doctor straight away. If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse. 4.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Some side effects could be or could become serious: Rare (these may affect up to 1 in 1000 patients)  Allergic reactions following and during the infusion. Symptoms can include:  Changes to blood pressure or heart rate  Low oxygen level in blood  High temperature  Shortness of breath, wheezing  Swelling of the face, lips, tongue or throat (angioedema)  Rash  Feeling sick (nausea)  Being sick (vomiting)  Sweating  Shivering Not known (frequency cannot be estimated from the available data)  Anaphylactic reactions, anaphylactic shock (sudden life-threatening allergic reactions) Symptoms are the same as for allergic reactions however the reaction is more severe and requires immediate medical care.  Sinus bradycardia (heart beats more slowly than normal).  Tell your doctor or nurse straight away if you notice any of these effects. Other side effects: Very common side effects (these may affect more than 1 in 10 patients)  Blood tests may show an increase in liver enzymes, called transaminases  Blood tests may show it takes longer for blood to clot Common side effects (these may affect up to 1 in 10 patients)  Headache  Feeling sick (nausea)  Rash Reporting of side effects If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the dedicated COVID-19 Yellow Card reporting site at coronavirus-yellowcard.mhra.gov.uk. By reporting side effects, you can help provide more information on the safety of this medicine. 5.

Possible side effects

. Reconstitute the powder For each single-use vial, the powder must be reconstituted and then diluted under aseptic conditions.  Add 19 mL of sterile water for injections to the vial, using a suitably sized syringe and needle for each vial, and insert the needle in the centre of the vial stopper.  This produces a solution of 5 mg/mL of remdesivir. ◦ Discard the vial if a vacuum does not pull the sterile water into the vial.  Only use sterile water for injection to reconstitute remdesivir powder.  Immediately shake the vial for 30 seconds.  Allow the contents of the vial to settle for 2 to 3 minutes. A clear solution should result.  If the contents of the vial are not completely dissolved, shake the vial again for 30 seconds and allow the contents to settle for 2 to 3 minutes. Repeat this procedure as necessary until the contents of the vial are completely dissolved.  Inspect the vial to ensure the container closure is free from defects.  The solution should only be used if it is clear and free from particles.  Dilute immediately after reconstitution. Dilute the concentrate with sodium chloride solution Reconstituted Veklury must be diluted with sodium chloride 9 mg/mL (0.9%) solution for injection under aseptic conditions. Dilution instructions for adults and paediatric patients weighing at least 40 kg Using Table 3, decide how much sodium chloride solution 9 mg/mL (0.9%) to withdraw from the infusion bag. Table 3: Dose 200 mg (2 vials) 100 mg (1 vial)

Dilution instructions Size of infusion bag to be used 250 mL 100 mL 250 mL 100 mL

How much sodium chloride solution to withdraw and discard from infusion bag 40 mL 40 mL 20 mL 20 mL

Volume of reconstituted Veklury 2 × 20 mL 2 × 20 mL 20 mL 20 mL

Note: 100 mL infusion should only be used for patients with severe fluid restrictions.

    

Withdraw and discard the required volume of sodium chloride solution from the infusion bag using an appropriately sized syringe and needle. See Table 3. Withdraw the required volume of reconstituted Veklury from the vial using an appropriately sized syringe. See Table 3. Transfer the reconstituted Veklury to the infusion bag. Gently invert the bag 20 times to mix the solution in the bag. Do not shake. Administer the diluted solution immediately, or as soon as possible after preparation. The diluted solution is stable for 24 hours at room temperature (20°C to 25°C) or 48 hours in a fridge (2°C to 8°C).

Dilution instructions for paediatric patients at least 4 weeks of age and weighing at least 3 kg but less than 40 kg   

Further dilute the 100 mg/20 mL (5 mg/mL) remdesivir concentrate to a fixed concentration of 1.25 mg/mL using 0.9% sodium chloride. The total required infusion volume of the 1.25 mg/mL remdesivir solution for infusion is calculated from the paediatric weight-based dosing regimens of 5 mg/kg for the loading dose and 2.5 mg/kg for each maintenance dose. Small 0.9% sodium chloride infusion bags (e.g., 25, 50, or 100 mL) or an appropriately sized syringe should be used for paediatric dosing. The recommended dose is administered via IV infusion in a total volume dependent on the dose to yield the target remdesivir concentration of 1.25 mg/mL. A syringe may be used for delivering volumes < 50 mL.

