[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Other antivirals](https://durgical.com/en/pharmacology/classes/other-antivirals/) › Remdesivir

[Pharmacology](https://durgical.com/en/pharmacology/) · [Other antivirals](https://durgical.com/en/pharmacology/classes/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

- Class: [Other antivirals](https://durgical.com/en/pharmacology/classes/other-antivirals/)
- Enzyme: SARS-CoV-2 RNA-dependent RNA polymerase (nsp12)
- ATC code: J05AB16

✂**SARS-CoV-2 RNA-dependent RNA polymerase (nsp12)**Remdesivir

ⓘ The figure shows remdesivir monophosphate incorporated into the RNA primer in the SARS-CoV-2 polymerase complex (nsp12-nsp7-nsp8) (cryo-EM).

**Target in 3D:** SARS-CoV-2 RNA-dependent RNA polymerase (nsp12). PDB structure 7BV2 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/7BV2) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/covid-19/)
- COVID-19 in non-hospitalized patients at high risk of severe disease, started within 7 days of symptoms [COVID-19 →](https://durgical.com/en/conditions/covid-19/)

## Adverse effects

### Common

- Nausea
- Raised ALT and AST
- Pain, bruising or swelling at the infusion site

### Serious (rare, important)

- Infusion-related reactions and anaphylaxis (low blood pressure, fast heart rate, breathlessness, rash)
- Liver injury

## 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.

## Memory aid

REMdesivir: «three more and stop» (delayed chain termination) for the coronavirus polymerase.

## 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.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/remdesivir/)

## Related drugs

- [Nirmatrelvir + ritonavir](https://durgical.com/en/pharmacology/nirmatrelvir-ritonavir/)
- [Sofosbuvir](https://durgical.com/en/pharmacology/sofosbuvir/)

## Related conditions

- [COVID-19](https://durgical.com/en/conditions/covid-19/)

[← Back to the class: Other antivirals](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a620033.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J05AB16) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 62 (McGraw Hill, 2023).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/remdesivir/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/remdesivir/