🕷️ Crawler Inspector

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Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 152 (from laksa174)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa152.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Remdesivir\')), getAhrefsUnparsedNoserviceFromURL(\'https://en.wikipedia.org/wiki/Remdesivir\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/en.wikipedia.org\/wiki\/Remdesivir","crawl_time":1775387571,"first_indexed_time":1521614638,"http_code":200,"src_unparsed":"org,wikipedia!en,\/wiki\/Remdesivir s443","src_root_hash":"17790707453426894952","history_drop_reason":null,"meta_title":"Remdesivir - Wikipedia","meta_descriptions":[],"attrs_boilerpipe_text":"Remdesivir\nClinical data\nPronunciation\nrem-\nDESS\n-i-veer\nTrade names\nVeklury\nOther names\nGS-5734, RDV\nAHFS\n\/\nDrugs.com\nMonograph\nMedlinePlus\na620033\nLicense data\nUS\n \nDailyMed\n: \nRemdesivir\nPregnancy\ncategory\nAU\n:\nB2\n[\n1\n]\n[\n2\n]\nRoutes of\nadministration\nIntravenous\nDrug class\nAntiviral\nATC code\nJ05AB16\n(\nWHO\n)\nLegal status\nLegal status\nAU\n:\nS4\n(Prescription only)\n[\n3\n]\n[\n1\n]\n[\n4\n]\n[\n5\n]\n[\n2\n]\nCA\n:\n℞-only\n[\n6\n]\n[\n7\n]\n[\n8\n]\nUK\n:\nPOM\n(Prescription only)\n[\n9\n]\n[\n10\n]\nUS\n:\n℞-only\n[\n11\n]\nEU\n:\nRx-only\n[\n12\n]\n[\n13\n]\nIN\n:\nSchedule H\n(℞-only)\n[\n14\n]\n[\n15\n]\nIdentifiers\nIUPAC name\n(2\nS\n)-2-{(2\nR\n,3\nS\n,4\nR\n,5\nR\n)-[5-(4-Aminopyrrolo[2,1-\nf\n] [1,2,4]triazin-7-yl)-5-cyano-3,4-dihydroxy-tetrahydro-furan-2-ylmethoxy]phenoxy-(\nS\n)-phosphorylamino}propionic acid 2-ethyl-butyl ester\nCAS Number\n1809249-37-3\nPubChem\nCID\n121304016\nDrugBank\nDB14761\nChemSpider\n58827832\nUNII\n3QKI37EEHE\nKEGG\nD11472\nChEBI\nCHEBI:145994\nChEMBL\nChEMBL4065616\nCompTox Dashboard\n(\nEPA\n)\nDTXSID701022537\nECHA InfoCard\n100.302.974\nChemical and physical data\nFormula\nC\n27\nH\n35\nN\n6\nO\n8\nP\nMolar mass\n602.585\n g·mol\n−1\n3D model (\nJSmol\n)\nInteractive image\nSMILES\nCCC(COC(=O)[C@@H](NP(=O)(Oc1ccccc1)OC[C@H]1O[C@@]([C@@H]([C@@H]1O)O)(C#N)c1ccc2n1ncnc2N)C)CC\nInChI\nInChI=1S\/C27H35N6O8P\/c1-4-18(5-2)13-38-26(36)17(3)32-42(37,41-19-9-7-6-8-10-19)39-14-21-23(34)24(35)27(15-28,40-21)22-12-11-20-25(29)30-16-31-33(20)22\/h6-12,16-18,21,23-24,34-35H,4-5,13-14H2,1-3H3,(H,32,37)(H2,29,30,31)\/t17-,21+,23+,24+,27-,42-\/m0\/s1\nKey:RWWYLEGWBNMMLJ-YSOARWBDSA-N\nRemdesivir\n, sold under the brand name\nVeklury\n,\n[\n12\n]\n[\n16\n]\nis a\nbroad-spectrum antiviral medication\ndeveloped by the\nbiopharmaceutical\ncompany\nGilead Sciences\n.\n[\n17\n]\nIt is administered via\ninjection into a vein\n.\n[\n18\n]\n[\n19\n]\nDuring the\nCOVID‑19 pandemic\n, remdesivir was approved or authorized for emergency use to treat\nCOVID‑19\nin numerous countries.\n[\n20\n]\nRemdesivir was originally developed to treat\nhepatitis C\n,\n[\n21\n]\nand was subsequently investigated for\nEbola virus disease\nand\nMarburg virus\ninfections\n[\n22\n]\nbefore being studied as a post-infection treatment for COVID‑19.\n[\n23\n]\nRemdesivir is a\nprodrug\nthat is intended to allow intracellular delivery of\nGS-441524\nmonophosphate and subsequent biotransformation into GS-441524\ntriphosphate\n, a ribo\nnucleotide analogue\ninhibitor of viral\nRNA polymerase\n.\n[\n24\n]\nThe most common side effect in healthy volunteers is raised blood levels of\nliver enzymes\n.\n[\n12\n]\nThe most common side effect in people with COVID‑19 is\nnausea\n.\n[\n12\n]\nSide effects may include liver inflammation and an\ninfusion\n-related reaction with nausea,\nlow blood pressure\n, and sweating.\n[\n25\n]\nThe US\nFood and Drug Administration\n(FDA) considers it to be a\nfirst-in-class medication\n.\n[\n26\n]\nMedical uses\nIn the European Union, remdesivir is\nindicated\nfor the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) with\npneumonia\nrequiring supplemental oxygen and for adults who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID‑19.\n[\n9\n]\n[\n12\n]\nIn the United States, remdesivir is indicated for the treatment of COVID‑19 in people 28 days of age and older and weighing at least 3 kilograms (6.6 lb) who are hospitalized; or not hospitalized and have mild-to-moderate COVID‑19, and are at high risk for progression to severe COVID‑19, including hospitalization or death.\n[\n11\n]\n[\n27\n]\nIn November 2020, the FDA issued an emergency use authorization (EUA) for the combination of\nbaricitinib\nwith remdesivir, for the treatment of suspected or laboratory confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or\nextracorporeal membrane oxygenation\n(ECMO).\n[\n28\n]\nIn Australia, it is approved for those aged four weeks of age and older with a body weight at least 3 kilograms (6.6 lb) with\npneumonia\nrequiring supplemental oxygen or those aged four weeks of age and older with body weight at least 40 kilograms (88 lb) who do not require supplemental oxygen and who are at high risk of progressing to severe COVID‑19.\n[\n29\n]\n[\n2\n]\nIn 2024, a retrospective study found treatment with the antiviral remdesivir plus dexamethasone was associated with fewer deaths in hospitalized COVID-19 patients compared to dexamethasone alone.\n[\n30\n]\nThe combination led to a 26% reduction in mortality at 14 days and a 24% reduction at 28 days.\n[\n31\n]\nSide effects\nThe most common adverse effects in people treated with remdesivir were\nrespiratory failure\nand blood\nbiomarkers\nof\norgan\nimpairment, including\nlow albumin\n,\nlow potassium\n,\nlow count of red blood cells\n,\nlow count of thrombocytes\n, and\nelevated bilirubin (jaundice)\n.\n[\n32\n]\nOther reported adverse effects include\ngastrointestinal distress\n, elevated\ntransaminase\nlevels in the blood (\nliver enzymes\n),\ninfusion\nsite reactions, and\nelectrocardiogram abnormalities\n.\n[\n19\n]\nRemdesivir may cause\ninfusion-related\nreactions, including low blood pressure, nausea, vomiting, sweating or shivering.\n[\n33\n]\nOther possible side effects of remdesivir include:\nInfusion-related reactions. Infusion-related reactions have been seen during a remdesivir infusion or around the time remdesivir was given.\n[\n33\n]\nSigns and symptoms of infusion-related reactions may include: low blood pressure, nausea, vomiting, sweating, and shivering.\n[\n33\n]\nIncreases in levels of liver enzymes, seen in abnormal liver blood tests.\n[\n33\n]\nIncreases in levels of liver enzymes have been seen in people who have received remdesivir, which may be a sign of inflammation or damage to cells in the liver.\n[\n33\n]\nPharmacology\nActivation\nActivation of remdesivir into its active triphosphate metabolite\n[\n34\n]\nRemdesivir is a\nprotide\n(\nprodrug\nof nucleotide) able to diffuse into cells, where it is converted to\nGS-441524\nmonophosphate via the actions of\nesterases\n(\nCES1\nand\nCTSA\n) and a\nphosphoamidase\n(\nHINT1\n); this in turn is further phosphorylated to its\nactive metabolite\ntriphosphate by\nnucleoside-phosphate kinases\n.\n[\n35\n]\n[\n36\n]\nThis pathway of bioactivation is meant to occur\nintracellularly\n, but a substantial amount of remdesivir is prematurely\nhydrolyzed\nin plasma, with GS-441524 being the major metabolite in plasma, and the only metabolite remaining two hours after dosing.\n[\n24\n]\nMechanism of action\nAs an\nadenosine\nnucleoside triphosphate analog (GS-443902),\n[\n37\n]\nthe\nactive metabolite\nof remdesivir interferes with the action of viral\nRNA-dependent RNA polymerase\nand evades\nproofreading\nby viral\nexoribonuclease\n(ExoN), causing a decrease in viral RNA production.\n[\n17\n]\n[\n38\n]\nIn some viruses, such as the\nrespiratory syncytial virus\n, it causes the RNA-dependent RNA polymerases to pause, but its predominant effect (as in Ebola) is to induce an irreversible\nchain termination\n. Unlike with many other chain terminators, this is not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain.\n[\n39\n]\nFor the RNA-dependent RNA polymerases of\nMERS-CoV\n,\nSARS-CoV-1\n, and\nSARS-CoV-2\n, arrest of RNA synthesis occurs after incorporation of three additional nucleotides.\n[\n40\n]\n[\n36\n]\nHence, remdesivir is classified as a direct-acting antiviral agent that works as a delayed chain terminator.\n[\n34\n]\n[\n36\n]\nPharmacokinetics\nIn non-human primates, the plasma\nhalf-life\nof the prodrug is 20 minutes, with the main metabolite being the\nnucleoside\n,\nGS-441524\n. Two hours post injection, the main metabolite GS-441524 is present at micromolar concentrations, whilst intact Remdesivir is no longer detectable. Because of this rapid extracellular conversion to the nucleoside GS-441524, some researchers have questioned whether the active nucleotide triphosphate is truly derived from remdesivir pro-drug removal or whether it occurs by GS-441524 phosphorylation, and whether direct administration of GS-441524 would constitute a cheaper and easier to administer COVID‑19 drug compared to remdesivir.\n[\n41\n]\n[\n24\n]\nThe activated nucleotide triphosphate form has sustained intracellular levels in\nPBMC\nand presumably in other cells as well.\n[\n34\n]\nResistance\nMutations in the\nmouse hepatitis virus\nRNA replicase\nthat cause partial resistance to remdesivir were identified in 2018. These mutations make the viruses less effective in nature, and the researchers believe they will likely not persist where the drug is not being used.\n[\n42\n]\nInteractions\nRemdesivir is at least partially metabolized by the\ncytochrome P450\nenzymes\nCYP2C8\n,\nCYP2D6\n, and\nCYP3A4\n.\n[\n43\n]\n[\n25\n]\nBlood plasma\nconcentrations of remdesivir are expected to decrease if it is administered together with cytochrome P450\ninducers\nsuch as\nrifampicin\n,\ncarbamazepine\n,\nphenobarbital\n,\nphenytoin\n,\nprimidone\n, and\nSt John's wort\n.\n[\n44\n]\nUsing chloroquine or\nhydroxychloroquine\nwith remdesivir may reduce the antiviral activity of remdesivir.\n[\n11\n]\n[\n9\n]\n[\n45\n]\nCoadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on\nin vitro\ndata demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir.\n[\n11\n]\nSynthesis\nSynthesis of remdesivir in\nstructural formulae\nRemdesivir can be synthesized in multiple steps from\nribose\nderivatives. The figure to the right is one of the synthesis routes of remdesivir invented by Chun and coauthors from Gilead Sciences.\n[\n46\n]\n[\n47\n]\nIn vitro\nexperiments\nAn\nin vitro\nstudy of remdesivir assessing antiviral activity against SARS-CoV-2 was performed.\n[\n48\n]\nCells were pre-treated with the different doses of remdesivir for 1 hour, and the virus (MOI of 0.05) was subsequently added to allow infection for 2 hours.\n[\n48\n]\nThe results found that remdesivir functioned well as an inhibitor of the infection.\n[\n48\n]\nThe study was published as a letter to the editor, and as such did not undergo peer review.\nManufacturing\nRemdesivir requires \"70 raw materials, reagents, and catalysts\" to make, and approximately \"25 chemical steps.\"\n[\n49\n]\nSome of the ingredients are extremely dangerous to humans, especially\ntrimethylsilyl cyanide\n.\n[\n49\n]\nThe original end-to-end manufacturing process required 9 to 12 months to go from raw materials at contract manufacturers to finished product, but after restarting production in January 2020, Gilead Sciences was able to find ways to reduce the production time to six months.\n[\n49\n]\nIn January 2020, Gilead began working on restarting remdesivir production in glass-lined steel\nchemical reactors\nat its manufacturing plant in\nEdmonton, Alberta\n.\n[\n49\n]\nOn 2 February 2020, the company flew its entire stock of remdesivir, 100 kilograms in powder form (left over from Ebola research), to its filling plant in\nLa Verne, California\n, to start filling vials.\n[\n49\n]\nThe Edmonton plant finished its first new batch of remdesivir in April 2020.\n[\n49\n]\nAround the same time, fresh raw materials began to arrive from contract manufacturers reactivated by Gilead in January.\n[\n49\n]\nAnother challenge is getting remdesivir into patients despite the drug's \"poor predicted solubility and poor stability.\"\n[\n50\n]\nIn June 2020,\nLigand Pharmaceuticals\nrevealed that Gilead has been managing those issues by mixing Ligand's proprietary\nexcipient\nCaptisol (based on\nUniversity of Kansas\nresearch into\ncyclodextrin\n) with remdesivir at a 30:1 ratio.\n[\n50\n]\nSince that implies an enormous amount of Captisol is needed to stabilize and deliver remdesivir (on top of amounts needed for several other drugs for which the excipient is already in regular use), Ligand announced that it is trying to boost Captisol annual manufacturing capacity to as much as 500 metric tons.\n[\n50\n]\nOn 12 May 2020, Gilead announced that it had granted non-exclusive voluntary licenses to five\ngeneric drug\ncompanies in India and Pakistan to manufacture remdesivir for distribution to 127 countries.\n[\n51\n]\n[\n52\n]\n[\n53\n]\nThe agreements were structured so that the licensees can set their own prices and will not have to pay royalties to Gilead until the WHO declares an end to the COVID‑19 emergency or another medicine or vaccine is approved for COVID‑19, whichever comes first.\n[\n51\n]\nOn 23 June 2020, India granted emergency marketing approval of generic remdesivir manufactured by two Gilead licensees,\nCipla\nand\nHetero Drugs\n.\n[\n54\n]\nSociety and culture\nLegal status\nRemdesivir is approved, or authorized for emergency use, to treat COVID‑19 in many countries.\n[\n20\n]\nRemdesivir has been authorized for emergency use in India,\n[\n55\n]\nSingapore,\n[\n56\n]\nand approved for use in Japan,\n[\n57\n]\nthe European Union, the United States, and Australia for people with severe symptoms.\n[\n12\n]\n[\n16\n]\n[\n58\n]\n[\n59\n]\n[\n60\n]\n[\n61\n]\n[\n62\n]\n[\n63\n]\n[\n64\n]\nRemdesivir is the first treatment for COVID‑19 to be approved by the US\nFood and Drug Administration\n(FDA).\n[\n64\n]\nThe approval by the FDA does not include the entire population that had been authorized to use remdesivir under an Emergency Use Authorization (EUA) originally issued in May 2020.\n[\n64\n]\nIn order to ensure continued access to the pediatric population previously covered under the EUA, the FDA revised the EUA for remdesivir to authorize the drug's use for treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized pediatric patients weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized pediatric patients less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).\n[\n64\n]\nAustralia\nIn July 2020, remdesivir was provisionally approved for use in Australia for use in adults and adolescents with severe COVID‑19 symptoms who have been hospitalized.\n[\n61\n]\n[\n65\n]\nAustralia claims to have a sufficient supply of remdesivir in its national stockpile.\n[\n66\n]\nCanada\nAs of 11 April 2020, access in Canada was available only through clinical trials.\n[\n67\n]\nHealth Canada\napproved requests to treat twelve people with remdesivir under the department's special-access program (SAP).\n[\n68\n]\nAdditional doses of remdesivir are not available through the SAP except for pregnant women or children with confirmed COVID‑19 and severe illness.\n[\n67\n]\nIn June 2020, Health Canada received an application from Gilead for the use of remdesivir for treating COVID‑19.\n[\n67\n]\nOn 27 July 2020, Health Canada conditionally approved the application.\n[\n69\n]\n[\n6\n]\nIn September 2020,\nMinister of Public Services and Procurement\nAnita Anand\nannounced that Canada had entered into a deal to obtain up to 150,000 vials of remdesivir from Gilead starting in October.\n[\n70\n]\nAs of 8 October, remdesivir was still not widely available in\nAlberta\n, because\nAlberta Health Services\nwas undertaking a \"\nformulary\nreview\" to be completed by mid-November.\n[\n71\n]\nCzech Republic\nIn March 2020, the drug was provisionally approved for use for COVID‑19 patients in a serious condition as a result of\nthe outbreak in the Czech Republic\n.\n[\n72\n]\nEuropean Union\nIn February 2016,\norphan designation\n(EU\/3\/16\/1615) was granted by the European Commission to Gilead Sciences International Ltd, United Kingdom, for remdesivir for the treatment of Ebola virus disease.\n[\n73\n]\nIn April 2020, the\nEuropean Medicines Agency\n(EMA) provided recommendations on compassionate use of remdesivir for COVID‑19 in the EU.\n[\n74\n]\nIn May 2020, the\nCommittee for Medicinal Products for Human Use\n(CHMP) of the EMA recommended expanding the compassionate use of remdesivir to those not on mechanical ventilation.\n[\n75\n]\nIn addition to those undergoing invasive mechanical ventilation, the compassionate use recommendations cover the treatment of hospitalized individuals requiring supplemental oxygen, non-invasive ventilation, high-flow oxygen devices or ECMO (extracorporeal membrane oxygenation).\n[\n75\n]\nThe updated recommendations were based on preliminary results from the NIAID-ACTT study,\n[\n76\n]\nwhich suggested a beneficial effect of remdesivir in the treatment of hospitalized individuals with severe COVID‑19.\n[\n75\n]\n[\n77\n]\nIn addition, a treatment duration of five days was introduced alongside the longer ten-day course, based on preliminary results from another study (GS-US-540-5773) suggesting that for those not requiring mechanical ventilation or ECMO, the treatment course may be shortened from ten to five days without any loss of efficacy.\n[\n75\n]\nIndividuals who receive a five-day treatment course but do not show clinical improvement will be eligible to continue receiving remdesivir for an additional five days.\n[\n75\n]\nIn July 2020, the European Union granted a conditional marketing authorization for remdesivir with an indication for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms [88 lb]) with pneumonia requiring supplemental oxygen.\n[\n12\n]\n[\n78\n]\nIn August 2022, the European Union granted a full marketing authorization for remdesivir.\n[\n12\n]\n[\n78\n]\n[\n79\n]\nIran\nRemdesivir has been also produced in Iran by\nBarakat\n; Iran is planning to increase the productions of Remdesivir ampoules from 20,000 to 150,000 ampoules per month. It has also the permission of the \"Food and Drug Administration\" of\nMOHME\n.\n[\n80\n]\nJapan\nIn May 2020,\nJapan's Ministry of Health, Labour and Welfare\napproved the drug for use in Japan, in a fast-tracked process, based on the US emergency authorization.\n[\n16\n]\n[\n60\n]\nMexico\nIn October 2020, Deputy Secretary of Prevention and Health Promotion\nHugo López-Gatell Ramírez\nstated at a news conference that Mexico would not necessarily follow the United States in approving the drug for use in Mexico. López-Gatell explained that the\nFederal Commission for the Protection against Sanitary Risk\n(Cofepris) had already twice denied the approval of remdesivir because, in that agency's view, the evidence does not suggest \"sufficient efficacy\".\n[\n81\n]\nIn March 2020, Cofepris authorized the drug for emergency cases, advising to give continuous surveillance of the integral health of the patient.\n[\n82\n]\nSingapore\nIn June 2020, Singapore's\nHealth Sciences Authority\nconditionally approved the usage of remdesivir in Singapore.\n[\n56\n]\nUnited States\nIn March 2020, United States President\nDonald Trump\nannounced that remdesivir was available for \"\ncompassionate use\n\" for people with COVID‑19; FDA Commissioner\nStephen Hahn\nconfirmed the statement at the same press conference.\n[\n83\n]\nIt was later revealed that Gilead had been providing remdesivir in response to compassionate use requests since 25 January.\n[\n21\n]\n[\n84\n]\nOn 23 March 2020, Gilead voluntarily suspended access for compassionate use (excepting cases of critically ill children and pregnant women), for reasons related to supply, citing the need to continue to provide the agent for testing in clinical trials.\n[\n85\n]\n[\n86\n]\nIn May 2020, the US\nFood and Drug Administration\ngranted Gilead\nemergency use authorization\n(EUA) for remdesivir to be distributed and used by licensed healthcare providers to treat adults and children hospitalized with severe COVID‑19.\n[\n59\n]\n[\n33\n]\nSevere COVID‑19 is defined as patients with an oxygen saturation (SpO2) <= 94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring\nextracorporeal membrane oxygenation\n(ECMO), a heart–lung bypass machine.\n[\n25\n]\n[\n33\n]\n[\n87\n]\n[\n88\n]\nDistribution of remdesivir under the EUA was controlled by the US government for use consistent with the terms and conditions of the EUA.\n[\n33\n]\nGilead supplied remdesivir to authorized distributors, or directly to a US government agency, who distributed it to hospitals and other healthcare facilities as directed by the US government, in collaboration with state and local government authorities, as needed.\n[\n33\n]\nGilead stated they were donating 1.5\n \nmillion vials for emergency use\n[\n87\n]\nand estimated, as of April 2020, they had enough remdesivir for 140,000 treatment courses and expect to have 500,000 courses by October 2020, and one million courses by the end of 2020.\n[\n89\n]\n[\n90\n]\nThe initial distribution of the drug in the US was tripped up by seemingly capricious decision-making and finger-pointing, resulting in over a week of confusion and frustration among healthcare providers and patients alike.\n[\n91\n]\n[\n92\n]\n[\n93\n]\nOn 9 May 2020, the\nUnited States Department of Health and Human Services\n(HHS) explained in a statement that it would be distributing remdesivir vials to\nstate health departments\n, then would allow each department to redistribute vials to hospitals in their respective states based upon each department's insight into \"community-level needs.\"\n[\n94\n]\nHHS also clarified that only 607,000 vials of Gilead's promised donation of 1.5\n \nmillion vials would be going to American patients.\n[\n94\n]\nHowever, HHS did not explain why several states with some of the highest caseloads had been omitted from the first two distribution rounds, including California, Florida, and Pennsylvania.\n[\n94\n]\nIn May 2020, Gilead indicated they would increase the number of doses donated to the US from 607,000 to around 940,000.\n[\n95\n]\n[\n93\n]\nSome of the initial distribution was sent to the wrong hospitals, to hospitals with no intensive care units, and to facilities without the needed refrigeration to store it.\n[\n93\n]\nIn June 2020, HHS announced an unusual agreement with Gilead in which HHS agreed to Gilead's\nwholesale acquisition price\n, HHS would continue to work together with state governments and drug wholesaler\nAmerisourceBergen\nto allocate shipments of remdesivir vials to American hospitals through the end of September 2020, and in exchange, during that three-month timeframe (July, August, and September), American patients would be allocated over 90% of Gilead's projected remdesivir output of more than 500,000 treatment courses.\n[\n96\n]\n[\n97\n]\nAbsent from these announcements was any discussion of allocation of remdesivir production to the approximately 70 countries omitted from Gilead's generic drug licensing agreements—including much of Europe\n[\n98\n]\nand countries as populous as Brazil, China, and Mexico—or the 127 countries listed on those agreements (during the time it will take for Gilead's generic licensees to ramp up their own production).\n[\n99\n]\nAs the implications of this began to sink in, several countries publicly confirmed the next day that they already had adequate supplies of remdesivir to cover current needs, including Australia,\n[\n100\n]\nGermany,\n[\n101\n]\nand the United Kingdom.\n[\n102\n]\nIn August 2020, the FDA broadened the Emergency Use Authorization (EUA) for remdesivir to include all hospitalized patients with suspected or laboratory-confirmed COVID‑19, irrespective of the severity of their disease.\n[\n103\n]\n[\n104\n]\nThe Fact Sheet was updated to reflect the new guidance.\n[\n25\n]\nIn October 2020, Gilead and HHS announced that HHS was relinquishing control over remdesivir allocation because production of the drug had finally caught up with US domestic demand.\n[\n105\n]\n[\n106\n]\n[\n107\n]\nAmerisourceBergen will remain the sole distributor of Veklury in the US through the end of 2020.\n[\n107\n]\nOn 22 October 2020, the FDA approved remdesivir and also revised the EUA to permit the use of remdesivir for treatment of suspected or laboratory confirmed COVID‑19 in hospitalized children weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized children less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).\n[\n64\n]\n[\n25\n]\n[\n108\n]\n[\n109\n]\nThis decision was criticized for an alleged lack of previous consultation on part of the FDA given the complications of antiviral drug issues.\n[\n110\n]\nIn November 2020, the FDA issued an EUA for the combination of\nbaricitinib\nwith remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).\n[\n28\n]\nThe data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).\n[\n28\n]\nThe EUA was issued to Eli Lilly and Company.\n[\n28\n]\nRemdesivir received approval from the US\nFood and Drug Administration\n(FDA) in October 2020, for use in adults and children twelve years and older requiring hospitalization for treatment of severe COVID‑19 infections.