Administer the infusion    

Use under conditions where treatment of severe hypersensitivity reactions, including anaphylaxis, is possible. Administer the diluted solution over 30 to 120 minutes at the rate described in Table 4 or Table 5. After infusion is complete, flush with at least 30 mL of 9 mg/mL (0.9%) sodium chloride solution. The diluted solution should not be administered simultaneously with any other medicines in the same intravenous line. The compatibility of Veklury with IV solutions and medications other than sodium chloride is not known.

Table 4:

Rate of infusion in adults and paediatric patients weighing 40 kg or more

Infusion bag volume 250 mL

100 mL

Table 5:

Rate of infusion 8.33 mL/min 4.17 mL/min 2.08 mL/min 3.33 mL/min 1.67 mL/min 0.83 mL/min

Rate of infusion in paediatric patients at least 4 weeks of age and weighing at least 3 kg but less than 40 kg

Infusion Bag Volume 100 mL 50 mL 25 mL a

Infusion time 30 min 60 min 120 min 30 min 60 min 120 min

Infusion Time 30 min 60 min 120 min 30 min 60 min 120 min 30 min 60 min 120 min

Rate of Infusiona 3.33 mL/min 1.67 mL/min 0.83 mL/min 1.67 mL/min 0.83 mL/min 0.42 mL/min 0.83 mL/min 0.42 mL/min 0.21 mL/min

Rate of infusion may be adjusted based on total volume to be infused.

Monitor and report side effects  

Monitor the patient for side effects during and after the infusion, according to local medical practice. Healthcare professionals are asked to report any suspected adverse reactions via the dedicated COVID-19 Yellow Card reporting site at coronavirus-yellowcard.mhra.gov.uk.

Store Veklury safely    

Before use, this medicinal product does not require any special storage conditions. Do not use after expiry date, marked on the vials/cartons after the letters EXP. Veklury powder appears white to off-white to yellow. The colour does not affect product stability. Once reconstituted, Veklury should be diluted immediately. Once diluted, Veklury should be administered immediately. If necessary, bags of diluted solution can be stored for up to 24 hours at room temperature (20°C to 25°C), or for up to 48 hours in a fridge (2°C to 8°C). Do not leave more than 48 hours between dilution and administration.

Do not reuse or save unused Veklury powder, reconstituted solution or diluted solution. Information in other languages 

Scan the code below with a mobile device to get the information in different languages.

QR code to be included www.veklury.eu This leaflet was last revised in 01/2026.

How to store it

Veklury

Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the label and carton after EXP. The expiry date refers to the last day of that month.  

Before use, this medicinal product does not require any special storage conditions. Once reconstituted, Veklury should be diluted immediately.

Once diluted, Veklury should be used immediately. If necessary, bags of diluted solution can be stored for up to 24 hours below 25°C, or for up to 48 hours in a refrigerator. Do not allow more than 48 hours between dilution and administration.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment. 6.

Contents of the pack and other information

What Veklury contains  The active substance is remdesivir. Each vial contains 100 mg.  The other ingredients are: betadex sulfobutyl ether sodium, hydrochloric acid and sodium hydroxide. What Veklury looks like and contents of the pack Veklury 100 mg powder for concentrate for solution for infusion is a white, off-white to yellow powder, to be reconstituted and then diluted into sodium chloride solution prior to administration by intravenous infusion. It is supplied in a single-use clear glass vial. Veklury is available in cartons containing 1 vial. Marketing Authorisation Holder Gilead Sciences Ltd 280 High Holborn London WC1V 7EE United Kingdom Manufacturer Gilead Sciences Ireland UC Carrigtohill County Cork, T45 DP77 Ireland For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: Gilead Sciences Ltd Tel: + 44 (0) 8000 113 700 This leaflet was last revised in 01/2026. Other sources of information Scan the code below with a mobile device to get this information in different languages. QR code to be included www.veklury.eu ———————————————————————————————————————–The following information is intended for healthcare professionals only. Please refer to the Summary of Product Characteristics for further information.

