Pharmacology · Other antivirals
Remdesivir !
An intravenous COVID-19 antiviral that blocks the coronavirus RNA polymerase. It needs liver tests and watch for infusion reactions.
Updated 2026-11-01
The figure shows remdesivir monophosphate incorporated into the RNA primer in the SARS-CoV-2 polymerase complex (nsp12-nsp7-nsp8) (cryo-EM).
Mechanism of action
Remdesivir is a phosphoramidate prodrug of an adenosine nucleotide analogue. Inside cells it becomes remdesivir triphosphate, which the viral RNA-dependent RNA polymerase uses in place of ATP. After incorporating it, the polymerase adds only three more nucleotides and then stops: a delayed chain termination.
- Enters cells and is converted to remdesivir triphosphate
- The viral polymerase incorporates it in place of ATP
- Three more nucleotides are added
- RNA synthesis stops
Pharmacokinetics
- Absorption
- Intravenous only
- Metabolism
- Extensively metabolized in cells and tissues to its active triphosphate; main circulating metabolite GS-441524
- Elimination
- Mainly as metabolites in the urine
Indications
- COVID-19 in hospitalized patients COVID-19 →
- COVID-19 in non-hospitalized patients at high risk of severe disease, started within 7 days of symptoms COVID-19 →
Adverse effects
Common
- Nausea
- Raised ALT and AST
- Pain, bruising or swelling at the infusion site
Contraindications
- Clinically significant hypersensitivity to remdesivir or its components
Key interactions
- Chloroquine or hydroxychloroquine
- Reduce the antiviral activity of remdesivir; not recommended together
What is monitored
- Liver tests and prothrombin time before starting and during treatment
- Vital signs during the infusion and for at least an hour after
- Kidney function in children (the solubilizing excipient is cleared by the kidneys)
Administration and safety
- Intravenous infusion over 30 to 120 minutes
- Reactions usually appear in the first hour: the patient is observed during and after
- Slow or stop the infusion if a reaction appears, and inform the doctor
Nursing care
- Record baseline vital signs
- Watch for chills, rash, wheeze, low blood pressure or fast heart rate during the infusion
- Teach to report jaundice, dark urine or right upper abdominal pain
- Check the infusion site
Pregnancy and breastfeeding
Data from the second and third trimesters have not shown a drug-related risk of major birth defects or miscarriage; first-trimester data are insufficient.
Test yourself
Think of the answer, then tap the question to see it.
Which viral enzyme does remdesivir target?
The SARS-CoV-2 RNA-dependent RNA polymerase (nsp12).
What is meant by delayed chain termination?
After remdesivir is incorporated, the polymerase adds three more nucleotides and then stops.
Which drugs reduce the antiviral activity of remdesivir?
Chloroquine and hydroxychloroquine.
Which laboratory tests are done before remdesivir?
Liver tests and prothrombin time.
Related drugs
Related conditions
← Back to the class: Other antivirals
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Remdesivir Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 62 (McGraw Hill, 2023).
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Representative model, for educational purposes only.