\n[\n64\n]\nIn January 2022, the FDA gave regulatory approval to remdesivir for use in adults and children (twelve years of age and older who weigh at least 40 kilograms (88 lb) and are positive for COVID‑19, not hospitalized, and are ill with COVID‑19 having high risk for developing severe COVID‑19, including hospitalization or death.\n[\n111\n]\nIn April 2022, the FDA expanded the approval of remdesivir to include people 28 days of age and older weighing at least 3 kilograms (6.6 lb).\n[\n27\n]\nThe FDA also provided\nemergency use authorization\nin 2022, for remdesivir treatment of children under age twelve who are COVID‑positive and not hospitalized, but have mild-to-moderate COVID‑19 with high risk of developing severe infection, including hospitalization or death.\n[\n111\n]\nEconomics\nIn June 2020, Gilead announced that it had set the price of remdesivir at\nUS$390\nper vial for the governments of developed countries, including the United States, and\nUS$520\nfor US private health insurance companies.\n[\n112\n]\nThe expected course of treatment is six vials over five days for a total cost of\nUS$2,340\n.\n[\n112\n]\nBeing a\nrepurposed drug\n, the minimum production cost for remdesivir is estimated at\nUS$0.93\nper day of treatment.\n[\n113\n]\nIn July 2020, the European Union secured a\n€63 million\n(\nUS$74 million\n) contract with Gilead, to make the drug available there in early August 2020.\n[\n114\n]\nIn October 2020, Gilead Sciences and the European Commission announced they had signed a joint procurement framework contract in which Gilead agreed to provide up to 500,000 remdesivir treatment courses over the next six months to 37 European countries. Among the contracting countries were all 27 EU member states plus the United Kingdom, \"Albania, Bosnia & Herzegovina, Iceland, Kosovo, Montenegro, North Macedonia, Norway, and Serbia\".\n[\n115\n]\nAt the time, the price per treatment course was not disclosed; Reuters reported the price was 2,070 euros, thereby implying the total value of the contract (if all 500,000 courses are ordered) is approximately €1.035 billion.\n[\n116\n]\nUnder the contract, each participating country will directly place orders with Gilead and pay Gilead directly for its own orders.\n[\n116\n]\nNames\nRemdesivir is the\ninternational nonproprietary name\n(INN)\n[\n117\n]\nwhile the development code name was GS-5734.\n[\n118\n]\nResearch\nRemdesivir was originally created and developed by\nGilead Sciences\nin 2009, to treat\nhepatitis C\nand\nrespiratory syncytial virus\n(RSV).\n[\n21\n]\n[\n119\n]\nIt did not work against hepatitis C or RSV,\n[\n21\n]\n[\n119\n]\nbut was then repurposed and studied as a potential treatment for\nEbola virus disease\nand\nMarburg virus\ninfections.\n[\n120\n]\n[\n119\n]\nAccording to the\nCzech News Agency\n, this new line of research was carried out under the direction of scientist\nTomáš Cihlář\n.\n[\n121\n]\nA collaboration of researchers from the\nCenters for Disease Control and Prevention\n(CDC) and\nGilead Sciences\nsubsequently discovered that remdesivir had antiviral activity\nin vitro\nagainst multiple\nfiloviruses\n,\npneumoviruses\n, paramyxoviruses, and\ncoronaviruses\n.\n[\n122\n]\nPreclinical and clinical research and development was done in collaboration between Gilead Sciences and various US government agencies and academic institutions.\n[\n34\n]\n[\n123\n]\n[\n124\n]\n[\n125\n]\nDuring the mid-2010s, the\nMintz Levin\nlaw firm prosecuted various patent applications for remdesivir on behalf of Gilead Sciences before the\nUnited States Patent and Trademark Office\n(USPTO). The USPTO granted two patents on remdesivir to Gilead Sciences on 9 April 2019: one for filoviruses,\n[\n126\n]\nand one which covered both\narenaviruses\nand coronaviruses.\n[\n127\n]\nEbola\nIn October 2015, the\nUnited States Army Medical Research Institute of Infectious Diseases\n(USAMRIID) announced preclinical results that remdesivir had blocked the\nEbola virus\nin\nRhesus monkeys\n. Travis Warren, who has been a USAMRIID principal investigator since 2007, said that the \"work is a result of the continuing collaboration between USAMRIID and Gilead Sciences\".\n[\n128\n]\nThe \"initial screening\" of the \"Gilead Sciences compound library to find molecules with promising antiviral activity\" was performed by scientists at the\nCenters for Disease Control and Prevention\n(CDC).\n[\n128\n]\nAs a result of this work, it was recommended that remdesivir \"should be further developed as a potential treatment.\"\n[\n120\n]\n[\n128\n]\nRemdesivir was rapidly pushed through clinical trials due to the\nWest African Ebola virus epidemic\nof 2013–2016, eventually being used in people with the disease. Preliminary results were promising; it was used in the emergency setting during the\nKivu Ebola epidemic\nthat started in 2018, along with further clinical trials, until August 2019, when Congolese health officials announced that it was significantly less effective than\nmonoclonal antibody\ntreatments such as\nansuvimab\nand\natoltivimab\/maftivimab\/odesivimab\n. The trials, however, established its safety profile.\n[\n129\n]\nCOVID-19\nHospitalized patients\nRemdesivir was approved for medical use in the United States in October 2020.\n[\n62\n]\n[\n63\n]\n[\n64\n]\n[\n109\n]\nThe US\nFood and Drug Administration\n(FDA) approved remdesivir based on the agency's analysis of data from three randomized, controlled clinical trials that included participants hospitalized with mild-to-severe COVID‑19.\n[\n64\n]\n[\n109\n]\nThe FDA granted approval and reissued the revised EUA to Gilead Sciences Inc.\n[\n64\n]\nThe FDA approved remdesivir based primarily on evidence from three clinical trials (NCT04280705, NCT04292899, and NCT04292730) of 2043 hospitalized participants with COVID‑19.\n[\n109\n]\nThe trials were conducted at 226 sites in 17 countries including the United States.\n[\n109\n]\nIn November 2020, the World Health Organization (WHO) updated its guideline on therapeutics for COVID‑19 to include a conditional recommendation against the use of remdesivir, triggered by results from the WHO\nSolidarity trial\n.\n[\n130\n]\n[\n131\n]\n[\n132\n]\n[\n133\n]\nMeanwhile, the\nPublic Health Agency of Canada\n's COVID‑19 Clinical Pharmacology Task Group recommended that remdesivir only be administered to hospitalized patients as part of a\nrandomized controlled trial\ndue to limited information on risks and benefits.\n[\n134\n]\nIn January 2022, the Canadian component of the WHO Solidarity Trial reported that in-hospital people with COVID‑19 treated with remdesivir had 17% lower relative risk of death (18.7% versus 22.6% death rates) and 47% reduced relative risk for needing oxygen and mechanical ventilation (8.0% versus 15.0%) compared to people receiving standard-of-care treatments.\n[\n135\n]\nIn September 2022, the WHO updated their guidelines to recommend use of remdesivir for both non-hospitalized and hospitalized patients.\n[\n136\n]\nThis was based on final results from the SOLIDARITY trial that showed a reduction in mortality or progression to mechanical ventilation for non-ventilated patients.\nNonhospitalized outpatients\nIn January 2022, a study indicated that nonhospitalized people who were at high risk for COVID‑19 progression had an 87% lower risk of hospitalization or death after a 3-day course of intravenous remdesivir.\n[\n137\n]\nRemdesivir\/baricitinib\nIn May 2020, the\nNational Institute of Allergy and Infectious Diseases\n(NIAID) started the Adaptive COVID‑19 Treatment Trial 2 (ACTT-2) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus\nbaricitinib\nfor treating hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.\n[\n138\n]\n[\n139\n]\n[\n140\n]\nIn November 2020, the US\nFood and Drug Administration\n(FDA) issued an\nemergency use authorization\n(EUA) for the drug baricitinib, in combination with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or\nextracorporeal membrane oxygenation\n(ECMO).\n[\n28\n]\nThe data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).\n[\n28\n]\nThe EUA was issued to Eli Lilly and Company.\n[\n28\n]\nRemdesivir\/interferon beta-1a\nIn August 2020, the NIAID started the Adaptive COVID‑19 Treatment Trial 3 (ACTT 3) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus\ninterferon beta-1a\nfor hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.\n[\n139\n]\n[\n141\n]\nVeterinary uses\nIn 2019, GS-441524 was shown to have promise for treating\nfeline infectious peritonitis\ncaused by a\ncoronavirus\n.\n[\n142\n]\nIt has not been evaluated or approved by the US\nFood and Drug Administration\n(FDA) for the treatment of\nfeline coronavirus\nor feline infectious peritonitis but has been available since 2019, through websites and social media as an unregulated black market substance.\n[\n143\n]\nBecause GS-441524 is the main circulating metabolite of remdesivir and because GS-441524 has similar potency against SARS-CoV-2\nin vitro\n, some researchers have argued for the direct administration of GS-441524 as a COVID‑19 treatment.\n[\n144\n]\nReferences\n^\na\nb\n\"Veklury Australian prescription medicine decision summary\"\n.\nTherapeutic Goods Administration\n(TGA)\n. 13 July 2020.\nArchived\nfrom the original on 13 August 2020\n. 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Retrieved\n5 August\n2020\n.\nThis article incorporates text from this source, which is in the\npublic domain\n.\n^\n\"Adaptive COVID-19 Treatment Trial 2 (ACTT-2)\"\n.\nClinicalTrials.gov\n. 26 May 2020.\nArchived\nfrom the original on 5 August 2020\n. Retrieved\n6 August\n2020\n.\n^\n\"Adaptive COVID-19 Treatment Trial 3 (ACTT-3)\"\n.\nClinicalTrials.gov\n. 30 July 2020.\nArchived\nfrom the original on 6 October 2020\n. Retrieved\n5 August\n2020\n.\n^\nPedersen NC, Perron M, Bannasch M, Montgomery E, Murakami E, Liepnieks M, et al. (April 2019).\n\"Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis\"\n.\nJournal of Feline Medicine and Surgery\n.\n21\n(4):\n271–\n281.\ndoi\n:\n10.1177\/1098612X19825701\n.\nPMC\n \n6435921\n.\nPMID\n \n30755068\n.\n^\nPedersen NC (18 June 2019).\n\"Black market production and sale of GS-441524 and GC376\"\n(PDF)\n. Feline Infectious Peritonitis Therapeutics\/Clinical Trials Team, UC Davis.\nArchived\n(PDF)\nfrom the original on 25 March 2020\n. Retrieved\n14 April\n2020\n.\n^\nWestgate J (7 May 2020).\n\"Vet science 'being ignored' in quest for COVID-19 drug\"\n.\nvettimes.co.uk\n.\nArchived\nfrom the original on 4 December 2020\n. Retrieved\n6 July\n2020\n.\nExternal links\nWikimedia Commons has media related to\nRemdesivir\n.\nKolata G (1 May 2020).\n\"How Remdesivir, New Hope for Covid-19 Patients, Was Resurrected\"\n.\nThe New York Times\n.","attrs_markdown":"[Jump to content](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#bodyContent)\n\nMain menu\n\nMain menu\n\nmove to sidebar\n\nhide\n\nNavigation\n\n- [Main page](https:\/\/en.wikipedia.org\/wiki\/Main_Page \"Visit the main page [z]\")\n- [Contents](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contents \"Guides to browsing Wikipedia\")\n- [Current events](https:\/\/en.wikipedia.org\/wiki\/Portal:Current_events \"Articles related to current events\")\n- [Random article](https:\/\/en.wikipedia.org\/wiki\/Special:Random \"Visit a randomly selected article [x]\")\n- [About Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:About \"Learn about Wikipedia and how it works\")\n- [Contact us](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contact_us \"How to contact Wikipedia\")\n\nContribute\n\n- [Help](https:\/\/en.wikipedia.org\/wiki\/Help:Contents \"Guidance on how to use and edit Wikipedia\")\n- [Learn to edit](https:\/\/en.wikipedia.org\/wiki\/Help:Introduction \"Learn how to edit Wikipedia\")\n- [Community portal](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Community_portal \"The hub for editors\")\n- [Recent changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChanges \"A list of recent changes to Wikipedia [r]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_upload_wizard \"Add images or other media for use on Wikipedia\")\n- [Special pages](https:\/\/en.wikipedia.org\/wiki\/Special:SpecialPages \"A list of all special pages [q]\")\n\n[![](https:\/\/en.wikipedia.org\/static\/images\/icons\/enwiki-25.svg) ![Wikipedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-wordmark-en-25.svg) ![The Free Encyclopedia](https:\/\/en.wikipedia.org\/static\/images\/mobile\/copyright\/wikipedia-tagline-en-25.svg)](https:\/\/en.wikipedia.org\/wiki\/Main_Page)\n\n[Search](https:\/\/en.wikipedia.org\/wiki\/Special:Search \"Search Wikipedia [f]\")\n\nAppearance\n\n- [Donate](https:\/\/donate.wikimedia.org\/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en)\n- [Create account](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CreateAccount&returnto=Remdesivir \"You are encouraged to create an account and log in; however, it is not mandatory\")\n- [Log in](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UserLogin&returnto=Remdesivir \"You're encouraged to log in; however, it's not mandatory. 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[o]\")\n\n## Contents\nmove to sidebar\n\nhide\n\n- [(Top)](https:\/\/en.wikipedia.org\/wiki\/Remdesivir)\n- [1 Medical uses](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Medical_uses)\n- [2 Side effects](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Side_effects)\n- [3 Pharmacology](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Pharmacology)\n  Toggle Pharmacology subsection\n  - [3\\.1 Activation](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Activation)\n  - [3\\.2 Mechanism of action](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Mechanism_of_action)\n  - [3\\.3 Pharmacokinetics](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Pharmacokinetics)\n  - [3\\.4 Resistance](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Resistance)\n- [4 Interactions](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Interactions)\n- [5 Synthesis](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Synthesis)\n- [6 *In vitro* experiments](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#In_vitro_experiments)\n- [7 Manufacturing](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Manufacturing)\n- [8 Society and culture](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Society_and_culture)\n  Toggle Society and culture subsection\n  - [8\\.1 Legal status](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Legal_status)\n    - [8\\.1.1 Australia](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Australia)\n    - [8\\.1.2 Canada](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Canada)\n    - [8\\.1.3 Czech Republic](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Czech_Republic)\n    - [8\\.1.4 European Union](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#European_Union)\n    - [8\\.1.5 Iran](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Iran)\n    - [8\\.1.6 Japan](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Japan)\n    - [8\\.1.7 Mexico](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Mexico)\n    - [8\\.1.8 Singapore](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Singapore)\n    - [8\\.1.9 United States](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#United_States)\n  - [8\\.2 Economics](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Economics)\n  - [8\\.3 Names](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Names)\n- [9 Research](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Research)\n  Toggle Research subsection\n  - [9\\.1 Ebola](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Ebola)\n  - [9\\.2 COVID-19](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#COVID-19)\n    - [9\\.2.1 Hospitalized patients](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Hospitalized_patients)\n    - [9\\.2.2 Nonhospitalized outpatients](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Nonhospitalized_outpatients)\n    - [9\\.2.3 Remdesivir\/baricitinib](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Remdesivir\/baricitinib)\n    - [9\\.2.4 Remdesivir\/interferon beta-1a](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Remdesivir\/interferon_beta-1a)\n- [10 Veterinary uses](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#Veterinary_uses)\n- [11 References](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#References)\n- [12 External links](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#External_links)\n\nToggle the table of contents\n\n# Remdesivir\n49 languages\n\n- [العربية](https:\/\/ar.wikipedia.org\/wiki\/%D8%B1%D9%8A%D9%85%D8%AF%D9%8A%D8%B3%D9%8A%D9%81%D9%8A%D8%B1 \"ريمديسيفير – Arabic\")\n- [বাংলা](https:\/\/bn.wikipedia.org\/wiki\/%E0%A6%B0%E0%A7%87%E0%A6%AE%E0%A6%A1%E0%A7%87%E0%A6%B8%E0%A6%BF%E0%A6%AD%E0%A6%BF%E0%A6%B0 \"রেমডেসিভির – Bangla\")\n- [Català](https:\/\/ca.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Catalan\")\n- [Čeština](https:\/\/cs.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Czech\")\n- [Dansk](https:\/\/da.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Danish\")\n- [Deutsch](https:\/\/de.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – German\")\n- [Ελληνικά](https:\/\/el.wikipedia.org\/wiki\/%CE%A1%CE%B5%CE%BC%CE%BD%CF%84%CE%B5%CF%83%CE%B9%CE%B2%CE%AF%CF%81%CE%B7 \"Ρεμντεσιβίρη – Greek\")\n- [Español](https:\/\/es.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Spanish\")\n- [Euskara](https:\/\/eu.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Basque\")\n- [فارسی](https:\/\/fa.wikipedia.org\/wiki\/%D8%B1%D9%85%D8%AF%D8%B3%DB%8C%D9%88%DB%8C%D8%B1 \"رمدسیویر – Persian\")\n- [Suomi](https:\/\/fi.wikipedia.org\/wiki\/Remdesiviiri \"Remdesiviiri – Finnish\")\n- [Français](https:\/\/fr.wikipedia.org\/wiki\/Remd%C3%A9sivir \"Remdésivir – French\")\n- [עברית](https:\/\/he.wikipedia.org\/wiki\/%D7%A8%D7%9E%D7%93%D7%A1%D7%99%D7%91%D7%99%D7%A8 \"רמדסיביר – Hebrew\")\n- [हिन्दी](https:\/\/hi.wikipedia.org\/wiki\/%E0%A4%B0%E0%A5%87%E0%A4%AE%E0%A4%A1%E0%A5%87%E0%A4%B8%E0%A4%BF%E0%A4%B5%E0%A4%BF%E0%A4%B0 \"रेमडेसिविर – Hindi\")\n- [Hrvatski](https:\/\/hr.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Croatian\")\n- [Magyar](https:\/\/hu.wikipedia.org\/wiki\/Remdezivir \"Remdezivir – Hungarian\")\n- [Հայերեն](https:\/\/hy.wikipedia.org\/wiki\/%D5%8C%D5%A5%D5%B4%D5%A4%D5%A5%D5%BD%D5%AB%D5%BE%D5%AB%D6%80 \"Ռեմդեսիվիր – Armenian\")\n- [Bahasa Indonesia](https:\/\/id.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Indonesian\")\n- [Íslenska](https:\/\/is.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Icelandic\")\n- [Italiano](https:\/\/it.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Italian\")\n- [日本語](https:\/\/ja.wikipedia.org\/wiki\/%E3%83%AC%E3%83%A0%E3%83%87%E3%82%B7%E3%83%93%E3%83%AB \"レムデシビル – Japanese\")\n- [ქართული](https:\/\/ka.wikipedia.org\/wiki\/%E1%83%A0%E1%83%94%E1%83%9B%E1%83%93%E1%83%94%E1%83%A1%E1%83%98%E1%83%95%E1%83%98%E1%83%A0%E1%83%98 \"რემდესივირი – Georgian\")\n- [한국어](https:\/\/ko.wikipedia.org\/wiki\/%EB%A0%98%EB%8D%B0%EC%8B%9C%EB%B9%84%EB%A5%B4 \"렘데시비르 – Korean\")\n- [Lietuvių](https:\/\/lt.wikipedia.org\/wiki\/Remdesiviras \"Remdesiviras – Lithuanian\")\n- [മലയാളം](https:\/\/ml.wikipedia.org\/wiki\/%E0%B4%B1%E0%B5%86%E0%B4%82%E0%B4%A1%E0%B5%86%E0%B4%B8%E0%B4%BF%E0%B4%B5%E0%B4%BF%E0%B5%BC \"റെംഡെസിവിർ – Malayalam\")\n- [Bahasa Melayu](https:\/\/ms.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Malay\")\n- [မြန်မာဘာသာ](https:\/\/my.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Burmese\")\n- [Nederlands](https:\/\/nl.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Dutch\")\n- [Norsk bokmål](https:\/\/no.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Norwegian Bokmål\")\n- [ଓଡ଼ିଆ](https:\/\/or.wikipedia.org\/wiki\/%E0%AC%B0%E0%AD%87%E0%AC%AE%E0%AC%A1%E0%AD%87%E0%AC%B8%E0%AC%BF%E0%AC%AD%E0%AC%BF%E0%AC%B0 \"ରେମଡେସିଭିର – Odia\")\n- [Polski](https:\/\/pl.wikipedia.org\/wiki\/Remdesiwir \"Remdesiwir – Polish\")\n- [پنجابی](https:\/\/pnb.wikipedia.org\/wiki\/%D8%B1%DB%8C%D9%85%DA%88%DB%8C%D8%B3%DB%8C%D9%88%DB%8C%D8%B1 \"ریمڈیسیویر – Western Punjabi\")\n- [Português](https:\/\/pt.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Portuguese\")\n- [Română](https:\/\/ro.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Romanian\")\n- [Русский](https:\/\/ru.wikipedia.org\/wiki\/%D0%A0%D0%B5%D0%BC%D0%B4%D0%B5%D1%81%D0%B8%D0%B2%D0%B8%D1%80 \"Ремдесивир – Russian\")\n- [Simple English](https:\/\/simple.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Simple English\")\n- [Shqip](https:\/\/sq.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Albanian\")\n- [Српски \/ srpski](https:\/\/sr.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Serbian\")\n- [Svenska](https:\/\/sv.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Swedish\")\n- [தமிழ்](https:\/\/ta.wikipedia.org\/wiki\/%E0%AE%B0%E0%AF%86%E0%AE%AE%E0%AF%8D%E0%AE%9F%E0%AE%BF%E0%AE%9A%E0%AE%BF%E0%AE%B5%E0%AE%BF%E0%AE%AF%E0%AE%B0%E0%AF%8D \"ரெம்டிசிவியர் – Tamil\")\n- [Türkçe](https:\/\/tr.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Turkish\")\n- [ئۇيغۇرچە \/ Uyghurche](https:\/\/ug.wikipedia.org\/wiki\/%D8%B1%DB%90%D9%85%D8%AF%DB%90%D8%B3%D9%89%DB%8B%D9%89%D8%B1\$%DB%8B%D8%A7%D9%83%D8%B3%D9%89%D9%86\$ \"رېمدېسىۋىر(ۋاكسىن) – Uyghur\")\n- [Українська](https:\/\/uk.wikipedia.org\/wiki\/%D0%A0%D0%B5%D0%BC%D0%B4%D0%B5%D1%81%D0%B8%D0%B2%D1%96%D1%80 \"Ремдесивір – Ukrainian\")\n- [اردو](https:\/\/ur.wikipedia.org\/wiki\/%D8%B1%DB%8C%D9%85%DA%88%DB%8C%D8%B3%DB%8C%D9%88%DB%8C%D8%B1 \"ریمڈیسیویر – Urdu\")\n- [Tiếng Việt](https:\/\/vi.wikipedia.org\/wiki\/Remdesivir \"Remdesivir – Vietnamese\")\n- [吴语](https:\/\/wuu.wikipedia.org\/wiki\/%E7%91%9E%E5%BE%B7%E8%A5%BF%E9%9F%A6 \"瑞德西韦 – Wu\")\n- [მარგალური](https:\/\/xmf.wikipedia.org\/wiki\/%E1%83%A0%E1%83%94%E1%83%9B%E1%83%93%E1%83%94%E1%83%A1%E1%83%98%E1%83%95%E1%83%98%E1%83%A0%E1%83%98 \"რემდესივირი – Mingrelian\")\n- [粵語](https:\/\/zh-yue.wikipedia.org\/wiki\/%E7%91%9E%E5%BE%B7%E8%A5%BF%E9%9F%8B \"瑞德西韋 – Cantonese\")\n- [中文](https:\/\/zh.wikipedia.org\/wiki\/%E7%91%9E%E5%BE%B7%E8%A5%BF%E9%9F%A6 \"瑞德西韦 – Chinese\")\n\n[Edit links](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q28209496#sitelinks-wikipedia \"Edit interlanguage links\")\n\n- [Article](https:\/\/en.wikipedia.org\/wiki\/Remdesivir \"View the content page [c]\")\n- [Talk](https:\/\/en.wikipedia.org\/wiki\/Talk:Remdesivir \"Discuss improvements to the content page [t]\")\n\nEnglish\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/Remdesivir)\n- [View source](https:\/\/en.wikipedia.org\/w\/index.php?title=Remdesivir&action=edit \"This page is protected.\n  You can view its source [e]\")\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Remdesivir&action=history \"Past revisions of this page [h]\")\n\nTools\n\nTools\n\nmove to sidebar\n\nhide\n\nActions\n\n- [Read](https:\/\/en.wikipedia.org\/wiki\/Remdesivir)\n- [View source](https:\/\/en.wikipedia.org\/w\/index.php?title=Remdesivir&action=edit)\n- [View history](https:\/\/en.wikipedia.org\/w\/index.php?title=Remdesivir&action=history)\n\nGeneral\n\n- [What links here](https:\/\/en.wikipedia.org\/wiki\/Special:WhatLinksHere\/Remdesivir \"List of all English Wikipedia pages containing links to this page [j]\")\n- [Related changes](https:\/\/en.wikipedia.org\/wiki\/Special:RecentChangesLinked\/Remdesivir \"Recent changes in pages linked from this page [k]\")\n- [Upload file](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:File_Upload_Wizard \"Upload files [u]\")\n- [Permanent link](https:\/\/en.wikipedia.org\/w\/index.php?title=Remdesivir&oldid=1342542449 \"Permanent link to this revision of this page\")\n- [Page information](https:\/\/en.wikipedia.org\/w\/index.php?title=Remdesivir&action=info \"More information about this page\")\n- [Cite this page](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:CiteThisPage&page=Remdesivir&id=1342542449&wpFormIdentifier=titleform \"Information on how to cite this page\")\n- [Get shortened URL](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:UrlShortener&url=https%3A%2F%2Fen.wikipedia.org%2Fwiki%2FRemdesivir)\n\nPrint\/export\n\n- [Download as PDF](https:\/\/en.wikipedia.org\/w\/index.php?title=Special:DownloadAsPdf&page=Remdesivir&action=show-download-screen \"Download this page as a PDF file\")\n- [Printable version](https:\/\/en.wikipedia.org\/w\/index.php?title=Remdesivir&printable=yes \"Printable version of this page [p]\")\n\nIn other projects\n\n- [Wikimedia Commons](https:\/\/commons.wikimedia.org\/wiki\/Category:Remdesivir)\n- [Wikidata item](https:\/\/www.wikidata.org\/wiki\/Special:EntityPage\/Q28209496 \"Structured data on this page hosted by Wikidata [g]\")\n\nAppearance\n\nmove to sidebar\n\nhide\n\n[![Page semi-protected](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/1\/1b\/Semi-protection-shackle.svg\/20px-Semi-protection-shackle.svg.png)](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Protection_policy#semi \"This article is semi-protected.