Coronavirus in Maharashtra: State issues guidelines for Remdesivir use
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Amid reports of increasing demand for Remdesivir vial and its black marketing, the Maharashtra Directorate of Medical Education and Research has issued a circular asking the civic and district administration to strictly implement guidelines issued by the Drug Control General of India (DCGI) and the state Task Force for its use to treat Covid 19 patients. The circular was issued by the state nodal officer and the Director of Medical Education and Research Dr Tatyarao Lahane. According to these guidelines, it is mandatory for hospitals and nursing homes to take informed consent from relatives of Covid 19 patients prior to administration of Remdesivir.

According to these guidelines, Remdesivir being an anti-Covid and antiviral, will have to be used for moderate to severe patients in hospital in the first 10 days of the infection and only for five days. Its use for 10 days is not recommended and the vial should be used by hospitals and nursing homes only. The directorate has recommended monitoring of liver function tests and ADRs as well as pharmacovigilance.

‘’Remdesivir triphosphate acts as an adenosine triphosphate (ATP) analog and competes for incorporation into RNA chains by the SARS-CoB-2 RNA-dependent RNA polymerase resulting in delayed chain termination during viral RNA replications. It is a repurposed drug.

The circular states that infusion related reactions including diaphoresis, hypotension, nausea, shivering and vomiting have been observed during and/or have been temporarily associated with Remdesivir administration. ‘’Discontinue administration and institute appropriate treatment if a clinically/significant infusion reaction occurs,’’ it added.

Further, the Directorate has made it amply clear that the concomitant use of Hydroxychloroquine and Remdesivir is not recommended as it may decrease the anti-viral activity. It has suggested that methylprednisolone can be an alternative.

As far as use of Steroids are concerned, the Directorate has said that it should not be administered for prevention or treatment of Covid 19 infection not requiring Oxygen. ‘’Patients receiving Steroids should be monitored for adverse effects. The Recovery Trial, a large randomized open label trial in the United Kingdom has demonstrated mortality benefit with the use of Steroids in patients with Covid 19 infection who have requirements for Oxygen or are on mechanical ventilation,’’ it noted.

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