Instructions for healthcare professionals Veklury 100 mg powder for concentrate for solution for infusion remdesivir Each single-use vial contains 100 mg of remdesivir as a white to off-white to yellow powder for reconstitution and dilution. Summary of treatment Veklury is used for the treatment of COVID-19 in adults and paediatric patients (who are at least 4 weeks of age and weighing at least 3 kg):  with pneumonia, who require supplemental oxygen (low- or high-flow oxygen or other noninvasive ventilation at start of treatment)  who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID-19 Veklury should be administered by intravenous infusion in a total volume of 25 mL, 50 mL, 100 mL or 250 mL 0.9% sodium chloride over 30 to 120 minutes. Table 1:

Recommended dose in adults and paediatric patients Adults Paediatric patients Paediatric patients at (weighing at least least 4 weeks old 40 kg) (weighing at least 3 kg but less than 40 kg)

Day 1 (single loading dose) Day 2 and onwards (once daily) Table 2:

200 mg

200 mg

5 mg/kg

100 mg

100 mg

2.5 mg/kg

Paediatric patients (weighing at least 40 kg)

Paediatric patients at least 4 weeks old (weighing at least 3 kg but less than 40 kg) Daily for up to a total of 10 days.

Treatment duration Adults

Patients with pneumonia and requiring supplemental oxygen Patients who do not require supplemental oxygen and are at increased risk for progressing to severe COVID-19

Daily for at least 5 days and not more than 10 days. Daily for 3 days, starting as soon as possible after diagnosis of COVID-19 and within 7 days of the onset of symptoms.

Daily for at least 5 days and not more than 10 days. Daily for 3 days, starting as soon as possible after diagnosis of COVID19 and within 7 days of the onset of symptoms.

Daily for 3 days, starting as soon as possible after diagnosis of COVID-19 and within 7 days of the onset of symptoms.

The powder must be reconstituted with sterile water for injections, and then diluted with sodium chloride solution 9 mg/mL (0.9%) under aseptic conditions. Administer the diluted solution immediately.

As clinically appropriate, patients should have their renal function determined before starting and while receiving remdesivir. Monitor the patient for side effects during and after the infusion. See below for details on reporting of

Frequently asked questions about Veklury 100 mg powder for concentrate for solution for infusion

How do I take Veklury 100 mg powder for concentrate for solution for infusion?

Veklury 100 mg powder for concentrate for solution for infusion comes as infusion containing 100mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Veklury 100 mg powder for concentrate for solution for infusion?

The active substance in Veklury 100 mg powder for concentrate for solution for infusion is remdesivir.

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Veklury 100 mg powder for concentrate for solution for infusion, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Veklury 100 mg powder for concentrate for solution for infusion without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Remdesivir (1 medicine)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Veklury is indicated for the treatment of coronavirus disease 2019 (COVID‑19) in adults and paediatric patients (at least 4 weeks of age and weighing at least 3 kg):

• with pneumonia requiring supplemental oxygen (low- or high-flow oxygen or other non-invasive ventilation at start of treatment).

• who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID-19.

(see section 5.1).

4.2. Posology and method of administration

Patients should be monitored when receiving remdesivir (see section 4.4).

Patients receiving remdesivir in an outpatient setting should be monitored according to local medical practice. Use under conditions where treatment of severe hypersensitivity reactions, including anaphylaxis, is possible.

Posology

Table 1: Recommended dose in adults and paediatric patients

Given by intravenous infusion

Adults

Paediatric patients (weighing at least 40 kg)

Paediatric patients at least 4 weeks old (weighing at least 3 kg but less than 40 kg)

Day 1

(single loading dose)

200 mg

200 mg

5 mg/kg

Day 2 and onwards

(once daily)

100 mg

100 mg

2.5 mg/kg

Table 2: Treatment duration

Adults

Paediatric patients (weighing at least 40 kg)

Paediatric patients at least 4 weeks old (weighing at least 3 kg but less than 40 kg)

Patients with pneumonia and requiring supplemental oxygen

Daily for at least 5 days and not more than 10 days.

Daily for at least 5 days and not more than 10 days.

Daily for up to a total of 10 days.

Patients who do not require supplemental oxygen and are at increased risk for progressing to severe COVID-19

Daily for 3 days, starting as soon as possible after diagnosis of COVID-19 and within 7 days of the onset of symptoms.

Daily for 3 days, starting as soon as possible after diagnosis of COVID-19 and within 7 days of the onset of symptoms.

Daily for 3 days, starting as soon as possible after diagnosis of COVID-19 and within 7 days of the onset of symptoms.

Special populations

Elderly

No dose adjustment of remdesivir is required in patients over the age of 65 years (see sections 5.1 and 5.2).