\")\n\nFrom Wikipedia, the free encyclopedia\n\nAntiviral drug\n\nPharmaceutical compound\n\n|   |   |\n|---|---|\n| [![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/b\/bc\/Remdesivir.svg\/250px-Remdesivir.svg.png)](https:\/\/en.wikipedia.org\/wiki\/File:Remdesivir.svg) |   |\n| [![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5b\/Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png\/250px-Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png)](https:\/\/en.wikipedia.org\/wiki\/File:Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png) |   |\n| Clinical data |   |\n| Pronunciation | [\/rɛmˈdɛsɪvɪər\/](https:\/\/en.wikipedia.org\/wiki\/Help:IPA\/English \"Help:IPA\/English\") [*rem-DESS\\-i-veer*](https:\/\/en.wikipedia.org\/wiki\/Help:Pronunciation_respelling_key \"Help:Pronunciation respelling key\") |\n| [Trade names](https:\/\/en.wikipedia.org\/wiki\/Drug_nomenclature#Trade_names \"Drug nomenclature\") | Veklury |\n| Other names | GS-5734, RDV |\n| [AHFS](https:\/\/en.wikipedia.org\/wiki\/American_Society_of_Health-System_Pharmacists \"American Society of Health-System Pharmacists\")\/[Drugs.com](https:\/\/en.wikipedia.org\/wiki\/Drugs.com \"Drugs.com\") | [Monograph](https:\/\/www.drugs.com\/monograph\/remdesivir.html) |\n| [MedlinePlus](https:\/\/en.wikipedia.org\/wiki\/MedlinePlus \"MedlinePlus\") | [a620033](https:\/\/medlineplus.gov\/druginfo\/meds\/a620033.html) |\n| [License data](https:\/\/en.wikipedia.org\/wiki\/Regulation_of_therapeutic_goods \"Regulation of therapeutic goods\") | US [DailyMed](https:\/\/en.wikipedia.org\/wiki\/DailyMed \"DailyMed\"): [Remdesivir](https:\/\/dailymed.nlm.nih.gov\/dailymed\/search.cfm?labeltype=all&query=Remdesivir) |\n| [Pregnancy category](https:\/\/en.wikipedia.org\/wiki\/Pregnancy_category \"Pregnancy category\") | AU : B2[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_APM_summary-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-AusPAR:_Remdesivir-2) |\n| [Routes of administration](https:\/\/en.wikipedia.org\/wiki\/Route_of_administration \"Route of administration\") | [Intravenous](https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy \"Intravenous therapy\") |\n| [Drug class](https:\/\/en.wikipedia.org\/wiki\/Drug_class \"Drug class\") | [Antiviral](https:\/\/en.wikipedia.org\/wiki\/Antiviral \"Antiviral\") |\n| [ATC code](https:\/\/en.wikipedia.org\/wiki\/Anatomical_Therapeutic_Chemical_Classification_System \"Anatomical Therapeutic Chemical Classification System\") | [J05AB16](https:\/\/en.wikipedia.org\/wiki\/ATC_code_J05 \"ATC code J05\") ([WHO](https:\/\/www.whocc.no\/atc_ddd_index\/?code=J05AB16)) |\n| Legal status |   |\n| [Legal status](https:\/\/en.wikipedia.org\/wiki\/Regulation_of_therapeutic_goods \"Regulation of therapeutic goods\") | AU : [S4](https:\/\/en.wikipedia.org\/wiki\/Standard_for_the_Uniform_Scheduling_of_Medicines_and_Poisons#Schedule_4 \"Standard for the Uniform Scheduling of Medicines and Poisons\") (Prescription only)[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-3)[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_APM_summary-1)[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-5)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-AusPAR:_Remdesivir-2) CA :  [℞-only](https:\/\/en.wikipedia.org\/wiki\/Prescription_drug \"Prescription drug\")[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-CA_Veklury_Product_information-6)[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-7)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-8) UK : [POM](https:\/\/en.wikipedia.org\/wiki\/Prescription_drug \"Prescription drug\") (Prescription only)[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_SmPC-9)[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-10) US : [℞-only](https:\/\/en.wikipedia.org\/wiki\/Prescription_drug \"Prescription drug\")[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11) EU : Rx-only[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-13) IN : [Schedule H](https:\/\/en.wikipedia.org\/wiki\/Schedule_H \"Schedule H\") (℞-only) [\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-14)[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-15) |\n| Identifiers |   |\n| [IUPAC name](https:\/\/en.wikipedia.org\/wiki\/IUPAC_nomenclature_of_chemistry \"IUPAC nomenclature of chemistry\") (2*S*)-2-{(2*R*,3*S*,4*R*,5*R*)-\\[5-(4-Aminopyrrolo\\[2,1-*f*\\] \\[1,2,4\\]triazin-7-yl)-5-cyano-3,4-dihydroxy-tetrahydro-furan-2-ylmethoxy\\]phenoxy-(*S*)-phosphorylamino}propionic acid 2-ethyl-butyl ester |   |\n| [CAS Number](https:\/\/en.wikipedia.org\/wiki\/CAS_Registry_Number \"CAS Registry Number\") | [1809249-37-3](https:\/\/commonchemistry.cas.org\/detail?cas_rn=1809249-37-3) |\n| [PubChem](https:\/\/en.wikipedia.org\/wiki\/PubChem#CID \"PubChem\") CID | [121304016](https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/121304016) |\n| [DrugBank](https:\/\/en.wikipedia.org\/wiki\/DrugBank \"DrugBank\") | [DB14761](https:\/\/www.drugbank.ca\/drugs\/DB14761) |\n| [ChemSpider](https:\/\/en.wikipedia.org\/wiki\/ChemSpider \"ChemSpider\") | [58827832](https:\/\/www.chemspider.com\/Chemical-Structure.58827832.html) |\n| [UNII](https:\/\/en.wikipedia.org\/wiki\/Unique_Ingredient_Identifier \"Unique Ingredient Identifier\") | [3QKI37EEHE](https:\/\/precision.fda.gov\/uniisearch\/srs\/unii\/3QKI37EEHE) |\n| [KEGG](https:\/\/en.wikipedia.org\/wiki\/KEGG \"KEGG\") | [D11472](https:\/\/www.kegg.jp\/entry\/D11472) |\n| [ChEBI](https:\/\/en.wikipedia.org\/wiki\/ChEBI \"ChEBI\") | [CHEBI:145994](https:\/\/www.ebi.ac.uk\/chebi\/searchId.do?chebiId=CHEBI:145994) |\n| [ChEMBL](https:\/\/en.wikipedia.org\/wiki\/ChEMBL \"ChEMBL\") | [ChEMBL4065616](https:\/\/www.ebi.ac.uk\/chembl\/explore\/compound\/ChEMBL4065616) |\n| [CompTox Dashboard](https:\/\/en.wikipedia.org\/wiki\/CompTox_Chemicals_Dashboard \"CompTox Chemicals Dashboard\") ( EPA ) | [DTXSID701022537](https:\/\/comptox.epa.gov\/dashboard\/chemical\/details\/DTXSID701022537) [![Edit this at Wikidata](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/8\/8a\/OOjs_UI_icon_edit-ltr-progressive.svg\/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https:\/\/www.wikidata.org\/wiki\/Q28209496#P3117 \"Edit this at Wikidata\") |\n| [ECHA InfoCard](https:\/\/en.wikipedia.org\/wiki\/ECHA_InfoCard \"ECHA InfoCard\") | [100\\.302.974](https:\/\/echa.europa.eu\/substance-information\/-\/substanceinfo\/100.302.974) [![Edit this at Wikidata](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/8\/8a\/OOjs_UI_icon_edit-ltr-progressive.svg\/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https:\/\/www.wikidata.org\/wiki\/Q28209496#P2566 \"Edit this at Wikidata\") |\n| Chemical and physical data |   |\n| [Formula](https:\/\/en.wikipedia.org\/wiki\/Chemical_formula \"Chemical formula\") | C27H35N6O8P |\n| [Molar mass](https:\/\/en.wikipedia.org\/wiki\/Molar_mass \"Molar mass\") | 602\\.585 g·mol−1 |\n| 3D model ([JSmol](https:\/\/en.wikipedia.org\/wiki\/JSmol \"JSmol\")) | [Interactive image](https:\/\/chemapps.stolaf.edu\/jmol\/jmol.php?model=CCC%28COC%28%3DO%29%5BC%40%40H%5D%28NP%28%3DO%29%28Oc1ccccc1%29OC%5BC%40H%5D1O%5BC%40%40%5D%28%5BC%40%40H%5D%28%5BC%40%40H%5D1O%29O%29%28C%23N%29c1ccc2n1ncnc2N%29C%29CC) |\n| [SMILES](https:\/\/en.wikipedia.org\/wiki\/Simplified_molecular-input_line-entry_system \"Simplified molecular-input line-entry system\") CCC(COC(=O)\\[C@@H\\](NP(=O)(Oc1ccccc1)OC\\[C@H\\]1O\\[C@@\\](\\[C@@H\\](\\[C@@H\\]1O)O)(C\\#N)c1ccc2n1ncnc2N)C)CC |   |\n| [InChI](https:\/\/en.wikipedia.org\/wiki\/International_Chemical_Identifier \"International Chemical Identifier\") InChI=1S\/C27H35N6O8P\/c1-4-18(5-2)13-38-26(36)17(3)32-42(37,41-19-9-7-6-8-10-19)39-14-21-23(34)24(35)27(15-28,40-21)22-12-11-20-25(29)30-16-31-33(20)22\/h6-12,16-18,21,23-24,34-35H,4-5,13-14H2,1-3H3,(H,32,37)(H2,29,30,31)\/t17-,21+,23+,24+,27-,42-\/m0\/s1 Key:RWWYLEGWBNMMLJ-YSOARWBDSA-N |   |\n\n**Remdesivir**, sold under the brand name **Veklury**,[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR-16) is a [broad-spectrum antiviral medication](https:\/\/en.wikipedia.org\/wiki\/Broad-spectrum_antiviral_drug \"Broad-spectrum antiviral drug\") developed by the [biopharmaceutical](https:\/\/en.wikipedia.org\/wiki\/Biopharmaceutical \"Biopharmaceutical\") company [Gilead Sciences](https:\/\/en.wikipedia.org\/wiki\/Gilead_Sciences \"Gilead Sciences\").[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Scavone_2020-17) It is administered via [injection into a vein](https:\/\/en.wikipedia.org\/wiki\/Intravenous \"Intravenous\").[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-18)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Mehta2020-19) During the [COVID‑19 pandemic](https:\/\/en.wikipedia.org\/wiki\/COVID-19_pandemic \"COVID-19 pandemic\"), remdesivir was approved or authorized for emergency use to treat [COVID‑19](https:\/\/en.wikipedia.org\/wiki\/Coronavirus_disease_2019 \"Coronavirus disease 2019\") in numerous countries.[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20201022-20)\n\nRemdesivir was originally developed to treat [hepatitis C](https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C \"Hepatitis C\"),[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21) and was subsequently investigated for [Ebola virus disease](https:\/\/en.wikipedia.org\/wiki\/Ebola \"Ebola\") and [Marburg virus](https:\/\/en.wikipedia.org\/wiki\/Marburg_virus_disease \"Marburg virus disease\") infections[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pmid269342202-22) before being studied as a post-infection treatment for COVID‑19.[\\[23\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-kai2-23)\n\nRemdesivir is a [prodrug](https:\/\/en.wikipedia.org\/wiki\/Prodrug \"Prodrug\") that is intended to allow intracellular delivery of [GS-441524](https:\/\/en.wikipedia.org\/wiki\/GS-441524 \"GS-441524\") monophosphate and subsequent biotransformation into GS-441524 [triphosphate](https:\/\/en.wikipedia.org\/wiki\/Triphosphate \"Triphosphate\"), a ribo[nucleotide analogue](https:\/\/en.wikipedia.org\/wiki\/Nucleotide_analogue \"Nucleotide analogue\") inhibitor of viral [RNA polymerase](https:\/\/en.wikipedia.org\/wiki\/RNA_polymerase \"RNA polymerase\").[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020-24)\n\nThe most common side effect in healthy volunteers is raised blood levels of [liver enzymes](https:\/\/en.wikipedia.org\/wiki\/Liver_enzymes \"Liver enzymes\").[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12) The most common side effect in people with COVID‑19 is [nausea](https:\/\/en.wikipedia.org\/wiki\/Nausea \"Nausea\").[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12) Side effects may include liver inflammation and an [infusion](https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy \"Intravenous therapy\")\\-related reaction with nausea, [low blood pressure](https:\/\/en.wikipedia.org\/wiki\/Hypotension \"Hypotension\"), and sweating.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)\n\nThe US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) considers it to be a [first-in-class medication](https:\/\/en.wikipedia.org\/wiki\/First-in-class_medication \"First-in-class medication\").[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-26)\n\n## Medical uses\nIn the European Union, remdesivir is [indicated](https:\/\/en.wikipedia.org\/wiki\/Indication_\$medicine\$ \"Indication (medicine)\") for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) with [pneumonia](https:\/\/en.wikipedia.org\/wiki\/Pneumonia \"Pneumonia\") requiring supplemental oxygen and for adults who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID‑19.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_SmPC-9)[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)\n\nIn the United States, remdesivir is indicated for the treatment of COVID‑19 in people 28 days of age and older and weighing at least 3 kilograms (6.6 lb) who are hospitalized; or not hospitalized and have mild-to-moderate COVID‑19, and are at high risk for progression to severe COVID‑19, including hospitalization or death.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11)[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20220425-27)\n\nIn November 2020, the FDA issued an emergency use authorization (EUA) for the combination of [baricitinib](https:\/\/en.wikipedia.org\/wiki\/Baricitinib \"Baricitinib\") with remdesivir, for the treatment of suspected or laboratory confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_membrane_oxygenation \"Extracorporeal membrane oxygenation\") (ECMO).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28)\n\nIn Australia, it is approved for those aged four weeks of age and older with a body weight at least 3 kilograms (6.6 lb) with [pneumonia](https:\/\/en.wikipedia.org\/wiki\/Pneumonia \"Pneumonia\") requiring supplemental oxygen or those aged four weeks of age and older with body weight at least 40 kilograms (88 lb) who do not require supplemental oxygen and who are at high risk of progressing to severe COVID‑19.[\\[29\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-29)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-AusPAR:_Remdesivir-2)\n\nIn 2024, a retrospective study found treatment with the antiviral remdesivir plus dexamethasone was associated with fewer deaths in hospitalized COVID-19 patients compared to dexamethasone alone.[\\[30\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-30) The combination led to a 26% reduction in mortality at 14 days and a 24% reduction at 28 days.[\\[31\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-31)\n\n## Side effects\nThe most common adverse effects in people treated with remdesivir were [respiratory failure](https:\/\/en.wikipedia.org\/wiki\/Respiratory_failure \"Respiratory failure\") and blood [biomarkers](https:\/\/en.wikipedia.org\/wiki\/Biomarker \"Biomarker\") of [organ](https:\/\/en.wikipedia.org\/wiki\/Organ_\$anatomy\$ \"Organ (anatomy)\") impairment, including [low albumin](https:\/\/en.wikipedia.org\/wiki\/Human_serum_albumin#Hypoalbuminemia \"Human serum albumin\"), [low potassium](https:\/\/en.wikipedia.org\/wiki\/Hypokalemia \"Hypokalemia\"), [low count of red blood cells](https:\/\/en.wikipedia.org\/wiki\/Anemia \"Anemia\"), [low count of thrombocytes](https:\/\/en.wikipedia.org\/wiki\/Thrombocytopenia \"Thrombocytopenia\"), and [elevated bilirubin (jaundice)](https:\/\/en.wikipedia.org\/wiki\/Jaundice \"Jaundice\").[\\[32\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wang-32) Other reported adverse effects include [gastrointestinal distress](https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_disease \"Gastrointestinal disease\"), elevated [transaminase](https:\/\/en.wikipedia.org\/wiki\/Transaminase \"Transaminase\") levels in the blood ([liver enzymes](https:\/\/en.wikipedia.org\/wiki\/Liver_function_tests \"Liver function tests\")), [infusion](https:\/\/en.wikipedia.org\/wiki\/Infusion_therapy \"Infusion therapy\") site reactions, and [electrocardiogram abnormalities](https:\/\/en.wikipedia.org\/wiki\/Drug-induced_QT_prolongation \"Drug-induced QT prolongation\").[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Mehta2020-19) Remdesivir may cause [infusion-related](https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy \"Intravenous therapy\") reactions, including low blood pressure, nausea, vomiting, sweating or shivering.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)\n\nOther possible side effects of remdesivir include:\n\n- Infusion-related reactions. Infusion-related reactions have been seen during a remdesivir infusion or around the time remdesivir was given.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Signs and symptoms of infusion-related reactions may include: low blood pressure, nausea, vomiting, sweating, and shivering.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)\n- Increases in levels of liver enzymes, seen in abnormal liver blood tests.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Increases in levels of liver enzymes have been seen in people who have received remdesivir, which may be a sign of inflammation or damage to cells in the liver.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)\n## Pharmacology\n### Activation\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/08\/Remdesivir_activation.svg\/500px-Remdesivir_activation.svg.png)](https:\/\/en.wikipedia.org\/wiki\/File:Remdesivir_activation.svg)\n\nActivation of remdesivir into its active triphosphate metabolite[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)\n\nRemdesivir is a [protide](https:\/\/en.wikipedia.org\/wiki\/Protide \"Protide\") ([prodrug](https:\/\/en.wikipedia.org\/wiki\/Prodrug \"Prodrug\") of nucleotide) able to diffuse into cells, where it is converted to [GS-441524](https:\/\/en.wikipedia.org\/wiki\/GS-441524 \"GS-441524\") monophosphate via the actions of [esterases](https:\/\/en.wikipedia.org\/wiki\/Esterase \"Esterase\") ([CES1](https:\/\/en.wikipedia.org\/wiki\/CES1 \"CES1\") and [CTSA](https:\/\/en.wikipedia.org\/wiki\/Cathepsin_A \"Cathepsin A\")) and a [phosphoamidase](https:\/\/en.wikipedia.org\/wiki\/Phosphoamidase \"Phosphoamidase\") ([HINT1](https:\/\/en.wikipedia.org\/wiki\/HINT1 \"HINT1\")); this in turn is further phosphorylated to its [active metabolite](https:\/\/en.wikipedia.org\/wiki\/Active_metabolite \"Active metabolite\") triphosphate by [nucleoside-phosphate kinases](https:\/\/en.wikipedia.org\/wiki\/Nucleoside-phosphate_kinase \"Nucleoside-phosphate kinase\").[\\[35\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Sheahan_2017-35)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon2020-36) This pathway of bioactivation is meant to occur [intracellularly](https:\/\/en.wikipedia.org\/wiki\/Intracellular \"Intracellular\"), but a substantial amount of remdesivir is prematurely [hydrolyzed](https:\/\/en.wikipedia.org\/wiki\/Hydrolysis \"Hydrolysis\") in plasma, with GS-441524 being the major metabolite in plasma, and the only metabolite remaining two hours after dosing.[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020-24)\n\n### Mechanism of action\nAs an [adenosine](https:\/\/en.wikipedia.org\/wiki\/Adenosine \"Adenosine\") nucleoside triphosphate analog (GS-443902),[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pmid22446091-37) the [active metabolite](https:\/\/en.wikipedia.org\/wiki\/Active_metabolite \"Active metabolite\") of remdesivir interferes with the action of viral [RNA-dependent RNA polymerase](https:\/\/en.wikipedia.org\/wiki\/RNA-dependent_RNA_polymerase \"RNA-dependent RNA polymerase\") and evades [proofreading](https:\/\/en.wikipedia.org\/wiki\/Proofreading_\$biology\$ \"Proofreading (biology)\") by viral [exoribonuclease](https:\/\/en.wikipedia.org\/wiki\/Exoribonuclease \"Exoribonuclease\") (ExoN), causing a decrease in viral RNA production.[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Scavone_2020-17)[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Ferner2020-38) In some viruses, such as the [respiratory syncytial virus](https:\/\/en.wikipedia.org\/wiki\/Respiratory_syncytial_virus \"Respiratory syncytial virus\"), it causes the RNA-dependent RNA polymerases to pause, but its predominant effect (as in Ebola) is to induce an irreversible [chain termination](https:\/\/en.wikipedia.org\/wiki\/Chain_termination \"Chain termination\"). Unlike with many other chain terminators, this is not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pmid30987343-39) For the RNA-dependent RNA polymerases of [MERS-CoV](https:\/\/en.wikipedia.org\/wiki\/MERS-CoV \"MERS-CoV\"), [SARS-CoV-1](https:\/\/en.wikipedia.org\/wiki\/SARS-CoV-1 \"SARS-CoV-1\"), and [SARS-CoV-2](https:\/\/en.wikipedia.org\/wiki\/SARS-CoV-2 \"SARS-CoV-2\"), arrest of RNA synthesis occurs after incorporation of three additional nucleotides.[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon_2020-40)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon2020-36) Hence, remdesivir is classified as a direct-acting antiviral agent that works as a delayed chain terminator.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon2020-36)\n\n### Pharmacokinetics\nIn non-human primates, the plasma [half-life](https:\/\/en.wikipedia.org\/wiki\/Biological_half-life \"Biological half-life\") of the prodrug is 20 minutes, with the main metabolite being the [nucleoside](https:\/\/en.wikipedia.org\/wiki\/Nucleoside \"Nucleoside\"), [GS-441524](https:\/\/en.wikipedia.org\/wiki\/GS-441524 \"GS-441524\"). Two hours post injection, the main metabolite GS-441524 is present at micromolar concentrations, whilst intact Remdesivir is no longer detectable. Because of this rapid extracellular conversion to the nucleoside GS-441524, some researchers have questioned whether the active nucleotide triphosphate is truly derived from remdesivir pro-drug removal or whether it occurs by GS-441524 phosphorylation, and whether direct administration of GS-441524 would constitute a cheaper and easier to administer COVID‑19 drug compared to remdesivir.[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020_2-41)[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020-24) The activated nucleotide triphosphate form has sustained intracellular levels in [PBMC](https:\/\/en.wikipedia.org\/wiki\/PBMC \"PBMC\") and presumably in other cells as well.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)\n\n### Resistance\nMutations in the [mouse hepatitis virus](https:\/\/en.wikipedia.org\/wiki\/Mouse_hepatitis_virus \"Mouse hepatitis virus\") [RNA replicase](https:\/\/en.wikipedia.org\/wiki\/RNA_replicase \"RNA replicase\") that cause partial resistance to remdesivir were identified in 2018. These mutations make the viruses less effective in nature, and the researchers believe they will likely not persist where the drug is not being used.[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Chiotos2020-42)\n\n## Interactions\nRemdesivir is at least partially metabolized by the [cytochrome P450](https:\/\/en.wikipedia.org\/wiki\/Cytochrome_P450 \"Cytochrome P450\") enzymes [CYP2C8](https:\/\/en.wikipedia.org\/wiki\/CYP2C8 \"CYP2C8\"), [CYP2D6](https:\/\/en.wikipedia.org\/wiki\/CYP2D6 \"CYP2D6\"), and [CYP3A4](https:\/\/en.wikipedia.org\/wiki\/CYP3A4 \"CYP3A4\").[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_Summary_on_compassionate_use-43)[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) [Blood plasma](https:\/\/en.wikipedia.org\/wiki\/Blood_plasma \"Blood plasma\") concentrations of remdesivir are expected to decrease if it is administered together with cytochrome P450 [inducers](https:\/\/en.wikipedia.org\/wiki\/List_of_cytochrome_P450_modulators \"List of cytochrome P450 modulators\") such as [rifampicin](https:\/\/en.wikipedia.org\/wiki\/Rifampicin \"Rifampicin\"), [carbamazepine](https:\/\/en.wikipedia.org\/wiki\/Carbamazepine \"Carbamazepine\"), [phenobarbital](https:\/\/en.wikipedia.org\/wiki\/Phenobarbital \"Phenobarbital\"), [phenytoin](https:\/\/en.wikipedia.org\/wiki\/Phenytoin \"Phenytoin\"), [primidone](https:\/\/en.wikipedia.org\/wiki\/Primidone \"Primidone\"), and [St John's wort](https:\/\/en.wikipedia.org\/wiki\/St_John%27s_wort \"St John's wort\").[\\[44\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-44)\n\nUsing chloroquine or [hydroxychloroquine](https:\/\/en.wikipedia.org\/wiki\/Hydroxychloroquine \"Hydroxychloroquine\") with remdesivir may reduce the antiviral activity of remdesivir.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11)[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_SmPC-9)[\\[45\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-45) Coadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on *in vitro* data demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11)\n\n## Synthesis\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ab\/Synthesis_of_Remdesivir.png\/500px-Synthesis_of_Remdesivir.png)](https:\/\/en.wikipedia.org\/wiki\/File:Synthesis_of_Remdesivir.png)\n\nSynthesis of remdesivir in [structural formulae](https:\/\/en.wikipedia.org\/wiki\/Structural_formula \"Structural formula\")\n\nRemdesivir can be synthesized in multiple steps from [ribose](https:\/\/en.wikipedia.org\/wiki\/Ribose \"Ribose\") derivatives. The figure to the right is one of the synthesis routes of remdesivir invented by Chun and coauthors from Gilead Sciences.[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-46)[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-47)\n\n## *In vitro* experiments\nAn *[in vitro](https:\/\/en.wikipedia.org\/wiki\/In_vitro \"In vitro\")* study of remdesivir assessing antiviral activity against SARS-CoV-2 was performed.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wangc:20-48) Cells were pre-treated with the different doses of remdesivir for 1 hour, and the virus (MOI of 0.05) was subsequently added to allow infection for 2 hours.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wangc:20-48) The results found that remdesivir functioned well as an inhibitor of the infection.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wangc:20-48) The study was published as a letter to the editor, and as such did not undergo peer review.\n\n## Manufacturing\nRemdesivir requires \"70 raw materials, reagents, and catalysts\" to make, and approximately \"25 chemical steps.