A Case Series on Suspected Remdesivir Induced Hyperammonemia



Abstract Views
440

Downloads
369

Citations

Share

##plugins.themes.bootstrap3.article.sidebar##

Submitted Jun 10, 2021
Published Jul 11, 2021
10.24018/clinicmed.2021.2.3.96

Abstract viewed = 440 times

Table of Contents

##plugins.themes.bootstrap3.article.main##

Remdesivir is a broad spectrum anti-viral drug that has shown to inhibit SARS-CoV-2. In absence of any effective treatment for SARS-CoV-2 infection (COVID-19), Remdesivir has been tried for a compassionate use in severe COVID-19. Remdesivir has shown promise in the management of patients with COVID-19 although recent studies have shown concerns with its effectiveness and safety in practice. Despite this there is a need to document potential Adverse drug Reaction (ADR) to guide future decisions. We describe 2 cases of Suspected Remdesivir-induced hyperammonemia (SRIH) in patients with normal liver function. Serum ammonia levels was raised much above the baseline after a fortnight of therapy. After completion of the therapy, there was gradual improvement and normalization of serum ammonia levels. This suggested a causal relationship which was possibly due to the administration of Remdesivir drug. With the increasing use, physicians should be aware of this potential ADR of Remdesivir and evaluate ammonia levels in patients taking Remdesivir who present with alterations in mental status.

Keywords: Adverse drug reaction, COVID-19, Hyperammonemia, Remdesivir, SARS-Co-V-2

References

  1. Lo M.K., Jordan R., Arvey A. GS-5734 and its parent nucleoside analog inhibit filo-, pneumo-, and paramyxoviruses. Sci Rep. 2017; 7:43395.
     Google Scholar
  2. Sheahan T.P., Sims A.C., Graham R.L. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Sci Transl Med. 2017;9.
     Google Scholar
  3. Agostini M.L., Andres E.L., Sims A.C., Graham R.L., Sheahan T.P., Lu X. Coronavirus susceptibility to the antiviral remdesivir (GS-5734) is mediated by the viral polymerase and the proofreading exoribonuclease. mBio. 2018;9/
     Google Scholar
  4. Summary on compassionate use remdesivir Gilead. https://www.ema.europa.eu/en/documents/other/summary-compassionate-use-remdesivir-gilead_en.pdf (Accessed May 5, 2020)/
     Google Scholar
  5. Singh AK, Singh A, Singh R, Misra A. Remdesivir in COVID-19: A critical review of pharmacology, pre-clinical and clinical studies. Diabetes Metab Syndr. 2020;14(4):641-648.
     Google Scholar
  6. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information; 2004-. PubChem Compound Summary for CID 121304016, Remdesivir; [cited 2021 June 6]. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Remdesivir/
     Google Scholar
  7. Häberle, J (2011). Clinical practice: the management of hyperammonemia. European Journal of Pediatrics, 170(1):21-34.
     Google Scholar
  8. Auron A, Brophy PD. Hyperammonemia in review: pathophysiology, diagnosis, and treatment. Pediatr Nephrol. 2012 Feb;27(2):207-22.
     Google Scholar
  9. Charan J, Kaur RJ, Bhardwaj P, et al. Rapid review of suspected adverse drug events due to remdesivir in the WHO database; findings and implications. Expert Rev Clin Pharmacol. 2021;14(1):95-103.
     Google Scholar
  10. Pan H, Peto R, Henao-Restrepo AM, Preziosi MP, Sathiyamoorthy V, Abdool Karim Q, Alejandria MM, Hernández García C, Kieny MP, Malekzadeh R, Murthy S, Reddy KS, Roses Periago M, Abi Hanna P, Ader F, Al-Bader AM, Alhasawi A, Allum E, Alotaibi A, Alvarez-Moreno CA, Appadoo S, Asiri A, Aukrust P, Barratt-Due A, Bellani S, Branca M, Cappel-Porter HBC, Cerrato N, Chow TS, Como N, Eustace J, García PJ, Godbole S, Gotuzzo E, Griskevicius L, Hamra R, Hassan M, Hassany M, Hutton D, Irmansyah I, Jancoriene L, Kirwan J, Kumar S, Lennon P, Lopardo G, Lydon P, Magrini N, Maguire T, Manevska S, Manuel O, McGinty S, Medina MT, Mesa Rubio ML, Miranda-Montoya MC, Nel J, Nunes EP, Perola M, Portolés A, Rasmin MR, Raza A, Rees H, Reges PPS, Rogers CA, Salami K, Salvadori MI, Sinani N, Sterne JAC, Stevanovikj M, Tacconelli E, Tikkinen KAO, Trelle S, Zaid H, Røttingen JA, Swaminathan S. Repurposed Antiviral Drugs for Covid-19 - Interim WHO Solidarity Trial Results. N Engl J Med. 2021 Feb 11;384(6):497-511.
     Google Scholar