Renal impairment

No dose adjustment of remdesivir is required in patients with renal impairment, including those on dialysis. However, safety data in patients with severe renal impairment and end stage renal disease (ESRD) are limited (see section 4.4) and based on a 5-day treatment duration. The timing of administration of remdesivir is without regard to dialysis (see section 5.2).

Hepatic impairment

No dose adjustment of remdesivir is required in patients with mild, moderate and severe hepatic impairment (Child-Pugh Class A, B, C) (see section 5.2). However, safety data in patients with severe hepatic impairment are limited and only based on a single 100 mg dose administration.

Paediatric population

The safety and efficacy of remdesivir in children less than 4 weeks of age and weighing less than 3 kg have not yet been established (see section 5.1).

Immunocompromised population

The safety and efficacy of remdesivir in immunocompromised patients have not yet been established. Only limited data are available (see section 4.4).

Method of administration

For intravenous use.

Remdesivir is for administration by intravenous infusion after reconstitution and further dilution.

It must not be given as an intramuscular (IM) injection.

For instructions on reconstitution and dilution of the medicinal product before administration, see section 6.6.

Table 3: Recommended rate of infusion – for reconstituted and diluted remdesivir powder for concentrate for solution for infusion in adults and paediatric patients weighing at least 40 kg

Infusion Bag Volume

Infusion Time

Rate of Infusion

250 mL

30 min

8.33 mL/min

60 min

4.17 mL/min

120 min

2.08 mL/min

100 mL

30 min

3.33 mL/min

60 min

1.67 mL/min

120 min

0.83 mL/min

Table 4: Recommended rate of infusion – for reconstituted and diluted remdesivir powder for concentrate for solution for infusion in paediatric patients at least 4 weeks of age and weighing at least 3 kg but less than 40 kg

Infusion Bag Volume

Infusion Time

Rate of Infusiona

100 mL

30 min

3.33 mL/min

60 min

1.67 mL/min

120 min

0.83 mL/min

50 mL

30 min

1.67 mL/min

60 min

0.83 mL/min

120 min

0.42 mL/min

25 mL

30 min

0.83 mL/min

60 min

0.42 mL/min

120 min

0.21 mL/min

a Rate of infusion may be adjusted based on total volume to be infused.

4.3. Contraindications

Hypersensitivity to the active substance(s) or to any of the excipients listed in section 6.1.

4.4. Special warnings and precautions for use

Hypersensitivity including infusion-related and anaphylactic reactions

Hypersensitivity reactions including infusion-related and anaphylactic reactions have been observed during and following administration of remdesivir. Signs and symptoms may include hypotension, hypertension, tachycardia, bradycardia, hypoxia, fever, dyspnoea, wheezing, angioedema, rash, nausea, vomiting, diaphoresis, and shivering. Slower infusion rates, with a maximum infusion time of up to 120 minutes, can be considered to potentially prevent these signs and symptoms. Monitor patients for hypersensitivity reactions during and following administration of remdesivir as clinically appropriate. Patients receiving remdesivir in an outpatient setting should be monitored after administration according to local medical practice. If signs and symptoms of a clinically significant hypersensitivity reaction occur, immediately discontinue administration of remdesivir and initiate appropriate treatment.

Renal impairment

As clinically appropriate, patients should have eGFR determined prior to starting remdesivir and while receiving it. Safety data from patients with severe renal impairment and ESRD reported during Study GS-US-540-5912 were comparable to the known safety profile of remdesivir However, there are limited safety data in this patient population. Therefore, taking the significant higher exposure of the metabolite GS-441524 into account, patients with severe renal impairment and ESRD should be closely monitored for adverse events during treatment with remdesivir (see section 5.2).

Risk of reduced antiviral activity when coadministered with chloroquine or hydroxychloroquine

Coadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulphate is not recommended based on in vitro data demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir (see sections 4.5 and 5.1)

Immunocompromised patients:

It is unclear if the treatment duration of three days is sufficient to clear the virus in immunocompromised patients, in whom prolonged viral shedding occurs. There is a potential risk of resistance development. Only limited data are available.

Excipients

This medicinal product contains 212 mg sodium per 100 mg dose, equivalent to 10.6% of the WHO recommended maximum daily intake of 2 g sodium for an adult.

4.5. Interaction with other medicinal products and other forms of interaction

Pharmacodynamic interactions

Due to antagonism observed in vitro, concomitant use of remdesivir with chloroquine phosphate or hydroxychloroquine sulphate is not recommended.