\"[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) Some of the ingredients are extremely dangerous to humans, especially [trimethylsilyl cyanide](https:\/\/en.wikipedia.org\/wiki\/Trimethylsilyl_cyanide \"Trimethylsilyl cyanide\").[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) The original end-to-end manufacturing process required 9 to 12 months to go from raw materials at contract manufacturers to finished product, but after restarting production in January 2020, Gilead Sciences was able to find ways to reduce the production time to six months.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49)\n\nIn January 2020, Gilead began working on restarting remdesivir production in glass-lined steel [chemical reactors](https:\/\/en.wikipedia.org\/wiki\/Chemical_reactor \"Chemical reactor\") at its manufacturing plant in [Edmonton, Alberta](https:\/\/en.wikipedia.org\/wiki\/Edmonton \"Edmonton\").[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) On 2 February 2020, the company flew its entire stock of remdesivir, 100 kilograms in powder form (left over from Ebola research), to its filling plant in [La Verne, California](https:\/\/en.wikipedia.org\/wiki\/La_Verne,_California \"La Verne, California\"), to start filling vials.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) The Edmonton plant finished its first new batch of remdesivir in April 2020.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) Around the same time, fresh raw materials began to arrive from contract manufacturers reactivated by Gilead in January.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49)\n\nAnother challenge is getting remdesivir into patients despite the drug's \"poor predicted solubility and poor stability.\"[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Pipkin-50) In June 2020, [Ligand Pharmaceuticals](https:\/\/en.wikipedia.org\/wiki\/Ligand_Pharmaceuticals \"Ligand Pharmaceuticals\") revealed that Gilead has been managing those issues by mixing Ligand's proprietary [excipient](https:\/\/en.wikipedia.org\/wiki\/Excipient \"Excipient\") Captisol (based on [University of Kansas](https:\/\/en.wikipedia.org\/wiki\/University_of_Kansas \"University of Kansas\") research into [cyclodextrin](https:\/\/en.wikipedia.org\/wiki\/Cyclodextrin \"Cyclodextrin\")) with remdesivir at a 30:1 ratio.[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Pipkin-50) Since that implies an enormous amount of Captisol is needed to stabilize and deliver remdesivir (on top of amounts needed for several other drugs for which the excipient is already in regular use), Ligand announced that it is trying to boost Captisol annual manufacturing capacity to as much as 500 metric tons.[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Pipkin-50)\n\nOn 12 May 2020, Gilead announced that it had granted non-exclusive voluntary licenses to five [generic drug](https:\/\/en.wikipedia.org\/wiki\/Generic_drug \"Generic drug\") companies in India and Pakistan to manufacture remdesivir for distribution to 127 countries.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Silverman-51)[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-52)[\\[53\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_licensing-53) The agreements were structured so that the licensees can set their own prices and will not have to pay royalties to Gilead until the WHO declares an end to the COVID‑19 emergency or another medicine or vaccine is approved for COVID‑19, whichever comes first.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Silverman-51) On 23 June 2020, India granted emergency marketing approval of generic remdesivir manufactured by two Gilead licensees, [Cipla](https:\/\/en.wikipedia.org\/wiki\/Cipla \"Cipla\") and [Hetero Drugs](https:\/\/en.wikipedia.org\/wiki\/Hetero_Drugs \"Hetero Drugs\").[\\[54\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Rajagopal-54)\n\n## Society and culture\n### Legal status\nRemdesivir is approved, or authorized for emergency use, to treat COVID‑19 in many countries.[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20201022-20) Remdesivir has been authorized for emergency use in India,[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-55) Singapore,[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Reuters_20200620-56) and approved for use in Japan,[\\[57\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-57) the European Union, the United States, and Australia for people with severe symptoms.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR-16)[\\[58\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_EUA-58)[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_EUA_PR-59)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-:0-60)[\\[61\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-TGA_approval-61)[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Veklury-62)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)\n\nRemdesivir is the first treatment for COVID‑19 to be approved by the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA).[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) The approval by the FDA does not include the entire population that had been authorized to use remdesivir under an Emergency Use Authorization (EUA) originally issued in May 2020.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) In order to ensure continued access to the pediatric population previously covered under the EUA, the FDA revised the EUA for remdesivir to authorize the drug's use for treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized pediatric patients weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized pediatric patients less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)\n\n#### Australia\nIn July 2020, remdesivir was provisionally approved for use in Australia for use in adults and adolescents with severe COVID‑19 symptoms who have been hospitalized.[\\[61\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-TGA_approval-61)[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-65) Australia claims to have a sufficient supply of remdesivir in its national stockpile.[\\[66\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-66)\n\n#### Canada\nAs of 11 April 2020, access in Canada was available only through clinical trials.[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Health_Canada-67) [Health Canada](https:\/\/en.wikipedia.org\/wiki\/Health_Canada \"Health Canada\") approved requests to treat twelve people with remdesivir under the department's special-access program (SAP).[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-68) Additional doses of remdesivir are not available through the SAP except for pregnant women or children with confirmed COVID‑19 and severe illness.[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Health_Canada-67)\n\nIn June 2020, Health Canada received an application from Gilead for the use of remdesivir for treating COVID‑19.[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Health_Canada-67) On 27 July 2020, Health Canada conditionally approved the application.[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Weikle-69)[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-CA_Veklury_Product_information-6)\n\nIn September 2020, [Minister of Public Services and Procurement](https:\/\/en.wikipedia.org\/wiki\/Minister_of_Public_Services_and_Procurement \"Minister of Public Services and Procurement\") [Anita Anand](https:\/\/en.wikipedia.org\/wiki\/Anita_Anand \"Anita Anand\") announced that Canada had entered into a deal to obtain up to 150,000 vials of remdesivir from Gilead starting in October.[\\[70\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Grant-70) As of 8 October, remdesivir was still not widely available in [Alberta](https:\/\/en.wikipedia.org\/wiki\/Alberta \"Alberta\"), because [Alberta Health Services](https:\/\/en.wikipedia.org\/wiki\/Alberta_Health_Services \"Alberta Health Services\") was undertaking a \"[formulary](https:\/\/en.wikipedia.org\/wiki\/Formulary_\$pharmacy\$ \"Formulary (pharmacy)\") review\" to be completed by mid-November.[\\[71\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Kury_de_Castillo-71)\n\n#### Czech Republic\nIn March 2020, the drug was provisionally approved for use for COVID‑19 patients in a serious condition as a result of [the outbreak in the Czech Republic](https:\/\/en.wikipedia.org\/wiki\/COVID%E2%80%9119_pandemic_in_the_Czech_Republic#Policies_to_fight_the_contagion \"COVID‑19 pandemic in the Czech Republic\").[\\[72\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-72)\n\n#### European Union\nIn February 2016, [orphan designation](https:\/\/en.wikipedia.org\/wiki\/Orphan_drug \"Orphan drug\") (EU\/3\/16\/1615) was granted by the European Commission to Gilead Sciences International Ltd, United Kingdom, for remdesivir for the treatment of Ebola virus disease.[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-73)\n\nIn April 2020, the [European Medicines Agency](https:\/\/en.wikipedia.org\/wiki\/European_Medicines_Agency \"European Medicines Agency\") (EMA) provided recommendations on compassionate use of remdesivir for COVID‑19 in the EU.[\\[74\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-74)\n\nIn May 2020, the [Committee for Medicinal Products for Human Use](https:\/\/en.wikipedia.org\/wiki\/Committee_for_Medicinal_Products_for_Human_Use \"Committee for Medicinal Products for Human Use\") (CHMP) of the EMA recommended expanding the compassionate use of remdesivir to those not on mechanical ventilation.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75) In addition to those undergoing invasive mechanical ventilation, the compassionate use recommendations cover the treatment of hospitalized individuals requiring supplemental oxygen, non-invasive ventilation, high-flow oxygen devices or ECMO (extracorporeal membrane oxygenation).[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75) The updated recommendations were based on preliminary results from the NIAID-ACTT study,[\\[76\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIAID_ACTT-76) which suggested a beneficial effect of remdesivir in the treatment of hospitalized individuals with severe COVID‑19.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75)[\\[77\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_PR-77) In addition, a treatment duration of five days was introduced alongside the longer ten-day course, based on preliminary results from another study (GS-US-540-5773) suggesting that for those not requiring mechanical ventilation or ECMO, the treatment course may be shortened from ten to five days without any loss of efficacy.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75) Individuals who receive a five-day treatment course but do not show clinical improvement will be eligible to continue receiving remdesivir for an additional five days.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75)\n\nIn July 2020, the European Union granted a conditional marketing authorization for remdesivir with an indication for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms \\[88 lb\\]) with pneumonia requiring supplemental oxygen.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EC_Veklury-78)\n\nIn August 2022, the European Union granted a full marketing authorization for remdesivir.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EC_Veklury-78)[\\[79\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-79)\n\n#### Iran\nRemdesivir has been also produced in Iran by [Barakat](https:\/\/en.wikipedia.org\/wiki\/Barakat_Pharmaceutical_Group \"Barakat Pharmaceutical Group\"); Iran is planning to increase the productions of Remdesivir ampoules from 20,000 to 150,000 ampoules per month. It has also the permission of the \"Food and Drug Administration\" of [MOHME](https:\/\/en.wikipedia.org\/wiki\/Ministry_of_Health_and_Medical_Education \"Ministry of Health and Medical Education\").[\\[80\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-80)\n\n#### Japan\nIn May 2020, [Japan's Ministry of Health, Labour and Welfare](https:\/\/en.wikipedia.org\/wiki\/Ministry_of_Health,_Labour_and_Welfare \"Ministry of Health, Labour and Welfare\") approved the drug for use in Japan, in a fast-tracked process, based on the US emergency authorization.[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR-16)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-:0-60)\n\n#### Mexico\nIn October 2020, Deputy Secretary of Prevention and Health Promotion [Hugo López-Gatell Ramírez](https:\/\/en.wikipedia.org\/wiki\/Hugo_L%C3%B3pez-Gatell_Ram%C3%ADrez \"Hugo López-Gatell Ramírez\") stated at a news conference that Mexico would not necessarily follow the United States in approving the drug for use in Mexico. López-Gatell explained that the [Federal Commission for the Protection against Sanitary Risk](https:\/\/en.wikipedia.org\/wiki\/Federal_Commission_for_the_Protection_against_Sanitary_Risk \"Federal Commission for the Protection against Sanitary Risk\") (Cofepris) had already twice denied the approval of remdesivir because, in that agency's view, the evidence does not suggest \"sufficient efficacy\".[\\[81\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Reuters_Mexico-81) In March 2020, Cofepris authorized the drug for emergency cases, advising to give continuous surveillance of the integral health of the patient.[\\[82\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Cofepris_Mexico-82)\n\n#### Singapore\nIn June 2020, Singapore's [Health Sciences Authority](https:\/\/en.wikipedia.org\/wiki\/Health_Sciences_Authority \"Health Sciences Authority\") conditionally approved the usage of remdesivir in Singapore.[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Reuters_20200620-56)\n\n#### United States\nIn March 2020, United States President [Donald Trump](https:\/\/en.wikipedia.org\/wiki\/Donald_Trump \"Donald Trump\") announced that remdesivir was available for \"[compassionate use](https:\/\/en.wikipedia.org\/wiki\/Compassionate_use \"Compassionate use\")\" for people with COVID‑19; FDA Commissioner [Stephen Hahn](https:\/\/en.wikipedia.org\/wiki\/Stephen_Hahn_\$oncologist\$ \"Stephen Hahn (oncologist)\") confirmed the statement at the same press conference.[\\[83\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-83) It was later revealed that Gilead had been providing remdesivir in response to compassionate use requests since 25 January.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21)[\\[84\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-84) On 23 March 2020, Gilead voluntarily suspended access for compassionate use (excepting cases of critically ill children and pregnant women), for reasons related to supply, citing the need to continue to provide the agent for testing in clinical trials.[\\[85\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Hopkins-85)[\\[86\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-86)\n\nIn May 2020, the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") granted Gilead [emergency use authorization](https:\/\/en.wikipedia.org\/wiki\/Emergency_use_authorization \"Emergency use authorization\") (EUA) for remdesivir to be distributed and used by licensed healthcare providers to treat adults and children hospitalized with severe COVID‑19.[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_EUA_PR-59)[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Severe COVID‑19 is defined as patients with an oxygen saturation (SpO2) \\<= 94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring [extracorporeal membrane oxygenation](https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_membrane_oxygenation \"Extracorporeal membrane oxygenation\") (ECMO), a heart–lung bypass machine.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)[\\[87\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NYT_EUA-87)[\\[88\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-88) Distribution of remdesivir under the EUA was controlled by the US government for use consistent with the terms and conditions of the EUA.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Gilead supplied remdesivir to authorized distributors, or directly to a US government agency, who distributed it to hospitals and other healthcare facilities as directed by the US government, in collaboration with state and local government authorities, as needed.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Gilead stated they were donating 1.5 million vials for emergency use[\\[87\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NYT_EUA-87) and estimated, as of April 2020, they had enough remdesivir for 140,000 treatment courses and expect to have 500,000 courses by October 2020, and one million courses by the end of 2020.[\\[89\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-89)[\\[90\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-90)\n\nThe initial distribution of the drug in the US was tripped up by seemingly capricious decision-making and finger-pointing, resulting in over a week of confusion and frustration among healthcare providers and patients alike.[\\[91\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-91)[\\[92\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Swan-92)[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WaPo20200528-93) On 9 May 2020, the [United States Department of Health and Human Services](https:\/\/en.wikipedia.org\/wiki\/United_States_Department_of_Health_and_Human_Services \"United States Department of Health and Human Services\") (HHS) explained in a statement that it would be distributing remdesivir vials to [state health departments](https:\/\/en.wikipedia.org\/wiki\/State_health_agency \"State health agency\"), then would allow each department to redistribute vials to hospitals in their respective states based upon each department's insight into \"community-level needs.\"[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Facher-94) HHS also clarified that only 607,000 vials of Gilead's promised donation of 1.5 million vials would be going to American patients.[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Facher-94) However, HHS did not explain why several states with some of the highest caseloads had been omitted from the first two distribution rounds, including California, Florida, and Pennsylvania.[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Facher-94) In May 2020, Gilead indicated they would increase the number of doses donated to the US from 607,000 to around 940,000.[\\[95\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stat_20200519-95)[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WaPo20200528-93) Some of the initial distribution was sent to the wrong hospitals, to hospitals with no intensive care units, and to facilities without the needed refrigeration to store it.[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WaPo20200528-93)\n\nIn June 2020, HHS announced an unusual agreement with Gilead in which HHS agreed to Gilead's [wholesale acquisition price](https:\/\/en.wikipedia.org\/wiki\/Wholesale_acquisition_cost \"Wholesale acquisition cost\"), HHS would continue to work together with state governments and drug wholesaler [AmerisourceBergen](https:\/\/en.wikipedia.org\/wiki\/AmerisourceBergen \"AmerisourceBergen\") to allocate shipments of remdesivir vials to American hospitals through the end of September 2020, and in exchange, during that three-month timeframe (July, August, and September), American patients would be allocated over 90% of Gilead's projected remdesivir output of more than 500,000 treatment courses.[\\[96\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Kolata-96)[\\[97\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-HHSPressRelease_29June2020-97) Absent from these announcements was any discussion of allocation of remdesivir production to the approximately 70 countries omitted from Gilead's generic drug licensing agreements—including much of Europe[\\[98\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Boseley-98) and countries as populous as Brazil, China, and Mexico—or the 127 countries listed on those agreements (during the time it will take for Gilead's generic licensees to ramp up their own production).[\\[99\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Baragona-99) As the implications of this began to sink in, several countries publicly confirmed the next day that they already had adequate supplies of remdesivir to cover current needs, including Australia,[\\[100\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Davey-100) Germany,[\\[101\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Rinke-101) and the United Kingdom.[\\[102\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stout-102)\n\nIn August 2020, the FDA broadened the Emergency Use Authorization (EUA) for remdesivir to include all hospitalized patients with suspected or laboratory-confirmed COVID‑19, irrespective of the severity of their disease.[\\[103\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-103)[\\[104\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-104) The Fact Sheet was updated to reflect the new guidance.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)\n\nIn October 2020, Gilead and HHS announced that HHS was relinquishing control over remdesivir allocation because production of the drug had finally caught up with US domestic demand.[\\[105\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Walker-105)[\\[106\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-106)[\\[107\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-HHS_PR_20201001-107) AmerisourceBergen will remain the sole distributor of Veklury in the US through the end of 2020.[\\[107\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-HHS_PR_20201001-107)\n\nOn 22 October 2020, the FDA approved remdesivir and also revised the EUA to permit the use of remdesivir for treatment of suspected or laboratory confirmed COVID‑19 in hospitalized children weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized children less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\\[108\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-108)[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) This decision was criticized for an alleged lack of previous consultation on part of the FDA given the complications of antiviral drug issues.[\\[110\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-110)\n\nIn November 2020, the FDA issued an EUA for the combination of [baricitinib](https:\/\/en.wikipedia.org\/wiki\/Baricitinib \"Baricitinib\") with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28)\n\nRemdesivir received approval from the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) in October 2020, for use in adults and children twelve years and older requiring hospitalization for treatment of severe COVID‑19 infections.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) In January 2022, the FDA gave regulatory approval to remdesivir for use in adults and children (twelve years of age and older who weigh at least 40 kilograms (88 lb) and are positive for COVID‑19, not hospitalized, and are ill with COVID‑19 having high risk for developing severe COVID‑19, including hospitalization or death.[\\[111\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20221021-111) In April 2022, the FDA expanded the approval of remdesivir to include people 28 days of age and older weighing at least 3 kilograms (6.6 lb).[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20220425-27)\n\nThe FDA also provided [emergency use authorization](https:\/\/en.wikipedia.org\/wiki\/Emergency_use_authorization \"Emergency use authorization\") in 2022, for remdesivir treatment of children under age twelve who are COVID‑positive and not hospitalized, but have mild-to-moderate COVID‑19 with high risk of developing severe infection, including hospitalization or death.[\\[111\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20221021-111)\n\n### Economics\nIn June 2020, Gilead announced that it had set the price of remdesivir at US\\$390 per vial for the governments of developed countries, including the United States, and US\\$520 for US private health insurance companies.[\\[112\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20200629-112) The expected course of treatment is six vials over five days for a total cost of US\\$2,340.[\\[112\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20200629-112) Being a [repurposed drug](https:\/\/en.wikipedia.org\/wiki\/Drug_repositioning \"Drug repositioning\"), the minimum production cost for remdesivir is estimated at US\\$0.93 per day of treatment.[\\[113\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-113)\n\nIn July 2020, the European Union secured a €63 million (US\\$74 million) contract with Gilead, to make the drug available there in early August 2020.[\\[114\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-114) In October 2020, Gilead Sciences and the European Commission announced they had signed a joint procurement framework contract in which Gilead agreed to provide up to 500,000 remdesivir treatment courses over the next six months to 37 European countries. Among the contracting countries were all 27 EU member states plus the United Kingdom, \"Albania, Bosnia & Herzegovina, Iceland, Kosovo, Montenegro, North Macedonia, Norway, and Serbia\".