Pharmacokinetic interactions

Effects of other medicinal products on remdesivir

In vitro, remdesivir is a substrate for esterases in plasma and tissue, drug metabolizing enzyme CYP3A4 and is a substrate for Organic Anion Transporting Polypeptides 1B1 (OATP1B1) and P‑glycoprotein (P‑gp) transporters. GS‑704277 (a metabolite of remdesivir) is a substrate for OATP1B1 and OATP1B3.

A drug-drug interaction study was conducted with remdesivir. Table 5 summarises the pharmacokinetic effects of studied drugs on remdesivir and metabolites GS-704277 and GS-441524.

Table 5: Effect of other drugs on remdesivir and metabolites GS-704277 and GS-441524

Co-administered Drug

Dose (mg)

Interaction

Geometric mean change (%)

Recommendation concerning co-administration

Cyclosporin

400 single dose

remdesivir:  Cmax    ↑49%

AUCinf   ↑89%

GS-704277:  Cmax   ↑151%

AUCinf   ↑197%

GS-441524:  Cmax   ↑17%

AUCinf   ↔

No interactions are expected when co-administering remdesivir with inhibitors of OATP1B1/1B3 and/or P-gp.

No dose adjustment of remdesivir is required when it is co-administered with inhibitors of OATP1B1 and OATP1B3.

Carbamazepine

300 twice daily

remdesivir:  Cmax    ↓13%

AUCinf   ↓8%

GS-704277:  Cmax   ↔

AUCinf   ↔

GS-441524:  Cmax   ↔

AUCinf   ↓17%

No interactions are expected when co-administering remdesivir with strong CYP3A4 inducers or CYP3A4 inhibitors.

No dose adjustment of remdesivir is required when it is co-administered with strong CYP3A4 and/or P-gp inducers.

NOTE: Interaction study conducted in healthy volunteers.

Effects of remdesivir on other medicinal products

Remdesivir is not a clinically relevant inhibitor of CYP3A4, OATP1B1, and OATP1B3. In vitro, remdesivir is an inhibitor of UGT1A1, MATE1, OAT3, and OCT1; however no clinically significant drug interactions are expected with remdesivir and substrates of these enzymes or transporters.

Remdesivir is not a clinically relevant inducer of CYP3A4. Remdesivir induced CYP1A2 in vitro; however no clinically significant drug interaction is expected with remdesivir and CYP1A2 substrates.

Drug-drug interaction studies were conducted with remdesivir. Table 6 summarises the effect of remdesivir on the pharmacokinetics of studied drugs.

Table 6: Effect of remdesivir on other drugs

Co‑administered Drug

Dose (mg)

Remdesivir

Dose (mg)

Interaction

Geometric mean change (%)

Recommendation concerning co‑administration

Midazolam

2.5 single dose

200 single dose

Cmax

↑29% a

No dose adjustment of remdesivir is required when it is co-administered with substrate of CYP3A

AUCinf

↑20% a

No inhibition is expected when co‑administering remdesivir with substrate of CYP3A

Midazolam

2.5 single dose

200 single dose followed by 100 once daily (10 doses)b

Cmax

↑45%c

AUCinf

↑30%c

No induction is expected when co‑administering remdesivir with substrate of CYP3A

Pitavastatin

2 single dose

200 single dose

Cmax

↑5% a

No dose adjustment of remdesivir is required when it is co-administered with substrate of OATP1B1/OATP1B3

AUCinf

↑17% a

No inhibition is expected when co‑administering remdesivir with substrate of OATP1B1/OATP1B3

NOTE: Interaction study conducted in healthy volunteers.

a. No effect = 1.00 (0.80-1.25).

b. Midazolam administered with last dose of remdesivir.

c. No effect = 1.00 (0.70-1.43)

4.6. Fertility, pregnancy and lactation

Pregnancy

There is a limited amount of data from the use of remdesivir in pregnant women (less than 300 pregnancy outcomes). Most of the exposures occurred in the second, third or an unknown trimester and available data do not indicate any risk.

Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity at exposures of the major metabolite of remdesivir that were around human therapeutic exposures (see section 5.3).

Due to very limited experience, remdesivir should not be used during first trimester in pregnancy unless the clinical condition of the woman requires treatment with it. Use in the second and third trimester of pregnancy may be considered.

Use of effective contraception during treatment should be considered in women of child-bearing potential.

Breast-feeding

Remdesivir and its major metabolite are excreted into breast milk in very small amounts after intravenous administration. No clinical effect on the infant is expected due to low breast milk transfer and poor oral bioavailability.

As the clinical experience is limited, a decision about breast-feeding during treatment should be made after a careful individual benefit-risk assessment.

Fertility

No human data on the effect of remdesivir on fertility are available. In male rats, there was no effect on mating or fertility with remdesivir treatment. In female rats, however, an impairment of fertility was observed (see section 5.3). The relevance for humans is unknown.

4.7. Effects on ability to drive and use machines

Remdesivir is predicted to have no or negligible influence on these abilities.

4.8. Undesirable effects

Summary of the safety profile

The most common adverse reaction in healthy volunteers is increased transaminases (14%). The most common adverse reaction in patients with COVID-19 is nausea (4%).

Tabulated summary of adverse reactions

The adverse reactions in Table 7 are listed below by system organ class and frequency. Frequencies are defined as follows: Very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1,000 to < 1/100); rare (≥ 1/10,000 to < 1/1,000); not known (cannot be estimated from the available data).

Table 7: Tabulated list of adverse reactions

Frequency

Adverse reaction

Immune system disorders

Rare

hypersensitivity

Not known

anaphylactic reaction, anaphylactic shock

Nervous system disorders

Common

headache

Cardiac disorders

Not known

sinus bradycardia*

Gastrointestinal disorders

Common

nausea

Hepatobiliary disorders

Very common

transaminases increased

Skin and subcutaneous tissue disorders

Common

rash

Investigations

Very common

prothrombin time prolonged

Injury, poisoning and procedural complications

Rare

infusion-related reaction

*Reported in post-marketing, usually normalised within 4 days following last remdesivir administration without additional intervention

Description of selected adverse reactions

Transaminases increased

In healthy volunteer studies, increases in alanine aminotransferase (ALT), aspartate aminotransferase (AST) or both in subjects who received remdesivir were 1.25 to 2.5 times the upper limit of normal (ULN) (10%) or 2.5 to 5 times ULN (4%). In clinical studies of patients with COVID-19, the incidence of increased transaminases was similar in patients treated with remdesivir compared to placebo or standard of care.

Prothrombin time prolonged

In a clinical study (NIAID ACTT-1) of patients with COVID-19, the incidence of prolonged prothrombin time or INR (predominantly less than 2 times ULN) was higher in subjects who received remdesivir compared to placebo, with no difference observed in the incidence of bleeding events between the two groups. In Study GS-US-540-9012, the incidence of increased prothrombin time or INR was similar in patients treated with remdesivir compared to placebo.

Patients with renal impairment

In Study GS-US-540-5912, 163 hospitalised patients with confirmed COVID-19 and acute kidney injury, chronic kidney disease or ESRD on haemodialysis received remdesivir for up to 5 days (see sections 4.4 and 5.2). Safety data from these patients were comparable to the known safety profile of remdesivir. In this same study, the incidence of increased prothrombin time or INR was higher in patients treated with remdesivir compared to placebo, with no difference observed in the incidence of bleeding events between the two groups (see section 5.1).

Paediatric population

The safety assessment of remdesivir in children 4 weeks of age and older and weighing at least 3 kg with COVID-19 is based on data from a Phase 2/3, open-label clinical trial (Study GS‑US‑540‑5823) in patients who were treated with remdesivir (see Section 5.1). The adverse reactions observed were consistent with those observed in clinical trials of remdesivir in adults.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the dedicated COVID-19 Yellow Card reporting site at coronavirus-yellowcard.mhra.gov.uk.

4.9. Overdose

Treatment of overdose with remdesivir should consist of general supportive measures including monitoring of vital signs and observation of the clinical status of the patient. There is no specific antidote for overdose with remdesivir. In one clinical pharmacology trial, remdesivir 600 mg as a single dose over 30 minutes, equivalent to 3 times the therapeutic loading dose of 200 mg, was administered to 60 healthy subjects. Nausea and/or vomiting (Grades 1-2) was reported for 33 (55%) subjects. One subject (2%) had increased AST and ALT (Grade 4) without elevation of bilirubin.

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Medicines sold in Romania with the same active substance: Cunoscut în România ca

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Medicines sold in Poland with the same active substance: W Polsce znany jako

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