[\\[115\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Saigol-115) At the time, the price per treatment course was not disclosed; Reuters reported the price was 2,070 euros, thereby implying the total value of the contract (if all 500,000 courses are ordered) is approximately €1.035 billion.[\\[116\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Guarascio-116) Under the contract, each participating country will directly place orders with Gilead and pay Gilead directly for its own orders.[\\[116\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Guarascio-116)\n\n### Names\nRemdesivir is the [international nonproprietary name](https:\/\/en.wikipedia.org\/wiki\/International_nonproprietary_name \"International nonproprietary name\") (INN)[\\[117\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-117) while the development code name was GS-5734.[\\[118\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-118)\n\n## Research\nRemdesivir was originally created and developed by [Gilead Sciences](https:\/\/en.wikipedia.org\/wiki\/Gilead_Sciences \"Gilead Sciences\") in 2009, to treat [hepatitis C](https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C \"Hepatitis C\") and [respiratory syncytial virus](https:\/\/en.wikipedia.org\/wiki\/Respiratory_syncytial_virus \"Respiratory syncytial virus\") (RSV).[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21)[\\[119\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_20201023-119) It did not work against hepatitis C or RSV,[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21)[\\[119\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_20201023-119) but was then repurposed and studied as a potential treatment for [Ebola virus disease](https:\/\/en.wikipedia.org\/wiki\/Ebola_virus_disease \"Ebola virus disease\") and [Marburg virus](https:\/\/en.wikipedia.org\/wiki\/Marburg_virus \"Marburg virus\") infections.[\\[120\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Warren_2016-120)[\\[119\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_20201023-119) According to the [Czech News Agency](https:\/\/en.wikipedia.org\/wiki\/Czech_News_Agency \"Czech News Agency\"), this new line of research was carried out under the direction of scientist [Tomáš Cihlář](https:\/\/en.wikipedia.org\/wiki\/Tom%C3%A1%C5%A1_Cihl%C3%A1%C5%99 \"Tomáš Cihlář\").[\\[121\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-121) A collaboration of researchers from the [Centers for Disease Control and Prevention](https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention \"Centers for Disease Control and Prevention\") (CDC) and [Gilead Sciences](https:\/\/en.wikipedia.org\/wiki\/Gilead_Sciences \"Gilead Sciences\") subsequently discovered that remdesivir had antiviral activity *in vitro* against multiple [filoviruses](https:\/\/en.wikipedia.org\/wiki\/Filovirus \"Filovirus\"), [pneumoviruses](https:\/\/en.wikipedia.org\/wiki\/Pneumovirus \"Pneumovirus\"), paramyxoviruses, and [coronaviruses](https:\/\/en.wikipedia.org\/wiki\/Coronavirus \"Coronavirus\").[\\[122\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Lo_2017-122)\n\nPreclinical and clinical research and development was done in collaboration between Gilead Sciences and various US government agencies and academic institutions.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)[\\[123\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-123)[\\[124\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-124)[\\[125\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-125)\n\nDuring the mid-2010s, the [Mintz Levin](https:\/\/en.wikipedia.org\/wiki\/Mintz,_Levin,_Cohn,_Ferris,_Glovsky,_and_Popeo \"Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo\") law firm prosecuted various patent applications for remdesivir on behalf of Gilead Sciences before the [United States Patent and Trademark Office](https:\/\/en.wikipedia.org\/wiki\/United_States_Patent_and_Trademark_Office \"United States Patent and Trademark Office\") (USPTO). The USPTO granted two patents on remdesivir to Gilead Sciences on 9 April 2019: one for filoviruses,[\\[126\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-126) and one which covered both [arenaviruses](https:\/\/en.wikipedia.org\/wiki\/Arenavirus \"Arenavirus\") and coronaviruses.[\\[127\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-127)\n\n### Ebola\nIn October 2015, the [United States Army Medical Research Institute of Infectious Diseases](https:\/\/en.wikipedia.org\/wiki\/United_States_Army_Medical_Research_Institute_of_Infectious_Diseases \"United States Army Medical Research Institute of Infectious Diseases\") (USAMRIID) announced preclinical results that remdesivir had blocked the [Ebola virus](https:\/\/en.wikipedia.org\/wiki\/Ebola_virus \"Ebola virus\") in [Rhesus monkeys](https:\/\/en.wikipedia.org\/wiki\/Rhesus_monkeys \"Rhesus monkeys\"). Travis Warren, who has been a USAMRIID principal investigator since 2007, said that the \"work is a result of the continuing collaboration between USAMRIID and Gilead Sciences\".[\\[128\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-USAMRIID_20151009-128) The \"initial screening\" of the \"Gilead Sciences compound library to find molecules with promising antiviral activity\" was performed by scientists at the [Centers for Disease Control and Prevention](https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention \"Centers for Disease Control and Prevention\") (CDC).[\\[128\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-USAMRIID_20151009-128) As a result of this work, it was recommended that remdesivir \"should be further developed as a potential treatment.\"[\\[120\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Warren_2016-120)[\\[128\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-USAMRIID_20151009-128)\n\nRemdesivir was rapidly pushed through clinical trials due to the [West African Ebola virus epidemic](https:\/\/en.wikipedia.org\/wiki\/West_African_Ebola_virus_epidemic \"West African Ebola virus epidemic\") of 2013–2016, eventually being used in people with the disease. Preliminary results were promising; it was used in the emergency setting during the [Kivu Ebola epidemic](https:\/\/en.wikipedia.org\/wiki\/Kivu_Ebola_epidemic \"Kivu Ebola epidemic\") that started in 2018, along with further clinical trials, until August 2019, when Congolese health officials announced that it was significantly less effective than [monoclonal antibody](https:\/\/en.wikipedia.org\/wiki\/Monoclonal_antibody \"Monoclonal antibody\") treatments such as [ansuvimab](https:\/\/en.wikipedia.org\/wiki\/Ansuvimab \"Ansuvimab\") and [atoltivimab\/maftivimab\/odesivimab](https:\/\/en.wikipedia.org\/wiki\/Atoltivimab\/maftivimab\/odesivimab \"Atoltivimab\/maftivimab\/odesivimab\"). The trials, however, established its safety profile.[\\[129\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-129)\n\n### COVID-19\n#### Hospitalized patients\nRemdesivir was approved for medical use in the United States in October 2020.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Veklury-62)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) The US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) approved remdesivir based on the agency's analysis of data from three randomized, controlled clinical trials that included participants hospitalized with mild-to-severe COVID‑19.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) The FDA granted approval and reissued the revised EUA to Gilead Sciences Inc.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) The FDA approved remdesivir based primarily on evidence from three clinical trials (NCT04280705, NCT04292899, and NCT04292730) of 2043 hospitalized participants with COVID‑19.[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) The trials were conducted at 226 sites in 17 countries including the United States.[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109)\n\nIn November 2020, the World Health Organization (WHO) updated its guideline on therapeutics for COVID‑19 to include a conditional recommendation against the use of remdesivir, triggered by results from the WHO [Solidarity trial](https:\/\/en.wikipedia.org\/wiki\/Solidarity_trial \"Solidarity trial\").[\\[130\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WHO_guidelines-130)[\\[131\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-131)[\\[132\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-who-lg-132)[\\[133\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-133) Meanwhile, the [Public Health Agency of Canada](https:\/\/en.wikipedia.org\/wiki\/Public_Health_Agency_of_Canada \"Public Health Agency of Canada\")'s COVID‑19 Clinical Pharmacology Task Group recommended that remdesivir only be administered to hospitalized patients as part of a [randomized controlled trial](https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial \"Randomized controlled trial\") due to limited information on risks and benefits.[\\[134\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-134)\n\nIn January 2022, the Canadian component of the WHO Solidarity Trial reported that in-hospital people with COVID‑19 treated with remdesivir had 17% lower relative risk of death (18.7% versus 22.6% death rates) and 47% reduced relative risk for needing oxygen and mechanical ventilation (8.0% versus 15.0%) compared to people receiving standard-of-care treatments.[\\[135\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Ali-135)\n\nIn September 2022, the WHO updated their guidelines to recommend use of remdesivir for both non-hospitalized and hospitalized patients.[\\[136\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-136) This was based on final results from the SOLIDARITY trial that showed a reduction in mortality or progression to mechanical ventilation for non-ventilated patients.\n\n#### Nonhospitalized outpatients\nIn January 2022, a study indicated that nonhospitalized people who were at high risk for COVID‑19 progression had an 87% lower risk of hospitalization or death after a 3-day course of intravenous remdesivir.[\\[137\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-137)\n\n#### Remdesivir\/baricitinib\nIn May 2020, the [National Institute of Allergy and Infectious Diseases](https:\/\/en.wikipedia.org\/wiki\/National_Institute_of_Allergy_and_Infectious_Diseases \"National Institute of Allergy and Infectious Diseases\") (NIAID) started the Adaptive COVID‑19 Treatment Trial 2 (ACTT-2) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [baricitinib](https:\/\/en.wikipedia.org\/wiki\/Baricitinib \"Baricitinib\") for treating hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\\[138\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-138)[\\[139\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-ACTT_3_PR-139)[\\[140\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-140)\n\nIn November 2020, the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) issued an [emergency use authorization](https:\/\/en.wikipedia.org\/wiki\/Emergency_use_authorization \"Emergency use authorization\") (EUA) for the drug baricitinib, in combination with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_membrane_oxygenation \"Extracorporeal membrane oxygenation\") (ECMO).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28)\n\n#### Remdesivir\/interferon beta-1a\nIn August 2020, the NIAID started the Adaptive COVID‑19 Treatment Trial 3 (ACTT 3) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [interferon beta-1a](https:\/\/en.wikipedia.org\/wiki\/Interferon_beta-1a \"Interferon beta-1a\") for hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\\[139\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-ACTT_3_PR-139)[\\[141\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-141)\n\n## Veterinary uses\nIn 2019, GS-441524 was shown to have promise for treating [feline infectious peritonitis](https:\/\/en.wikipedia.org\/wiki\/Feline_infectious_peritonitis \"Feline infectious peritonitis\") caused by a [coronavirus](https:\/\/en.wikipedia.org\/wiki\/Feline_coronavirus \"Feline coronavirus\").[\\[142\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pedersen-142) It has not been evaluated or approved by the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) for the treatment of [feline coronavirus](https:\/\/en.wikipedia.org\/wiki\/Feline_coronavirus \"Feline coronavirus\") or feline infectious peritonitis but has been available since 2019, through websites and social media as an unregulated black market substance.[\\[143\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-143) Because GS-441524 is the main circulating metabolite of remdesivir and because GS-441524 has similar potency against SARS-CoV-2 *in vitro*, some researchers have argued for the direct administration of GS-441524 as a COVID‑19 treatment.[\\[144\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-144)\n\n## References\n1. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-Veklury_APM_summary_1-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-Veklury_APM_summary_1-1)\n   [\"Veklury Australian prescription medicine decision summary\"](https:\/\/www.tga.gov.au\/apm-summary\/veklury). *[Therapeutic Goods Administration](https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration \"Therapeutic Goods Administration\") (TGA)*. 13 July 2020. [Archived](https:\/\/web.archive.org\/web\/20200813151939\/https:\/\/www.tga.gov.au\/apm-summary\/veklury) from the original on 13 August 2020. Retrieved 16 August 2020.\n2. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-2)\n   [\"AusPAR: Remdesivir\"](https:\/\/www.tga.gov.au\/auspar\/auspar-remdesivir-0). *[Therapeutic Goods Administration](https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration \"Therapeutic Goods Administration\") (TGA)*. 10 May 2022. [Archived](https:\/\/web.archive.org\/web\/20220510022413\/https:\/\/www.tga.gov.au\/auspar\/auspar-remdesivir-0) from the original on 10 May 2022. Retrieved 10 May 2022.\n3. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-3)**\n   [\"Veklury Powder for Injection Product Information\"](https:\/\/www.ebs.tga.gov.au\/ebs\/picmi\/picmirepository.nsf\/pdf?OpenAgent&id=CP-2020-PI-01927-1). *[Therapeutic Goods Administration](https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration \"Therapeutic Goods Administration\") (TGA)*. 9 June 2021. [Archived](https:\/\/web.archive.org\/web\/20200913004814\/https:\/\/www.ebs.tga.gov.au\/ebs\/picmi\/picmirepository.nsf\/pdf?OpenAgent&id=CP-2020-PI-01927-1) from the original on 13 September 2020. Retrieved 16 August 2020.\n4. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-4)**\n   [\"Veklury remdesivir 100 mg powder for injection vial\"](https:\/\/tga-search.clients.funnelback.com\/s\/search.html?collection=tga-artg&profile=record&meta_i=338419). *Therapeutic Goods Administration (TGA)*. [Archived](https:\/\/web.archive.org\/web\/20211023054715\/https:\/\/tga-search.clients.funnelback.com\/s\/search.html?collection=tga-artg&profile=record&meta_i=338419) from the original on 23 October 2021. Retrieved 22 October 2021.\n5. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-5)**\n   [\"COVID-19 treatment: Gilead Sciences Pty Ltd, remdesivir (Veklury)\"](https:\/\/www.tga.gov.au\/covid-19-treatment-gilead-sciences-pty-ltd-remdesivir-veklury). *Therapeutic Goods Administration (TGA)*. 10 July 2020. [Archived](https:\/\/web.archive.org\/web\/20211021023631\/https:\/\/www.tga.gov.au\/covid-19-treatment-gilead-sciences-pty-ltd-remdesivir-veklury) from the original on 21 October 2021. 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[Archived](https:\/\/web.archive.org\/web\/20201006214924\/https:\/\/www.niaid.nih.gov\/news-events\/nih-clinical-trial-testing-remdesivir-plus-interferon-beta-1a-covid-19-treatment-begins\/) from the original on 6 October 2020. Retrieved 5 August 2020.\n     \n     ![Public Domain](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/62\/PD-icon.svg\/20px-PD-icon.svg.png) This article incorporates text from this source, which is in the [public domain](https:\/\/en.wikipedia.org\/wiki\/Public_domain \"Public domain\").\n140. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-140)**\n     [\"Adaptive COVID-19 Treatment Trial 2 (ACTT-2)\"](https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04401579). *ClinicalTrials.gov*. 26 May 2020. [Archived](https:\/\/web.archive.org\/web\/20200805004912\/https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04401579) from the original on 5 August 2020. 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[doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\$identifier\$ \"Doi (identifier)\"):[10\\.1177\/1098612X19825701](https:\/\/doi.org\/10.1177%2F1098612X19825701). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\$identifier\$ \"PMC (identifier)\") [6435921](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6435921). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\$identifier\$ \"PMID (identifier)\") [30755068](https:\/\/pubmed.ncbi.nlm.nih.gov\/30755068).\n143. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-143)**\n     Pedersen NC (18 June 2019). [\"Black market production and sale of GS-441524 and GC376\"](https:\/\/ccah.vetmed.ucdavis.edu\/sites\/g\/files\/dgvnsk4586\/files\/inline-files\/Black%20market%20production%20and%20sale%20of%20GS.pdf) (PDF). Feline Infectious Peritonitis Therapeutics\/Clinical Trials Team, UC Davis. [Archived](https:\/\/web.archive.org\/web\/20200325213121\/https:\/\/ccah.vetmed.ucdavis.edu\/sites\/g\/files\/dgvnsk4586\/files\/inline-files\/Black%20market%20production%20and%20sale%20of%20GS.pdf) (PDF) from the original on 25 March 2020. Retrieved 14 April 2020.\n144. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-144)**\n     Westgate J (7 May 2020). [\"Vet science 'being ignored' in quest for COVID-19 drug\"](https:\/\/www.vettimes.co.uk\/news\/vet-science-being-ignored-in-quest-for-covid-19-drug\/). *vettimes.co.uk*. [Archived](https:\/\/web.archive.org\/web\/20201204142106\/https:\/\/www.vettimes.co.uk\/news\/vet-science-being-ignored-in-quest-for-covid-19-drug\/) from the original on 4 December 2020. Retrieved 6 July 2020.\n## External links\n[![Wikimedia Commons logo](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/40px-Commons-logo.svg.png)](https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg)\n\nWikimedia Commons has media related to [Remdesivir](https:\/\/commons.wikimedia.org\/wiki\/Category:Remdesivir \"commons:Category:Remdesivir\").\n\n[![logo](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/3\/32\/Scholia_logo.svg\/40px-Scholia_logo.svg.png)](https:\/\/en.wikipedia.org\/wiki\/File:Scholia_logo.svg)\n\n[Scholia](https:\/\/www.wikidata.org\/wiki\/Wikidata:Scholia \"d:Wikidata:Scholia\") has a profile for [**remdesivir (Q28209496)**](https:\/\/iw.toolforge.org\/scholia\/Q28209496 \"toolforge:scholia\/Q28209496\").\n\n- Kolata G (1 May 2020). [\"How Remdesivir, New Hope for Covid-19 Patients, Was Resurrected\"](https:\/\/www.nytimes.com\/2020\/05\/01\/health\/coronavirus-remdesivir.html). *[The New York Times](https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times \"The New York Times\")*.\n\n| [v](https:\/\/en.wikipedia.org\/wiki\/Template:RNA_antivirals \"Template:RNA antivirals\") [t](https:\/\/en.wikipedia.org\/wiki\/Template_talk:RNA_antivirals \"Template talk:RNA antivirals\") [e](https:\/\/en.wikipedia.org\/wiki\/Special:EditPage\/Template:RNA_antivirals \"Special:EditPage\/Template:RNA antivirals\")[RNA virus](https:\/\/en.wikipedia.org\/wiki\/RNA_virus \"RNA virus\") [antivirals](https:\/\/en.wikipedia.org\/wiki\/Antiviral_drug \"Antiviral drug\") (primarily [J05](https:\/\/en.wikipedia.org\/wiki\/ATC_code_J05 \"ATC code J05\"), also [S01AD](https:\/\/en.wikipedia.org\/wiki\/ATC_code_S01#S01AD \"ATC code S01\") and [D06BB](https:\/\/en.wikipedia.org\/wiki\/ATC_code_D06#D06BB \"ATC code D06\")) |   |\n|---|---|\n| [Hepatitis C](https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C \"Hepatitis C\") |   |\n|   |   |\n| [NS3](https:\/\/en.wikipedia.org\/wiki\/NS3_\$HCV\$ \"NS3 (HCV)\")\/[4A](https:\/\/en.wikipedia.org\/wiki\/NS4A \"NS4A\") protease inhibitors (–previr) | [Asunaprevir](https:\/\/en.wikipedia.org\/wiki\/Asunaprevir \"Asunaprevir\") [Boceprevir](https:\/\/en.wikipedia.org\/wiki\/Boceprevir \"Boceprevir\")**‡** [Ciluprevir](https:\/\/en.wikipedia.org\/wiki\/Ciluprevir \"Ciluprevir\")**§** [Danoprevir](https:\/\/en.wikipedia.org\/wiki\/Danoprevir \"Danoprevir\")**†** [Faldaprevir](https:\/\/en.wikipedia.org\/wiki\/Faldaprevir \"Faldaprevir\")**‡** [Glecaprevir](https:\/\/en.wikipedia.org\/wiki\/Glecaprevir \"Glecaprevir\") [Grazoprevir](https:\/\/en.wikipedia.org\/wiki\/Grazoprevir \"Grazoprevir\") [Narlaprevir](https:\/\/en.wikipedia.org\/wiki\/Narlaprevir \"Narlaprevir\") [Paritaprevir](https:\/\/en.wikipedia.org\/wiki\/Paritaprevir \"Paritaprevir\") [Simeprevir](https:\/\/en.wikipedia.org\/wiki\/Simeprevir \"Simeprevir\") [Sovaprevir](https:\/\/en.wikipedia.org\/wiki\/Sovaprevir \"Sovaprevir\")**†** [Telaprevir](https:\/\/en.wikipedia.org\/wiki\/Telaprevir \"Telaprevir\")**‡** [Vaniprevir](https:\/\/en.wikipedia.org\/wiki\/Vaniprevir \"Vaniprevir\") [Vedroprevir](https:\/\/en.wikipedia.org\/w\/index.php?title=Vedroprevir&action=edit&redlink=1 \"Vedroprevir (page does not exist)\")**§** [Voxilaprevir](https:\/\/en.wikipedia.org\/wiki\/Voxilaprevir \"Voxilaprevir\") |\n| [NS5A](https:\/\/en.wikipedia.org\/wiki\/NS5A \"NS5A\") inhibitors (–asvir) | [Coblopasvir](https:\/\/en.wikipedia.org\/wiki\/Coblopasvir \"Coblopasvir\") [Daclatasvir](https:\/\/en.wikipedia.org\/wiki\/Daclatasvir \"Daclatasvir\")**\\#** [Elbasvir](https:\/\/en.wikipedia.org\/wiki\/Elbasvir \"Elbasvir\") [Ledipasvir](https:\/\/en.wikipedia.org\/wiki\/Ledipasvir \"Ledipasvir\") [Netanasvir](https:\/\/en.wikipedia.org\/wiki\/Netanasvir \"Netanasvir\") [Odalasvir](https:\/\/en.wikipedia.org\/wiki\/Odalasvir \"Odalasvir\")**†** [Ombitasvir](https:\/\/en.wikipedia.org\/wiki\/Ombitasvir \"Ombitasvir\") [Pibrentasvir](https:\/\/en.wikipedia.org\/wiki\/Pibrentasvir \"Pibrentasvir\") [Ravidasvir](https:\/\/en.wikipedia.org\/wiki\/Ravidasvir \"Ravidasvir\")**†** [Ruzasvir](https:\/\/en.wikipedia.org\/w\/index.php?title=Ruzasvir&action=edit&redlink=1 \"Ruzasvir (page does not exist)\")**†** [Samatasvir](https:\/\/en.wikipedia.org\/wiki\/Samatasvir \"Samatasvir\")**†** [Velpatasvir](https:\/\/en.wikipedia.org\/wiki\/Velpatasvir \"Velpatasvir\") |\n| [NS5B](https:\/\/en.wikipedia.org\/wiki\/NS5B \"NS5B\") [RNA polymerase](https:\/\/en.wikipedia.org\/wiki\/RNA_polymerase \"RNA polymerase\") inhibitors (–buvir) | [Beclabuvir](https:\/\/en.wikipedia.org\/wiki\/Beclabuvir \"Beclabuvir\")**†** [Bemnifosbuvir](https:\/\/en.wikipedia.org\/wiki\/Bemnifosbuvir \"Bemnifosbuvir\")**†** [Dasabuvir](https:\/\/en.wikipedia.org\/wiki\/Dasabuvir \"Dasabuvir\")**\\#** [Deleobuvir](https:\/\/en.wikipedia.org\/wiki\/Deleobuvir \"Deleobuvir\")**§** [Encofosbuvir](https:\/\/en.wikipedia.org\/wiki\/Encofosbuvir \"Encofosbuvir\") [Filibuvir](https:\/\/en.wikipedia.org\/wiki\/Filibuvir \"Filibuvir\")**§** [GS-6620](https:\/\/en.wikipedia.org\/wiki\/GS-6620 \"GS-6620\")**§** [IDX-184](https:\/\/en.wikipedia.org\/wiki\/IDX-184 \"IDX-184\")**§** [Setrobuvir](https:\/\/en.wikipedia.org\/wiki\/Setrobuvir \"Setrobuvir\")**§** [Sofosbuvir](https:\/\/en.wikipedia.org\/wiki\/Sofosbuvir \"Sofosbuvir\")**\\#** [Tegobuvir](https:\/\/en.wikipedia.org\/w\/index.php?title=Tegobuvir&action=edit&redlink=1 \"Tegobuvir (page does not exist)\")**§** [TMC-647055](https:\/\/en.wikipedia.org\/wiki\/TMC-647055 \"TMC-647055\")**§** [Radalbuvir](https:\/\/en.wikipedia.org\/wiki\/Radalbuvir \"Radalbuvir\")**†** [Uprifosbuvir](https:\/\/en.wikipedia.org\/wiki\/Uprifosbuvir \"Uprifosbuvir\")**†** |\n| Combination drugs | [Elbasvir\/grazoprevir](https:\/\/en.wikipedia.org\/wiki\/Elbasvir\/grazoprevir \"Elbasvir\/grazoprevir\") [Glecaprevir\/pibrentasvir](https:\/\/en.wikipedia.org\/wiki\/Glecaprevir\/pibrentasvir \"Glecaprevir\/pibrentasvir\") [Ledipasvir\/sofosbuvir](https:\/\/en.wikipedia.org\/wiki\/Ledipasvir\/sofosbuvir \"Ledipasvir\/sofosbuvir\")**\\#** [Ombitasvir\/paritaprevir\/ritonavir](https:\/\/en.wikipedia.org\/wiki\/Ombitasvir\/paritaprevir\/ritonavir \"Ombitasvir\/paritaprevir\/ritonavir\")**\\#** [Sofosbuvir\/daclatasvir](https:\/\/en.wikipedia.org\/wiki\/Sofosbuvir\/daclatasvir \"Sofosbuvir\/daclatasvir\") [Sofosbuvir\/velpatasvir](https:\/\/en.wikipedia.org\/wiki\/Sofosbuvir\/velpatasvir \"Sofosbuvir\/velpatasvir\")**\\#** [Sofosbuvir\/velpatasvir\/voxilaprevir](https:\/\/en.wikipedia.org\/wiki\/Sofosbuvir\/velpatasvir\/voxilaprevir \"Sofosbuvir\/velpatasvir\/voxilaprevir\") |\n| [Hepatitis D](https:\/\/en.wikipedia.org\/wiki\/Hepatitis_D \"Hepatitis D\") | [Bulevirtide](https:\/\/en.wikipedia.org\/wiki\/Bulevirtide \"Bulevirtide\") |\n| [Picornavirus](https:\/\/en.wikipedia.org\/wiki\/Picornavirus \"Picornavirus\") | *[viral entry](https:\/\/en.wikipedia.org\/wiki\/Viral_entry \"Viral entry\"):* [Pleconaril](https:\/\/en.wikipedia.org\/wiki\/Pleconaril \"Pleconaril\")**†** |\n| Anti-[influenza](https:\/\/en.wikipedia.org\/wiki\/Influenza \"Influenza\") agents | [Baloxavir marboxil](https:\/\/en.wikipedia.org\/wiki\/Baloxavir_marboxil \"Baloxavir marboxil\") [Onradivir](https:\/\/en.wikipedia.org\/wiki\/Onradivir \"Onradivir\") [Pimodivir](https:\/\/en.wikipedia.org\/wiki\/Pimodivir \"Pimodivir\")**†** [Umifenovir](https:\/\/en.wikipedia.org\/wiki\/Umifenovir \"Umifenovir\") *[adamantane derivatives](https:\/\/en.wikipedia.org\/wiki\/Adamantane \"Adamantane\")\/[M2 inhibitors](https:\/\/en.wikipedia.org\/wiki\/M2_protein \"M2 protein\")* ([Adapromine](https:\/\/en.wikipedia.org\/wiki\/Adapromine \"Adapromine\") [Amantadine](https:\/\/en.wikipedia.org\/wiki\/Amantadine \"Amantadine\") [Rimantadine](https:\/\/en.wikipedia.org\/wiki\/Rimantadine \"Rimantadine\")) *[neuraminidase inhibitors](https:\/\/en.wikipedia.org\/wiki\/Neuraminidase_inhibitor \"Neuraminidase inhibitor\")\/[release phase](https:\/\/en.wikipedia.org\/wiki\/Antiviral_drug#Release_phase \"Antiviral drug\")* ([Oseltamivir](https:\/\/en.wikipedia.org\/wiki\/Oseltamivir \"Oseltamivir\")**\\#** [Zanamivir](https:\/\/en.wikipedia.org\/wiki\/Zanamivir \"Zanamivir\") [Peramivir](https:\/\/en.wikipedia.org\/wiki\/Peramivir \"Peramivir\"), [Laninamivir](https:\/\/en.wikipedia.org\/wiki\/Laninamivir \"Laninamivir\")**†**) |\n| Multiple\/general |   |\n|   |   |\n| [Interferon](https:\/\/en.wikipedia.org\/wiki\/Interferon \"Interferon\") | [Interferon alfa 2b](https:\/\/en.wikipedia.org\/wiki\/Interferon_alfa_2b \"Interferon alfa 2b\") [Peginterferon alfa-2a](https:\/\/en.wikipedia.org\/wiki\/Peginterferon_alfa-2a \"Peginterferon alfa-2a\")**\\#** [Peginterferon alfa-2b](https:\/\/en.wikipedia.org\/wiki\/Peginterferon_alfa-2b \"Peginterferon alfa-2b\")**\\#** |\n| [3CL protease](https:\/\/en.wikipedia.org\/wiki\/3C-like_protease \"3C-like protease\") inhibitors (–trelvir) | [Atilotrelvir](https:\/\/en.wikipedia.org\/wiki\/Atilotrelvir \"Atilotrelvir\") [Ensitrelvir](https:\/\/en.wikipedia.org\/wiki\/Ensitrelvir \"Ensitrelvir\")**†** [Ibuzatrelvir](https:\/\/en.wikipedia.org\/wiki\/Ibuzatrelvir \"Ibuzatrelvir\") [Leritrelvir](https:\/\/en.wikipedia.org\/wiki\/Leritrelvir \"Leritrelvir\") [Lufotrelvir](https:\/\/en.wikipedia.org\/wiki\/Lufotrelvir \"Lufotrelvir\") [Nirmatrelvir](https:\/\/en.wikipedia.org\/wiki\/Nirmatrelvir \"Nirmatrelvir\")**†** ([\\+ritonavir](https:\/\/en.wikipedia.org\/wiki\/Nirmatrelvir\/ritonavir \"Nirmatrelvir\/ritonavir\"))**†** [Rupintrivir](https:\/\/en.wikipedia.org\/wiki\/Rupintrivir \"Rupintrivir\") [Simnotrelvir](https:\/\/en.wikipedia.org\/wiki\/Simnotrelvir \"Simnotrelvir\") ([\\+ritonavir](https:\/\/en.wikipedia.org\/wiki\/Simnotrelvir\/ritonavir \"Simnotrelvir\/ritonavir\")**†**) |\n| RNA pol inhibitors | [CMX521](https:\/\/en.wikipedia.org\/wiki\/CMX521 \"CMX521\")**§** [Deuremidevir](https:\/\/en.wikipedia.org\/wiki\/Deuremidevir \"Deuremidevir\")**†** [Favipiravir](https:\/\/en.wikipedia.org\/wiki\/Favipiravir \"Favipiravir\") [Galidesivir](https:\/\/en.wikipedia.org\/wiki\/Galidesivir \"Galidesivir\")**†** [GS-441524](https:\/\/en.wikipedia.org\/wiki\/GS-441524 \"GS-441524\")**§** [Remdesivir]() [MK-608](https:\/\/en.wikipedia.org\/wiki\/MK-608 \"MK-608\")**§** [Mericitabine](https:\/\/en.wikipedia.org\/wiki\/Mericitabine \"Mericitabine\")**†** [Molnupiravir](https:\/\/en.wikipedia.org\/wiki\/Molnupiravir \"Molnupiravir\") [NITD008](https:\/\/en.wikipedia.org\/wiki\/NITD008 \"NITD008\")**§** [Ribavirin](https:\/\/en.wikipedia.org\/wiki\/Ribavirin \"Ribavirin\")**\\#** [Taribavirin](https:\/\/en.wikipedia.org\/wiki\/Taribavirin \"Taribavirin\")**†** [Triazavirin](https:\/\/en.wikipedia.org\/wiki\/Triazavirin \"Triazavirin\") [Valopicitabine](https:\/\/en.wikipedia.org\/wiki\/Valopicitabine \"Valopicitabine\")**†** |\n| Multiple\/Unknown\/Other | [EICAR](https:\/\/en.wikipedia.org\/wiki\/EICAR_\$antiviral\$ \"EICAR (antiviral)\")**§** [Merimepodib](https:\/\/en.wikipedia.org\/wiki\/Merimepodib \"Merimepodib\")**§** [Moroxydine](https:\/\/en.wikipedia.org\/wiki\/Moroxydine \"Moroxydine\") [Presatovir](https:\/\/en.wikipedia.org\/wiki\/Presatovir \"Presatovir\")**†** |\n| \\#[WHO-EM](https:\/\/en.wikipedia.org\/wiki\/WHO_Model_List_of_Essential_Medicines \"WHO Model List of Essential Medicines\") ‡[Withdrawn](https:\/\/en.wikipedia.org\/wiki\/List_of_withdrawn_drugs \"List of withdrawn drugs\") from market [Clinical trials](https:\/\/en.wikipedia.org\/wiki\/Clinical_trial \"Clinical trial\"): †[Phase III](https:\/\/en.wikipedia.org\/wiki\/Phases_of_clinical_research#Phase_III \"Phases of clinical research\") §Never to phase III |   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Wikipedia® is a registered trademark of the [Wikimedia Foundation, Inc.](https:\/\/wikimediafoundation.org\/), a non-profit organization.\n\n- [Privacy policy](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Policy:Privacy_policy)\n- [About Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:About)\n- [Disclaimers](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:General_disclaimer)\n- [Contact Wikipedia](https:\/\/en.wikipedia.org\/wiki\/Wikipedia:Contact_us)\n- [Legal & safety contacts](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Legal:Wikimedia_Foundation_Legal_and_Safety_Contact_Information)\n- [Code of Conduct](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Policy:Universal_Code_of_Conduct)\n- [Developers](https:\/\/developer.wikimedia.org\/)\n- [Statistics](https:\/\/stats.wikimedia.org\/#\/en.wikipedia.org)\n- [Cookie statement](https:\/\/foundation.wikimedia.org\/wiki\/Special:MyLanguage\/Policy:Cookie_statement)\n- [Mobile 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[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/5\/5b\/Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png\/250px-Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png)](https:\/\/en.wikipedia.org\/wiki\/File:Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png) |   |\n| Clinical data |   |\n| Pronunciation | [*rem-DESS\\-i-veer*](https:\/\/en.wikipedia.org\/wiki\/Help:Pronunciation_respelling_key \"Help:Pronunciation respelling key\") |\n| [Trade names](https:\/\/en.wikipedia.org\/wiki\/Drug_nomenclature#Trade_names \"Drug nomenclature\") | Veklury |\n| Other names | GS-5734, RDV |\n| [AHFS](https:\/\/en.wikipedia.org\/wiki\/American_Society_of_Health-System_Pharmacists \"American Society of Health-System Pharmacists\")\/[Drugs.com](https:\/\/en.wikipedia.org\/wiki\/Drugs.com \"Drugs.com\") | [Monograph](https:\/\/www.drugs.com\/monograph\/remdesivir.html) |\n| [MedlinePlus](https:\/\/en.wikipedia.org\/wiki\/MedlinePlus \"MedlinePlus\") | [a620033](https:\/\/medlineplus.gov\/druginfo\/meds\/a620033.html) |\n| [License data](https:\/\/en.wikipedia.org\/wiki\/Regulation_of_therapeutic_goods \"Regulation of therapeutic goods\") | US [DailyMed](https:\/\/en.wikipedia.org\/wiki\/DailyMed \"DailyMed\"): [Remdesivir](https:\/\/dailymed.nlm.nih.gov\/dailymed\/search.cfm?labeltype=all&query=Remdesivir) |\n| [Pregnancy category](https:\/\/en.wikipedia.org\/wiki\/Pregnancy_category \"Pregnancy category\") | AU : B2[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_APM_summary-1)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-AusPAR:_Remdesivir-2) |\n| [Routes of administration](https:\/\/en.wikipedia.org\/wiki\/Route_of_administration \"Route of administration\") | [Intravenous](https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy \"Intravenous therapy\") |\n| [Drug class](https:\/\/en.wikipedia.org\/wiki\/Drug_class \"Drug class\") | [Antiviral](https:\/\/en.wikipedia.org\/wiki\/Antiviral \"Antiviral\") |\n| [ATC code](https:\/\/en.wikipedia.org\/wiki\/Anatomical_Therapeutic_Chemical_Classification_System \"Anatomical Therapeutic Chemical Classification System\") | [J05AB16](https:\/\/en.wikipedia.org\/wiki\/ATC_code_J05 \"ATC code J05\") ([WHO](https:\/\/www.whocc.no\/atc_ddd_index\/?code=J05AB16)) |\n| Legal status |   |\n| [Legal status](https:\/\/en.wikipedia.org\/wiki\/Regulation_of_therapeutic_goods \"Regulation of therapeutic goods\") | AU : [S4](https:\/\/en.wikipedia.org\/wiki\/Standard_for_the_Uniform_Scheduling_of_Medicines_and_Poisons#Schedule_4 \"Standard for the Uniform Scheduling of Medicines and Poisons\") (Prescription only)[\\[3\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-3)[\\[1\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_APM_summary-1)[\\[4\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-4)[\\[5\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-5)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-AusPAR:_Remdesivir-2) CA :  [℞-only](https:\/\/en.wikipedia.org\/wiki\/Prescription_drug \"Prescription drug\")[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-CA_Veklury_Product_information-6)[\\[7\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-7)[\\[8\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-8) UK : [POM](https:\/\/en.wikipedia.org\/wiki\/Prescription_drug \"Prescription drug\") (Prescription only)[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_SmPC-9)[\\[10\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-10) US : [℞-only](https:\/\/en.wikipedia.org\/wiki\/Prescription_drug \"Prescription drug\")[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11) EU : Rx-only[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[13\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-13) IN : [Schedule H](https:\/\/en.wikipedia.org\/wiki\/Schedule_H \"Schedule H\") (℞-only) [\\[14\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-14)[\\[15\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-15) |\n| Identifiers |   |\n| [IUPAC name](https:\/\/en.wikipedia.org\/wiki\/IUPAC_nomenclature_of_chemistry \"IUPAC nomenclature of chemistry\") (2*S*)-2-{(2*R*,3*S*,4*R*,5*R*)-\\[5-(4-Aminopyrrolo\\[2,1-*f*\\] \\[1,2,4\\]triazin-7-yl)-5-cyano-3,4-dihydroxy-tetrahydro-furan-2-ylmethoxy\\]phenoxy-(*S*)-phosphorylamino}propionic acid 2-ethyl-butyl ester |   |\n| [CAS Number](https:\/\/en.wikipedia.org\/wiki\/CAS_Registry_Number \"CAS Registry Number\") | [1809249-37-3](https:\/\/commonchemistry.cas.org\/detail?cas_rn=1809249-37-3) |\n| [PubChem](https:\/\/en.wikipedia.org\/wiki\/PubChem#CID \"PubChem\") CID | [121304016](https:\/\/pubchem.ncbi.nlm.nih.gov\/compound\/121304016) |\n| [DrugBank](https:\/\/en.wikipedia.org\/wiki\/DrugBank \"DrugBank\") | [DB14761](https:\/\/www.drugbank.ca\/drugs\/DB14761) |\n| [ChemSpider](https:\/\/en.wikipedia.org\/wiki\/ChemSpider \"ChemSpider\") | [58827832](https:\/\/www.chemspider.com\/Chemical-Structure.58827832.html) |\n| [UNII](https:\/\/en.wikipedia.org\/wiki\/Unique_Ingredient_Identifier \"Unique Ingredient Identifier\") | [3QKI37EEHE](https:\/\/precision.fda.gov\/uniisearch\/srs\/unii\/3QKI37EEHE) |\n| [KEGG](https:\/\/en.wikipedia.org\/wiki\/KEGG \"KEGG\") | [D11472](https:\/\/www.kegg.jp\/entry\/D11472) |\n| [ChEBI](https:\/\/en.wikipedia.org\/wiki\/ChEBI \"ChEBI\") | [CHEBI:145994](https:\/\/www.ebi.ac.uk\/chebi\/searchId.do?chebiId=CHEBI:145994) |\n| [ChEMBL](https:\/\/en.wikipedia.org\/wiki\/ChEMBL \"ChEMBL\") | [ChEMBL4065616](https:\/\/www.ebi.ac.uk\/chembl\/explore\/compound\/ChEMBL4065616) |\n| [CompTox Dashboard](https:\/\/en.wikipedia.org\/wiki\/CompTox_Chemicals_Dashboard \"CompTox Chemicals Dashboard\") ( EPA ) | [DTXSID701022537](https:\/\/comptox.epa.gov\/dashboard\/chemical\/details\/DTXSID701022537) [![Edit this at Wikidata](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/8\/8a\/OOjs_UI_icon_edit-ltr-progressive.svg\/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https:\/\/www.wikidata.org\/wiki\/Q28209496#P3117 \"Edit this at Wikidata\") |\n| [ECHA InfoCard](https:\/\/en.wikipedia.org\/wiki\/ECHA_InfoCard \"ECHA InfoCard\") | [100\\.302.974](https:\/\/echa.europa.eu\/substance-information\/-\/substanceinfo\/100.302.974) [![Edit this at Wikidata](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/8\/8a\/OOjs_UI_icon_edit-ltr-progressive.svg\/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https:\/\/www.wikidata.org\/wiki\/Q28209496#P2566 \"Edit this at Wikidata\") |\n| Chemical and physical data |   |\n| [Formula](https:\/\/en.wikipedia.org\/wiki\/Chemical_formula \"Chemical formula\") | C27H35N6O8P |\n| [Molar mass](https:\/\/en.wikipedia.org\/wiki\/Molar_mass \"Molar mass\") | 602\\.585 g·mol−1 |\n| 3D model ([JSmol](https:\/\/en.wikipedia.org\/wiki\/JSmol \"JSmol\")) | [Interactive image](https:\/\/chemapps.stolaf.edu\/jmol\/jmol.php?model=CCC%28COC%28%3DO%29%5BC%40%40H%5D%28NP%28%3DO%29%28Oc1ccccc1%29OC%5BC%40H%5D1O%5BC%40%40%5D%28%5BC%40%40H%5D%28%5BC%40%40H%5D1O%29O%29%28C%23N%29c1ccc2n1ncnc2N%29C%29CC) |\n| [SMILES](https:\/\/en.wikipedia.org\/wiki\/Simplified_molecular-input_line-entry_system \"Simplified molecular-input line-entry system\") CCC(COC(=O)\\[C@@H\\](NP(=O)(Oc1ccccc1)OC\\[C@H\\]1O\\[C@@\\](\\[C@@H\\](\\[C@@H\\]1O)O)(C\\#N)c1ccc2n1ncnc2N)C)CC |   |\n| [InChI](https:\/\/en.wikipedia.org\/wiki\/International_Chemical_Identifier \"International Chemical Identifier\") InChI=1S\/C27H35N6O8P\/c1-4-18(5-2)13-38-26(36)17(3)32-42(37,41-19-9-7-6-8-10-19)39-14-21-23(34)24(35)27(15-28,40-21)22-12-11-20-25(29)30-16-31-33(20)22\/h6-12,16-18,21,23-24,34-35H,4-5,13-14H2,1-3H3,(H,32,37)(H2,29,30,31)\/t17-,21+,23+,24+,27-,42-\/m0\/s1 Key:RWWYLEGWBNMMLJ-YSOARWBDSA-N |   |\n\n**Remdesivir**, sold under the brand name **Veklury**,[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR-16) is a [broad-spectrum antiviral medication](https:\/\/en.wikipedia.org\/wiki\/Broad-spectrum_antiviral_drug \"Broad-spectrum antiviral drug\") developed by the [biopharmaceutical](https:\/\/en.wikipedia.org\/wiki\/Biopharmaceutical \"Biopharmaceutical\") company [Gilead Sciences](https:\/\/en.wikipedia.org\/wiki\/Gilead_Sciences \"Gilead Sciences\").[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Scavone_2020-17) It is administered via [injection into a vein](https:\/\/en.wikipedia.org\/wiki\/Intravenous \"Intravenous\").[\\[18\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-18)[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Mehta2020-19) During the [COVID‑19 pandemic](https:\/\/en.wikipedia.org\/wiki\/COVID-19_pandemic \"COVID-19 pandemic\"), remdesivir was approved or authorized for emergency use to treat [COVID‑19](https:\/\/en.wikipedia.org\/wiki\/Coronavirus_disease_2019 \"Coronavirus disease 2019\") in numerous countries.[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20201022-20)\n\nRemdesivir was originally developed to treat [hepatitis C](https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C \"Hepatitis C\"),[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21) and was subsequently investigated for [Ebola virus disease](https:\/\/en.wikipedia.org\/wiki\/Ebola \"Ebola\") and [Marburg virus](https:\/\/en.wikipedia.org\/wiki\/Marburg_virus_disease \"Marburg virus disease\") infections[\\[22\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pmid269342202-22) before being studied as a post-infection treatment for COVID‑19.[\\[23\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-kai2-23)\n\nRemdesivir is a [prodrug](https:\/\/en.wikipedia.org\/wiki\/Prodrug \"Prodrug\") that is intended to allow intracellular delivery of [GS-441524](https:\/\/en.wikipedia.org\/wiki\/GS-441524 \"GS-441524\") monophosphate and subsequent biotransformation into GS-441524 [triphosphate](https:\/\/en.wikipedia.org\/wiki\/Triphosphate \"Triphosphate\"), a ribo[nucleotide analogue](https:\/\/en.wikipedia.org\/wiki\/Nucleotide_analogue \"Nucleotide analogue\") inhibitor of viral [RNA polymerase](https:\/\/en.wikipedia.org\/wiki\/RNA_polymerase \"RNA polymerase\").[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020-24)\n\nThe most common side effect in healthy volunteers is raised blood levels of [liver enzymes](https:\/\/en.wikipedia.org\/wiki\/Liver_enzymes \"Liver enzymes\").[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12) The most common side effect in people with COVID‑19 is [nausea](https:\/\/en.wikipedia.org\/wiki\/Nausea \"Nausea\").[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12) Side effects may include liver inflammation and an [infusion](https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy \"Intravenous therapy\")\\-related reaction with nausea, [low blood pressure](https:\/\/en.wikipedia.org\/wiki\/Hypotension \"Hypotension\"), and sweating.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)\n\nThe US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) considers it to be a [first-in-class medication](https:\/\/en.wikipedia.org\/wiki\/First-in-class_medication \"First-in-class medication\").[\\[26\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-26)\n\nMedical uses\n\nIn the European Union, remdesivir is [indicated](https:\/\/en.wikipedia.org\/wiki\/Indication_\$medicine\$ \"Indication (medicine)\") for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) with [pneumonia](https:\/\/en.wikipedia.org\/wiki\/Pneumonia \"Pneumonia\") requiring supplemental oxygen and for adults who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID‑19.[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_SmPC-9)[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)\n\nIn the United States, remdesivir is indicated for the treatment of COVID‑19 in people 28 days of age and older and weighing at least 3 kilograms (6.6 lb) who are hospitalized; or not hospitalized and have mild-to-moderate COVID‑19, and are at high risk for progression to severe COVID‑19, including hospitalization or death.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11)[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20220425-27)\n\nIn November 2020, the FDA issued an emergency use authorization (EUA) for the combination of [baricitinib](https:\/\/en.wikipedia.org\/wiki\/Baricitinib \"Baricitinib\") with remdesivir, for the treatment of suspected or laboratory confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_membrane_oxygenation \"Extracorporeal membrane oxygenation\") (ECMO).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28)\n\nIn Australia, it is approved for those aged four weeks of age and older with a body weight at least 3 kilograms (6.6 lb) with [pneumonia](https:\/\/en.wikipedia.org\/wiki\/Pneumonia \"Pneumonia\") requiring supplemental oxygen or those aged four weeks of age and older with body weight at least 40 kilograms (88 lb) who do not require supplemental oxygen and who are at high risk of progressing to severe COVID‑19.[\\[29\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-29)[\\[2\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-AusPAR:_Remdesivir-2)\n\nIn 2024, a retrospective study found treatment with the antiviral remdesivir plus dexamethasone was associated with fewer deaths in hospitalized COVID-19 patients compared to dexamethasone alone.[\\[30\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-30) The combination led to a 26% reduction in mortality at 14 days and a 24% reduction at 28 days.[\\[31\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-31)\n\nSide effects\n\nThe most common adverse effects in people treated with remdesivir were [respiratory failure](https:\/\/en.wikipedia.org\/wiki\/Respiratory_failure \"Respiratory failure\") and blood [biomarkers](https:\/\/en.wikipedia.org\/wiki\/Biomarker \"Biomarker\") of [organ](https:\/\/en.wikipedia.org\/wiki\/Organ_\$anatomy\$ \"Organ (anatomy)\") impairment, including [low albumin](https:\/\/en.wikipedia.org\/wiki\/Human_serum_albumin#Hypoalbuminemia \"Human serum albumin\"), [low potassium](https:\/\/en.wikipedia.org\/wiki\/Hypokalemia \"Hypokalemia\"), [low count of red blood cells](https:\/\/en.wikipedia.org\/wiki\/Anemia \"Anemia\"), [low count of thrombocytes](https:\/\/en.wikipedia.org\/wiki\/Thrombocytopenia \"Thrombocytopenia\"), and [elevated bilirubin (jaundice)](https:\/\/en.wikipedia.org\/wiki\/Jaundice \"Jaundice\").[\\[32\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wang-32) Other reported adverse effects include [gastrointestinal distress](https:\/\/en.wikipedia.org\/wiki\/Gastrointestinal_disease \"Gastrointestinal disease\"), elevated [transaminase](https:\/\/en.wikipedia.org\/wiki\/Transaminase \"Transaminase\") levels in the blood ([liver enzymes](https:\/\/en.wikipedia.org\/wiki\/Liver_function_tests \"Liver function tests\")), [infusion](https:\/\/en.wikipedia.org\/wiki\/Infusion_therapy \"Infusion therapy\") site reactions, and [electrocardiogram abnormalities](https:\/\/en.wikipedia.org\/wiki\/Drug-induced_QT_prolongation \"Drug-induced QT prolongation\").[\\[19\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Mehta2020-19) Remdesivir may cause [infusion-related](https:\/\/en.wikipedia.org\/wiki\/Intravenous_therapy \"Intravenous therapy\") reactions, including low blood pressure, nausea, vomiting, sweating or shivering.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)\n\nOther possible side effects of remdesivir include:\n\n- Infusion-related reactions. Infusion-related reactions have been seen during a remdesivir infusion or around the time remdesivir was given.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Signs and symptoms of infusion-related reactions may include: low blood pressure, nausea, vomiting, sweating, and shivering.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)\n- Increases in levels of liver enzymes, seen in abnormal liver blood tests.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Increases in levels of liver enzymes have been seen in people who have received remdesivir, which may be a sign of inflammation or damage to cells in the liver.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)\n\nPharmacology\n\nActivation\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/0\/08\/Remdesivir_activation.svg\/500px-Remdesivir_activation.svg.png)](https:\/\/en.wikipedia.org\/wiki\/File:Remdesivir_activation.svg)\n\nActivation of remdesivir into its active triphosphate metabolite[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)\n\nRemdesivir is a [protide](https:\/\/en.wikipedia.org\/wiki\/Protide \"Protide\") ([prodrug](https:\/\/en.wikipedia.org\/wiki\/Prodrug \"Prodrug\") of nucleotide) able to diffuse into cells, where it is converted to [GS-441524](https:\/\/en.wikipedia.org\/wiki\/GS-441524 \"GS-441524\") monophosphate via the actions of [esterases](https:\/\/en.wikipedia.org\/wiki\/Esterase \"Esterase\") ([CES1](https:\/\/en.wikipedia.org\/wiki\/CES1 \"CES1\") and [CTSA](https:\/\/en.wikipedia.org\/wiki\/Cathepsin_A \"Cathepsin A\")) and a [phosphoamidase](https:\/\/en.wikipedia.org\/wiki\/Phosphoamidase \"Phosphoamidase\") ([HINT1](https:\/\/en.wikipedia.org\/wiki\/HINT1 \"HINT1\")); this in turn is further phosphorylated to its [active metabolite](https:\/\/en.wikipedia.org\/wiki\/Active_metabolite \"Active metabolite\") triphosphate by [nucleoside-phosphate kinases](https:\/\/en.wikipedia.org\/wiki\/Nucleoside-phosphate_kinase \"Nucleoside-phosphate kinase\").[\\[35\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Sheahan_2017-35)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon2020-36) This pathway of bioactivation is meant to occur [intracellularly](https:\/\/en.wikipedia.org\/wiki\/Intracellular \"Intracellular\"), but a substantial amount of remdesivir is prematurely [hydrolyzed](https:\/\/en.wikipedia.org\/wiki\/Hydrolysis \"Hydrolysis\") in plasma, with GS-441524 being the major metabolite in plasma, and the only metabolite remaining two hours after dosing.[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020-24)\n\nMechanism of action\n\nAs an [adenosine](https:\/\/en.wikipedia.org\/wiki\/Adenosine \"Adenosine\") nucleoside triphosphate analog (GS-443902),[\\[37\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pmid22446091-37) the [active metabolite](https:\/\/en.wikipedia.org\/wiki\/Active_metabolite \"Active metabolite\") of remdesivir interferes with the action of viral [RNA-dependent RNA polymerase](https:\/\/en.wikipedia.org\/wiki\/RNA-dependent_RNA_polymerase \"RNA-dependent RNA polymerase\") and evades [proofreading](https:\/\/en.wikipedia.org\/wiki\/Proofreading_\$biology\$ \"Proofreading (biology)\") by viral [exoribonuclease](https:\/\/en.wikipedia.org\/wiki\/Exoribonuclease \"Exoribonuclease\") (ExoN), causing a decrease in viral RNA production.[\\[17\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Scavone_2020-17)[\\[38\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Ferner2020-38) In some viruses, such as the [respiratory syncytial virus](https:\/\/en.wikipedia.org\/wiki\/Respiratory_syncytial_virus \"Respiratory syncytial virus\"), it causes the RNA-dependent RNA polymerases to pause, but its predominant effect (as in Ebola) is to induce an irreversible [chain termination](https:\/\/en.wikipedia.org\/wiki\/Chain_termination \"Chain termination\"). Unlike with many other chain terminators, this is not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain.[\\[39\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pmid30987343-39) For the RNA-dependent RNA polymerases of [MERS-CoV](https:\/\/en.wikipedia.org\/wiki\/MERS-CoV \"MERS-CoV\"), [SARS-CoV-1](https:\/\/en.wikipedia.org\/wiki\/SARS-CoV-1 \"SARS-CoV-1\"), and [SARS-CoV-2](https:\/\/en.wikipedia.org\/wiki\/SARS-CoV-2 \"SARS-CoV-2\"), arrest of RNA synthesis occurs after incorporation of three additional nucleotides.[\\[40\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon_2020-40)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon2020-36) Hence, remdesivir is classified as a direct-acting antiviral agent that works as a delayed chain terminator.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)[\\[36\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gordon2020-36)\n\nPharmacokinetics\n\nIn non-human primates, the plasma [half-life](https:\/\/en.wikipedia.org\/wiki\/Biological_half-life \"Biological half-life\") of the prodrug is 20 minutes, with the main metabolite being the [nucleoside](https:\/\/en.wikipedia.org\/wiki\/Nucleoside \"Nucleoside\"), [GS-441524](https:\/\/en.wikipedia.org\/wiki\/GS-441524 \"GS-441524\"). Two hours post injection, the main metabolite GS-441524 is present at micromolar concentrations, whilst intact Remdesivir is no longer detectable. Because of this rapid extracellular conversion to the nucleoside GS-441524, some researchers have questioned whether the active nucleotide triphosphate is truly derived from remdesivir pro-drug removal or whether it occurs by GS-441524 phosphorylation, and whether direct administration of GS-441524 would constitute a cheaper and easier to administer COVID‑19 drug compared to remdesivir.[\\[41\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020_2-41)[\\[24\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Yan_2020-24) The activated nucleotide triphosphate form has sustained intracellular levels in [PBMC](https:\/\/en.wikipedia.org\/wiki\/PBMC \"PBMC\") and presumably in other cells as well.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)\n\nResistance\n\nMutations in the [mouse hepatitis virus](https:\/\/en.wikipedia.org\/wiki\/Mouse_hepatitis_virus \"Mouse hepatitis virus\") [RNA replicase](https:\/\/en.wikipedia.org\/wiki\/RNA_replicase \"RNA replicase\") that cause partial resistance to remdesivir were identified in 2018. These mutations make the viruses less effective in nature, and the researchers believe they will likely not persist where the drug is not being used.[\\[42\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Chiotos2020-42)\n\nInteractions\n\nRemdesivir is at least partially metabolized by the [cytochrome P450](https:\/\/en.wikipedia.org\/wiki\/Cytochrome_P450 \"Cytochrome P450\") enzymes [CYP2C8](https:\/\/en.wikipedia.org\/wiki\/CYP2C8 \"CYP2C8\"), [CYP2D6](https:\/\/en.wikipedia.org\/wiki\/CYP2D6 \"CYP2D6\"), and [CYP3A4](https:\/\/en.wikipedia.org\/wiki\/CYP3A4 \"CYP3A4\").[\\[43\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_Summary_on_compassionate_use-43)[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) [Blood plasma](https:\/\/en.wikipedia.org\/wiki\/Blood_plasma \"Blood plasma\") concentrations of remdesivir are expected to decrease if it is administered together with cytochrome P450 [inducers](https:\/\/en.wikipedia.org\/wiki\/List_of_cytochrome_P450_modulators \"List of cytochrome P450 modulators\") such as [rifampicin](https:\/\/en.wikipedia.org\/wiki\/Rifampicin \"Rifampicin\"), [carbamazepine](https:\/\/en.wikipedia.org\/wiki\/Carbamazepine \"Carbamazepine\"), [phenobarbital](https:\/\/en.wikipedia.org\/wiki\/Phenobarbital \"Phenobarbital\"), [phenytoin](https:\/\/en.wikipedia.org\/wiki\/Phenytoin \"Phenytoin\"), [primidone](https:\/\/en.wikipedia.org\/wiki\/Primidone \"Primidone\"), and [St John's wort](https:\/\/en.wikipedia.org\/wiki\/St_John%27s_wort \"St John's wort\").[\\[44\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-44)\n\nUsing chloroquine or [hydroxychloroquine](https:\/\/en.wikipedia.org\/wiki\/Hydroxychloroquine \"Hydroxychloroquine\") with remdesivir may reduce the antiviral activity of remdesivir.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11)[\\[9\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_SmPC-9)[\\[45\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-45) Coadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on *in vitro* data demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir.[\\[11\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_FDA_label-11)\n\nSynthesis\n\n[![](https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/a\/ab\/Synthesis_of_Remdesivir.png\/500px-Synthesis_of_Remdesivir.png)](https:\/\/en.wikipedia.org\/wiki\/File:Synthesis_of_Remdesivir.png)\n\nSynthesis of remdesivir in [structural formulae](https:\/\/en.wikipedia.org\/wiki\/Structural_formula \"Structural formula\")\n\nRemdesivir can be synthesized in multiple steps from [ribose](https:\/\/en.wikipedia.org\/wiki\/Ribose \"Ribose\") derivatives. The figure to the right is one of the synthesis routes of remdesivir invented by Chun and coauthors from Gilead Sciences.[\\[46\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-46)[\\[47\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-47)\n\n*In vitro* experiments\n\nAn *[in vitro](https:\/\/en.wikipedia.org\/wiki\/In_vitro \"In vitro\")* study of remdesivir assessing antiviral activity against SARS-CoV-2 was performed.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wangc:20-48) Cells were pre-treated with the different doses of remdesivir for 1 hour, and the virus (MOI of 0.05) was subsequently added to allow infection for 2 hours.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wangc:20-48) The results found that remdesivir functioned well as an inhibitor of the infection.[\\[48\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-wangc:20-48) The study was published as a letter to the editor, and as such did not undergo peer review.\n\nManufacturing\n\nRemdesivir requires \"70 raw materials, reagents, and catalysts\" to make, and approximately \"25 chemical steps.\"[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) Some of the ingredients are extremely dangerous to humans, especially [trimethylsilyl cyanide](https:\/\/en.wikipedia.org\/wiki\/Trimethylsilyl_cyanide \"Trimethylsilyl cyanide\").[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) The original end-to-end manufacturing process required 9 to 12 months to go from raw materials at contract manufacturers to finished product, but after restarting production in January 2020, Gilead Sciences was able to find ways to reduce the production time to six months.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49)\n\nIn January 2020, Gilead began working on restarting remdesivir production in glass-lined steel [chemical reactors](https:\/\/en.wikipedia.org\/wiki\/Chemical_reactor \"Chemical reactor\") at its manufacturing plant in [Edmonton, Alberta](https:\/\/en.wikipedia.org\/wiki\/Edmonton \"Edmonton\").[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) On 2 February 2020, the company flew its entire stock of remdesivir, 100 kilograms in powder form (left over from Ebola research), to its filling plant in [La Verne, California](https:\/\/en.wikipedia.org\/wiki\/La_Verne,_California \"La Verne, California\"), to start filling vials.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) The Edmonton plant finished its first new batch of remdesivir in April 2020.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49) Around the same time, fresh raw materials began to arrive from contract manufacturers reactivated by Gilead in January.[\\[49\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Langreth-49)\n\nAnother challenge is getting remdesivir into patients despite the drug's \"poor predicted solubility and poor stability.\"[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Pipkin-50) In June 2020, [Ligand Pharmaceuticals](https:\/\/en.wikipedia.org\/wiki\/Ligand_Pharmaceuticals \"Ligand Pharmaceuticals\") revealed that Gilead has been managing those issues by mixing Ligand's proprietary [excipient](https:\/\/en.wikipedia.org\/wiki\/Excipient \"Excipient\") Captisol (based on [University of Kansas](https:\/\/en.wikipedia.org\/wiki\/University_of_Kansas \"University of Kansas\") research into [cyclodextrin](https:\/\/en.wikipedia.org\/wiki\/Cyclodextrin \"Cyclodextrin\")) with remdesivir at a 30:1 ratio.[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Pipkin-50) Since that implies an enormous amount of Captisol is needed to stabilize and deliver remdesivir (on top of amounts needed for several other drugs for which the excipient is already in regular use), Ligand announced that it is trying to boost Captisol annual manufacturing capacity to as much as 500 metric tons.[\\[50\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Pipkin-50)\n\nOn 12 May 2020, Gilead announced that it had granted non-exclusive voluntary licenses to five [generic drug](https:\/\/en.wikipedia.org\/wiki\/Generic_drug \"Generic drug\") companies in India and Pakistan to manufacture remdesivir for distribution to 127 countries.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Silverman-51)[\\[52\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-52)[\\[53\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_licensing-53) The agreements were structured so that the licensees can set their own prices and will not have to pay royalties to Gilead until the WHO declares an end to the COVID‑19 emergency or another medicine or vaccine is approved for COVID‑19, whichever comes first.[\\[51\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Silverman-51) On 23 June 2020, India granted emergency marketing approval of generic remdesivir manufactured by two Gilead licensees, [Cipla](https:\/\/en.wikipedia.org\/wiki\/Cipla \"Cipla\") and [Hetero Drugs](https:\/\/en.wikipedia.org\/wiki\/Hetero_Drugs \"Hetero Drugs\").[\\[54\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Rajagopal-54)\n\nSociety and culture\n\nLegal status\n\nRemdesivir is approved, or authorized for emergency use, to treat COVID‑19 in many countries.[\\[20\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20201022-20) Remdesivir has been authorized for emergency use in India,[\\[55\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-55) Singapore,[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Reuters_20200620-56) and approved for use in Japan,[\\[57\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-57) the European Union, the United States, and Australia for people with severe symptoms.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR-16)[\\[58\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_EUA-58)[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_EUA_PR-59)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-:0-60)[\\[61\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-TGA_approval-61)[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Veklury-62)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)\n\nRemdesivir is the first treatment for COVID‑19 to be approved by the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA).[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) The approval by the FDA does not include the entire population that had been authorized to use remdesivir under an Emergency Use Authorization (EUA) originally issued in May 2020.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) In order to ensure continued access to the pediatric population previously covered under the EUA, the FDA revised the EUA for remdesivir to authorize the drug's use for treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized pediatric patients weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized pediatric patients less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)\n\nAustralia\n\nIn July 2020, remdesivir was provisionally approved for use in Australia for use in adults and adolescents with severe COVID‑19 symptoms who have been hospitalized.[\\[61\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-TGA_approval-61)[\\[65\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-65) Australia claims to have a sufficient supply of remdesivir in its national stockpile.[\\[66\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-66)\n\nCanada\n\nAs of 11 April 2020, access in Canada was available only through clinical trials.[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Health_Canada-67) [Health Canada](https:\/\/en.wikipedia.org\/wiki\/Health_Canada \"Health Canada\") approved requests to treat twelve people with remdesivir under the department's special-access program (SAP).[\\[68\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-68) Additional doses of remdesivir are not available through the SAP except for pregnant women or children with confirmed COVID‑19 and severe illness.[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Health_Canada-67)\n\nIn June 2020, Health Canada received an application from Gilead for the use of remdesivir for treating COVID‑19.[\\[67\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Health_Canada-67) On 27 July 2020, Health Canada conditionally approved the application.[\\[69\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Weikle-69)[\\[6\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-CA_Veklury_Product_information-6)\n\nIn September 2020, [Minister of Public Services and Procurement](https:\/\/en.wikipedia.org\/wiki\/Minister_of_Public_Services_and_Procurement \"Minister of Public Services and Procurement\") [Anita Anand](https:\/\/en.wikipedia.org\/wiki\/Anita_Anand \"Anita Anand\") announced that Canada had entered into a deal to obtain up to 150,000 vials of remdesivir from Gilead starting in October.[\\[70\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Grant-70) As of 8 October, remdesivir was still not widely available in [Alberta](https:\/\/en.wikipedia.org\/wiki\/Alberta \"Alberta\"), because [Alberta Health Services](https:\/\/en.wikipedia.org\/wiki\/Alberta_Health_Services \"Alberta Health Services\") was undertaking a \"[formulary](https:\/\/en.wikipedia.org\/wiki\/Formulary_\$pharmacy\$ \"Formulary (pharmacy)\") review\" to be completed by mid-November.[\\[71\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Kury_de_Castillo-71)\n\nCzech Republic\n\nIn March 2020, the drug was provisionally approved for use for COVID‑19 patients in a serious condition as a result of [the outbreak in the Czech Republic](https:\/\/en.wikipedia.org\/wiki\/COVID%E2%80%9119_pandemic_in_the_Czech_Republic#Policies_to_fight_the_contagion \"COVID‑19 pandemic in the Czech Republic\").[\\[72\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-72)\n\nEuropean Union\n\nIn February 2016, [orphan designation](https:\/\/en.wikipedia.org\/wiki\/Orphan_drug \"Orphan drug\") (EU\/3\/16\/1615) was granted by the European Commission to Gilead Sciences International Ltd, United Kingdom, for remdesivir for the treatment of Ebola virus disease.[\\[73\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-73)\n\nIn April 2020, the [European Medicines Agency](https:\/\/en.wikipedia.org\/wiki\/European_Medicines_Agency \"European Medicines Agency\") (EMA) provided recommendations on compassionate use of remdesivir for COVID‑19 in the EU.[\\[74\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-74)\n\nIn May 2020, the [Committee for Medicinal Products for Human Use](https:\/\/en.wikipedia.org\/wiki\/Committee_for_Medicinal_Products_for_Human_Use \"Committee for Medicinal Products for Human Use\") (CHMP) of the EMA recommended expanding the compassionate use of remdesivir to those not on mechanical ventilation.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75) In addition to those undergoing invasive mechanical ventilation, the compassionate use recommendations cover the treatment of hospitalized individuals requiring supplemental oxygen, non-invasive ventilation, high-flow oxygen devices or ECMO (extracorporeal membrane oxygenation).[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75) The updated recommendations were based on preliminary results from the NIAID-ACTT study,[\\[76\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIAID_ACTT-76) which suggested a beneficial effect of remdesivir in the treatment of hospitalized individuals with severe COVID‑19.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75)[\\[77\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_PR-77) In addition, a treatment duration of five days was introduced alongside the longer ten-day course, based on preliminary results from another study (GS-US-540-5773) suggesting that for those not requiring mechanical ventilation or ECMO, the treatment course may be shortened from ten to five days without any loss of efficacy.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75) Individuals who receive a five-day treatment course but do not show clinical improvement will be eligible to continue receiving remdesivir for an additional five days.[\\[75\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EU_compassionate-75)\n\nIn July 2020, the European Union granted a conditional marketing authorization for remdesivir with an indication for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms \\[88 lb\\]) with pneumonia requiring supplemental oxygen.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EC_Veklury-78)\n\nIn August 2022, the European Union granted a full marketing authorization for remdesivir.[\\[12\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury_EPAR-12)[\\[78\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EC_Veklury-78)[\\[79\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-79)\n\nIran\n\nRemdesivir has been also produced in Iran by [Barakat](https:\/\/en.wikipedia.org\/wiki\/Barakat_Pharmaceutical_Group \"Barakat Pharmaceutical Group\"); Iran is planning to increase the productions of Remdesivir ampoules from 20,000 to 150,000 ampoules per month. It has also the permission of the \"Food and Drug Administration\" of [MOHME](https:\/\/en.wikipedia.org\/wiki\/Ministry_of_Health_and_Medical_Education \"Ministry of Health and Medical Education\").[\\[80\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-80)\n\nJapan\n\nIn May 2020, [Japan's Ministry of Health, Labour and Welfare](https:\/\/en.wikipedia.org\/wiki\/Ministry_of_Health,_Labour_and_Welfare \"Ministry of Health, Labour and Welfare\") approved the drug for use in Japan, in a fast-tracked process, based on the US emergency authorization.[\\[16\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR-16)[\\[60\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-:0-60)\n\nMexico\n\nIn October 2020, Deputy Secretary of Prevention and Health Promotion [Hugo López-Gatell Ramírez](https:\/\/en.wikipedia.org\/wiki\/Hugo_L%C3%B3pez-Gatell_Ram%C3%ADrez \"Hugo López-Gatell Ramírez\") stated at a news conference that Mexico would not necessarily follow the United States in approving the drug for use in Mexico. López-Gatell explained that the [Federal Commission for the Protection against Sanitary Risk](https:\/\/en.wikipedia.org\/wiki\/Federal_Commission_for_the_Protection_against_Sanitary_Risk \"Federal Commission for the Protection against Sanitary Risk\") (Cofepris) had already twice denied the approval of remdesivir because, in that agency's view, the evidence does not suggest \"sufficient efficacy\".[\\[81\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Reuters_Mexico-81) In March 2020, Cofepris authorized the drug for emergency cases, advising to give continuous surveillance of the integral health of the patient.[\\[82\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Cofepris_Mexico-82)\n\nSingapore\n\nIn June 2020, Singapore's [Health Sciences Authority](https:\/\/en.wikipedia.org\/wiki\/Health_Sciences_Authority \"Health Sciences Authority\") conditionally approved the usage of remdesivir in Singapore.[\\[56\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Reuters_20200620-56)\n\nUnited States\n\nIn March 2020, United States President [Donald Trump](https:\/\/en.wikipedia.org\/wiki\/Donald_Trump \"Donald Trump\") announced that remdesivir was available for \"[compassionate use](https:\/\/en.wikipedia.org\/wiki\/Compassionate_use \"Compassionate use\")\" for people with COVID‑19; FDA Commissioner [Stephen Hahn](https:\/\/en.wikipedia.org\/wiki\/Stephen_Hahn_\$oncologist\$ \"Stephen Hahn (oncologist)\") confirmed the statement at the same press conference.[\\[83\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-83) It was later revealed that Gilead had been providing remdesivir in response to compassionate use requests since 25 January.[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21)[\\[84\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-84) On 23 March 2020, Gilead voluntarily suspended access for compassionate use (excepting cases of critically ill children and pregnant women), for reasons related to supply, citing the need to continue to provide the agent for testing in clinical trials.[\\[85\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Hopkins-85)[\\[86\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-86)\n\nIn May 2020, the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") granted Gilead [emergency use authorization](https:\/\/en.wikipedia.org\/wiki\/Emergency_use_authorization \"Emergency use authorization\") (EUA) for remdesivir to be distributed and used by licensed healthcare providers to treat adults and children hospitalized with severe COVID‑19.[\\[59\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_EUA_PR-59)[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Severe COVID‑19 is defined as patients with an oxygen saturation (SpO2) \\<= 94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring [extracorporeal membrane oxygenation](https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_membrane_oxygenation \"Extracorporeal membrane oxygenation\") (ECMO), a heart–lung bypass machine.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33)[\\[87\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NYT_EUA-87)[\\[88\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-88) Distribution of remdesivir under the EUA was controlled by the US government for use consistent with the terms and conditions of the EUA.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Gilead supplied remdesivir to authorized distributors, or directly to a US government agency, who distributed it to hospitals and other healthcare facilities as directed by the US government, in collaboration with state and local government authorities, as needed.[\\[33\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-EUA_FAQ2-33) Gilead stated they were donating 1.5 million vials for emergency use[\\[87\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NYT_EUA-87) and estimated, as of April 2020, they had enough remdesivir for 140,000 treatment courses and expect to have 500,000 courses by October 2020, and one million courses by the end of 2020.[\\[89\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-89)[\\[90\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-90)\n\nThe initial distribution of the drug in the US was tripped up by seemingly capricious decision-making and finger-pointing, resulting in over a week of confusion and frustration among healthcare providers and patients alike.[\\[91\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-91)[\\[92\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Swan-92)[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WaPo20200528-93) On 9 May 2020, the [United States Department of Health and Human Services](https:\/\/en.wikipedia.org\/wiki\/United_States_Department_of_Health_and_Human_Services \"United States Department of Health and Human Services\") (HHS) explained in a statement that it would be distributing remdesivir vials to [state health departments](https:\/\/en.wikipedia.org\/wiki\/State_health_agency \"State health agency\"), then would allow each department to redistribute vials to hospitals in their respective states based upon each department's insight into \"community-level needs.\"[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Facher-94) HHS also clarified that only 607,000 vials of Gilead's promised donation of 1.5 million vials would be going to American patients.[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Facher-94) However, HHS did not explain why several states with some of the highest caseloads had been omitted from the first two distribution rounds, including California, Florida, and Pennsylvania.[\\[94\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Facher-94) In May 2020, Gilead indicated they would increase the number of doses donated to the US from 607,000 to around 940,000.[\\[95\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stat_20200519-95)[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WaPo20200528-93) Some of the initial distribution was sent to the wrong hospitals, to hospitals with no intensive care units, and to facilities without the needed refrigeration to store it.[\\[93\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WaPo20200528-93)\n\nIn June 2020, HHS announced an unusual agreement with Gilead in which HHS agreed to Gilead's [wholesale acquisition price](https:\/\/en.wikipedia.org\/wiki\/Wholesale_acquisition_cost \"Wholesale acquisition cost\"), HHS would continue to work together with state governments and drug wholesaler [AmerisourceBergen](https:\/\/en.wikipedia.org\/wiki\/AmerisourceBergen \"AmerisourceBergen\") to allocate shipments of remdesivir vials to American hospitals through the end of September 2020, and in exchange, during that three-month timeframe (July, August, and September), American patients would be allocated over 90% of Gilead's projected remdesivir output of more than 500,000 treatment courses.[\\[96\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Kolata-96)[\\[97\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-HHSPressRelease_29June2020-97) Absent from these announcements was any discussion of allocation of remdesivir production to the approximately 70 countries omitted from Gilead's generic drug licensing agreements—including much of Europe[\\[98\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Boseley-98) and countries as populous as Brazil, China, and Mexico—or the 127 countries listed on those agreements (during the time it will take for Gilead's generic licensees to ramp up their own production).[\\[99\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Baragona-99) As the implications of this began to sink in, several countries publicly confirmed the next day that they already had adequate supplies of remdesivir to cover current needs, including Australia,[\\[100\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Davey-100) Germany,[\\[101\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Rinke-101) and the United Kingdom.[\\[102\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stout-102)\n\nIn August 2020, the FDA broadened the Emergency Use Authorization (EUA) for remdesivir to include all hospitalized patients with suspected or laboratory-confirmed COVID‑19, irrespective of the severity of their disease.[\\[103\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-103)[\\[104\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-104) The Fact Sheet was updated to reflect the new guidance.[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)\n\nIn October 2020, Gilead and HHS announced that HHS was relinquishing control over remdesivir allocation because production of the drug had finally caught up with US domestic demand.[\\[105\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Walker-105)[\\[106\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-106)[\\[107\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-HHS_PR_20201001-107) AmerisourceBergen will remain the sole distributor of Veklury in the US through the end of 2020.[\\[107\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-HHS_PR_20201001-107)\n\nOn 22 October 2020, the FDA approved remdesivir and also revised the EUA to permit the use of remdesivir for treatment of suspected or laboratory confirmed COVID‑19 in hospitalized children weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized children less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)[\\[25\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\\[108\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-108)[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) This decision was criticized for an alleged lack of previous consultation on part of the FDA given the complications of antiviral drug issues.[\\[110\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-110)\n\nIn November 2020, the FDA issued an EUA for the combination of [baricitinib](https:\/\/en.wikipedia.org\/wiki\/Baricitinib \"Baricitinib\") with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28)\n\nRemdesivir received approval from the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) in October 2020, for use in adults and children twelve years and older requiring hospitalization for treatment of severe COVID‑19 infections.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) In January 2022, the FDA gave regulatory approval to remdesivir for use in adults and children (twelve years of age and older who weigh at least 40 kilograms (88 lb) and are positive for COVID‑19, not hospitalized, and are ill with COVID‑19 having high risk for developing severe COVID‑19, including hospitalization or death.[\\[111\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20221021-111) In April 2022, the FDA expanded the approval of remdesivir to include people 28 days of age and older weighing at least 3 kilograms (6.6 lb).[\\[27\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20220425-27)\n\nThe FDA also provided [emergency use authorization](https:\/\/en.wikipedia.org\/wiki\/Emergency_use_authorization \"Emergency use authorization\") in 2022, for remdesivir treatment of children under age twelve who are COVID‑positive and not hospitalized, but have mild-to-moderate COVID‑19 with high risk of developing severe infection, including hospitalization or death.[\\[111\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20221021-111)\n\nEconomics\n\nIn June 2020, Gilead announced that it had set the price of remdesivir at US\\$390 per vial for the governments of developed countries, including the United States, and US\\$520 for US private health insurance companies.[\\[112\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20200629-112) The expected course of treatment is six vials over five days for a total cost of US\\$2,340.[\\[112\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Gilead_PR_20200629-112) Being a [repurposed drug](https:\/\/en.wikipedia.org\/wiki\/Drug_repositioning \"Drug repositioning\"), the minimum production cost for remdesivir is estimated at US\\$0.93 per day of treatment.[\\[113\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-113)\n\nIn July 2020, the European Union secured a €63 million (US\\$74 million) contract with Gilead, to make the drug available there in early August 2020.[\\[114\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-114) In October 2020, Gilead Sciences and the European Commission announced they had signed a joint procurement framework contract in which Gilead agreed to provide up to 500,000 remdesivir treatment courses over the next six months to 37 European countries. Among the contracting countries were all 27 EU member states plus the United Kingdom, \"Albania, Bosnia & Herzegovina, Iceland, Kosovo, Montenegro, North Macedonia, Norway, and Serbia\".[\\[115\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Saigol-115) At the time, the price per treatment course was not disclosed; Reuters reported the price was 2,070 euros, thereby implying the total value of the contract (if all 500,000 courses are ordered) is approximately €1.035 billion.[\\[116\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Guarascio-116) Under the contract, each participating country will directly place orders with Gilead and pay Gilead directly for its own orders.[\\[116\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Guarascio-116)\n\nNames\n\nRemdesivir is the [international nonproprietary name](https:\/\/en.wikipedia.org\/wiki\/International_nonproprietary_name \"International nonproprietary name\") (INN)[\\[117\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-117) while the development code name was GS-5734.[\\[118\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-118)\n\nResearch\n\nRemdesivir was originally created and developed by [Gilead Sciences](https:\/\/en.wikipedia.org\/wiki\/Gilead_Sciences \"Gilead Sciences\") in 2009, to treat [hepatitis C](https:\/\/en.wikipedia.org\/wiki\/Hepatitis_C \"Hepatitis C\") and [respiratory syncytial virus](https:\/\/en.wikipedia.org\/wiki\/Respiratory_syncytial_virus \"Respiratory syncytial virus\") (RSV).[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21)[\\[119\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_20201023-119) It did not work against hepatitis C or RSV,[\\[21\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Stephens2-21)[\\[119\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_20201023-119) but was then repurposed and studied as a potential treatment for [Ebola virus disease](https:\/\/en.wikipedia.org\/wiki\/Ebola_virus_disease \"Ebola virus disease\") and [Marburg virus](https:\/\/en.wikipedia.org\/wiki\/Marburg_virus \"Marburg virus\") infections.[\\[120\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Warren_2016-120)[\\[119\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-NIH_20201023-119) According to the [Czech News Agency](https:\/\/en.wikipedia.org\/wiki\/Czech_News_Agency \"Czech News Agency\"), this new line of research was carried out under the direction of scientist [Tomáš Cihlář](https:\/\/en.wikipedia.org\/wiki\/Tom%C3%A1%C5%A1_Cihl%C3%A1%C5%99 \"Tomáš Cihlář\").[\\[121\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-121) A collaboration of researchers from the [Centers for Disease Control and Prevention](https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention \"Centers for Disease Control and Prevention\") (CDC) and [Gilead Sciences](https:\/\/en.wikipedia.org\/wiki\/Gilead_Sciences \"Gilead Sciences\") subsequently discovered that remdesivir had antiviral activity *in vitro* against multiple [filoviruses](https:\/\/en.wikipedia.org\/wiki\/Filovirus \"Filovirus\"), [pneumoviruses](https:\/\/en.wikipedia.org\/wiki\/Pneumovirus \"Pneumovirus\"), paramyxoviruses, and [coronaviruses](https:\/\/en.wikipedia.org\/wiki\/Coronavirus \"Coronavirus\").[\\[122\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Lo_2017-122)\n\nPreclinical and clinical research and development was done in collaboration between Gilead Sciences and various US government agencies and academic institutions.[\\[34\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Eastman_2020-34)[\\[123\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-123)[\\[124\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-124)[\\[125\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-125)\n\nDuring the mid-2010s, the [Mintz Levin](https:\/\/en.wikipedia.org\/wiki\/Mintz,_Levin,_Cohn,_Ferris,_Glovsky,_and_Popeo \"Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo\") law firm prosecuted various patent applications for remdesivir on behalf of Gilead Sciences before the [United States Patent and Trademark Office](https:\/\/en.wikipedia.org\/wiki\/United_States_Patent_and_Trademark_Office \"United States Patent and Trademark Office\") (USPTO). The USPTO granted two patents on remdesivir to Gilead Sciences on 9 April 2019: one for filoviruses,[\\[126\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-126) and one which covered both [arenaviruses](https:\/\/en.wikipedia.org\/wiki\/Arenavirus \"Arenavirus\") and coronaviruses.[\\[127\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-127)\n\nEbola\n\nIn October 2015, the [United States Army Medical Research Institute of Infectious Diseases](https:\/\/en.wikipedia.org\/wiki\/United_States_Army_Medical_Research_Institute_of_Infectious_Diseases \"United States Army Medical Research Institute of Infectious Diseases\") (USAMRIID) announced preclinical results that remdesivir had blocked the [Ebola virus](https:\/\/en.wikipedia.org\/wiki\/Ebola_virus \"Ebola virus\") in [Rhesus monkeys](https:\/\/en.wikipedia.org\/wiki\/Rhesus_monkeys \"Rhesus monkeys\"). Travis Warren, who has been a USAMRIID principal investigator since 2007, said that the \"work is a result of the continuing collaboration between USAMRIID and Gilead Sciences\".[\\[128\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-USAMRIID_20151009-128) The \"initial screening\" of the \"Gilead Sciences compound library to find molecules with promising antiviral activity\" was performed by scientists at the [Centers for Disease Control and Prevention](https:\/\/en.wikipedia.org\/wiki\/Centers_for_Disease_Control_and_Prevention \"Centers for Disease Control and Prevention\") (CDC).[\\[128\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-USAMRIID_20151009-128) As a result of this work, it was recommended that remdesivir \"should be further developed as a potential treatment.\"[\\[120\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Warren_2016-120)[\\[128\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-USAMRIID_20151009-128)\n\nRemdesivir was rapidly pushed through clinical trials due to the [West African Ebola virus epidemic](https:\/\/en.wikipedia.org\/wiki\/West_African_Ebola_virus_epidemic \"West African Ebola virus epidemic\") of 2013–2016, eventually being used in people with the disease. Preliminary results were promising; it was used in the emergency setting during the [Kivu Ebola epidemic](https:\/\/en.wikipedia.org\/wiki\/Kivu_Ebola_epidemic \"Kivu Ebola epidemic\") that started in 2018, along with further clinical trials, until August 2019, when Congolese health officials announced that it was significantly less effective than [monoclonal antibody](https:\/\/en.wikipedia.org\/wiki\/Monoclonal_antibody \"Monoclonal antibody\") treatments such as [ansuvimab](https:\/\/en.wikipedia.org\/wiki\/Ansuvimab \"Ansuvimab\") and [atoltivimab\/maftivimab\/odesivimab](https:\/\/en.wikipedia.org\/wiki\/Atoltivimab\/maftivimab\/odesivimab \"Atoltivimab\/maftivimab\/odesivimab\"). The trials, however, established its safety profile.[\\[129\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-129)\n\nCOVID-19\n\nHospitalized patients\n\nRemdesivir was approved for medical use in the United States in October 2020.[\\[62\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_Veklury-62)[\\[63\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) The US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) approved remdesivir based on the agency's analysis of data from three randomized, controlled clinical trials that included participants hospitalized with mild-to-severe COVID‑19.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64)[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) The FDA granted approval and reissued the revised EUA to Gilead Sciences Inc.[\\[64\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_20201022-64) The FDA approved remdesivir based primarily on evidence from three clinical trials (NCT04280705, NCT04292899, and NCT04292730) of 2043 hospitalized participants with COVID‑19.[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109) The trials were conducted at 226 sites in 17 countries including the United States.[\\[109\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_snapshot-109)\n\nIn November 2020, the World Health Organization (WHO) updated its guideline on therapeutics for COVID‑19 to include a conditional recommendation against the use of remdesivir, triggered by results from the WHO [Solidarity trial](https:\/\/en.wikipedia.org\/wiki\/Solidarity_trial \"Solidarity trial\").[\\[130\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-WHO_guidelines-130)[\\[131\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-131)[\\[132\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-who-lg-132)[\\[133\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-133) Meanwhile, the [Public Health Agency of Canada](https:\/\/en.wikipedia.org\/wiki\/Public_Health_Agency_of_Canada \"Public Health Agency of Canada\")'s COVID‑19 Clinical Pharmacology Task Group recommended that remdesivir only be administered to hospitalized patients as part of a [randomized controlled trial](https:\/\/en.wikipedia.org\/wiki\/Randomized_controlled_trial \"Randomized controlled trial\") due to limited information on risks and benefits.[\\[134\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-134)\n\nIn January 2022, the Canadian component of the WHO Solidarity Trial reported that in-hospital people with COVID‑19 treated with remdesivir had 17% lower relative risk of death (18.7% versus 22.6% death rates) and 47% reduced relative risk for needing oxygen and mechanical ventilation (8.0% versus 15.0%) compared to people receiving standard-of-care treatments.[\\[135\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-Ali-135)\n\nIn September 2022, the WHO updated their guidelines to recommend use of remdesivir for both non-hospitalized and hospitalized patients.[\\[136\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-136) This was based on final results from the SOLIDARITY trial that showed a reduction in mortality or progression to mechanical ventilation for non-ventilated patients.\n\nNonhospitalized outpatients\n\nIn January 2022, a study indicated that nonhospitalized people who were at high risk for COVID‑19 progression had an 87% lower risk of hospitalization or death after a 3-day course of intravenous remdesivir.[\\[137\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-137)\n\nRemdesivir\/baricitinib\n\nIn May 2020, the [National Institute of Allergy and Infectious Diseases](https:\/\/en.wikipedia.org\/wiki\/National_Institute_of_Allergy_and_Infectious_Diseases \"National Institute of Allergy and Infectious Diseases\") (NIAID) started the Adaptive COVID‑19 Treatment Trial 2 (ACTT-2) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [baricitinib](https:\/\/en.wikipedia.org\/wiki\/Baricitinib \"Baricitinib\") for treating hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\\[138\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-138)[\\[139\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-ACTT_3_PR-139)[\\[140\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-140)\n\nIn November 2020, the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) issued an [emergency use authorization](https:\/\/en.wikipedia.org\/wiki\/Emergency_use_authorization \"Emergency use authorization\") (EUA) for the drug baricitinib, in combination with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https:\/\/en.wikipedia.org\/wiki\/Extracorporeal_membrane_oxygenation \"Extracorporeal membrane oxygenation\") (ECMO).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\\[28\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-FDA_PR_202011192-28)\n\nRemdesivir\/interferon beta-1a\n\nIn August 2020, the NIAID started the Adaptive COVID‑19 Treatment Trial 3 (ACTT 3) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [interferon beta-1a](https:\/\/en.wikipedia.org\/wiki\/Interferon_beta-1a \"Interferon beta-1a\") for hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\\[139\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-ACTT_3_PR-139)[\\[141\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-141)\n\nVeterinary uses\n\nIn 2019, GS-441524 was shown to have promise for treating [feline infectious peritonitis](https:\/\/en.wikipedia.org\/wiki\/Feline_infectious_peritonitis \"Feline infectious peritonitis\") caused by a [coronavirus](https:\/\/en.wikipedia.org\/wiki\/Feline_coronavirus \"Feline coronavirus\").[\\[142\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-pedersen-142) It has not been evaluated or approved by the US [Food and Drug Administration](https:\/\/en.wikipedia.org\/wiki\/Food_and_Drug_Administration \"Food and Drug Administration\") (FDA) for the treatment of [feline coronavirus](https:\/\/en.wikipedia.org\/wiki\/Feline_coronavirus \"Feline coronavirus\") or feline infectious peritonitis but has been available since 2019, through websites and social media as an unregulated black market substance.[\\[143\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-143) Because GS-441524 is the main circulating metabolite of remdesivir and because GS-441524 has similar potency against SARS-CoV-2 *in vitro*, some researchers have argued for the direct administration of GS-441524 as a COVID‑19 treatment.[\\[144\\]](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_note-144)\n\nReferences\n\n1. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-Veklury_APM_summary_1-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-Veklury_APM_summary_1-1)\n   [\"Veklury Australian prescription medicine decision summary\"](https:\/\/www.tga.gov.au\/apm-summary\/veklury). *[Therapeutic Goods Administration](https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration \"Therapeutic Goods Administration\") (TGA)*. 13 July 2020. [Archived](https:\/\/web.archive.org\/web\/20200813151939\/https:\/\/www.tga.gov.au\/apm-summary\/veklury) from the original on 13 August 2020. Retrieved 16 August 2020.\n2. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-1) [***c***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-2)\n   [\"AusPAR: Remdesivir\"](https:\/\/www.tga.gov.au\/auspar\/auspar-remdesivir-0). *[Therapeutic Goods Administration](https:\/\/en.wikipedia.org\/wiki\/Therapeutic_Goods_Administration \"Therapeutic Goods Administration\") (TGA)*. 10 May 2022. [Archived](https:\/\/web.archive.org\/web\/20220510022413\/https:\/\/www.tga.gov.au\/auspar\/auspar-remdesivir-0) from the original on 10 May 2022. 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Retrieved 5 August 2020.\n     \n     ![Public Domain](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/62\/PD-icon.svg\/20px-PD-icon.svg.png) This article incorporates text from this source, which is in the [public domain](https:\/\/en.wikipedia.org\/wiki\/Public_domain \"Public domain\").\n139. ^ [***a***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-ACTT_3_PR_139-0) [***b***](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-ACTT_3_PR_139-1)\n     [\"NIH Clinical Trial Testing Remdesivir Plus Interferon Beta-1a for COVID-19 Treatment Begins\"](https:\/\/www.niaid.nih.gov\/news-events\/nih-clinical-trial-testing-remdesivir-plus-interferon-beta-1a-covid-19-treatment-begins). *[National Institute of Allergy and Infectious Diseases](https:\/\/en.wikipedia.org\/wiki\/National_Institute_of_Allergy_and_Infectious_Diseases \"National Institute of Allergy and Infectious Diseases\") (NIAID)* (Press release). 30 July 2020. [Archived](https:\/\/web.archive.org\/web\/20201006214924\/https:\/\/www.niaid.nih.gov\/news-events\/nih-clinical-trial-testing-remdesivir-plus-interferon-beta-1a-covid-19-treatment-begins\/) from the original on 6 October 2020. Retrieved 5 August 2020.\n     \n     ![Public Domain](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/6\/62\/PD-icon.svg\/20px-PD-icon.svg.png) This article incorporates text from this source, which is in the [public domain](https:\/\/en.wikipedia.org\/wiki\/Public_domain \"Public domain\").\n140. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-140)**\n     [\"Adaptive COVID-19 Treatment Trial 2 (ACTT-2)\"](https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04401579). *ClinicalTrials.gov*. 26 May 2020. [Archived](https:\/\/web.archive.org\/web\/20200805004912\/https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04401579) from the original on 5 August 2020. Retrieved 6 August 2020.\n141. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-141)**\n     [\"Adaptive COVID-19 Treatment Trial 3 (ACTT-3)\"](https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04492475). *ClinicalTrials.gov*. 30 July 2020. [Archived](https:\/\/web.archive.org\/web\/20201006214928\/https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04492475\/) from the original on 6 October 2020. Retrieved 5 August 2020.\n142. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-pedersen_142-0)**\n     Pedersen NC, Perron M, Bannasch M, Montgomery E, Murakami E, Liepnieks M, et al. (April 2019). [\"Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis\"](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6435921). *Journal of Feline Medicine and Surgery*. **21** (4): 271–281\\. [doi](https:\/\/en.wikipedia.org\/wiki\/Doi_\$identifier\$ \"Doi (identifier)\"):[10\\.1177\/1098612X19825701](https:\/\/doi.org\/10.1177%2F1098612X19825701). [PMC](https:\/\/en.wikipedia.org\/wiki\/PMC_\$identifier\$ \"PMC (identifier)\") [6435921](https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6435921). [PMID](https:\/\/en.wikipedia.org\/wiki\/PMID_\$identifier\$ \"PMID (identifier)\") [30755068](https:\/\/pubmed.ncbi.nlm.nih.gov\/30755068).\n143. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-143)**\n     Pedersen NC (18 June 2019). [\"Black market production and sale of GS-441524 and GC376\"](https:\/\/ccah.vetmed.ucdavis.edu\/sites\/g\/files\/dgvnsk4586\/files\/inline-files\/Black%20market%20production%20and%20sale%20of%20GS.pdf) (PDF). Feline Infectious Peritonitis Therapeutics\/Clinical Trials Team, UC Davis. [Archived](https:\/\/web.archive.org\/web\/20200325213121\/https:\/\/ccah.vetmed.ucdavis.edu\/sites\/g\/files\/dgvnsk4586\/files\/inline-files\/Black%20market%20production%20and%20sale%20of%20GS.pdf) (PDF) from the original on 25 March 2020. Retrieved 14 April 2020.\n144. **[^](https:\/\/en.wikipedia.org\/wiki\/Remdesivir#cite_ref-144)**\n     Westgate J (7 May 2020). [\"Vet science 'being ignored' in quest for COVID-19 drug\"](https:\/\/www.vettimes.co.uk\/news\/vet-science-being-ignored-in-quest-for-covid-19-drug\/). *vettimes.co.uk*. [Archived](https:\/\/web.archive.org\/web\/20201204142106\/https:\/\/www.vettimes.co.uk\/news\/vet-science-being-ignored-in-quest-for-covid-19-drug\/) from the original on 4 December 2020. Retrieved 6 July 2020.\n\nExternal links\n\n[![Wikimedia Commons logo](https:\/\/upload.wikimedia.org\/wikipedia\/en\/thumb\/4\/4a\/Commons-logo.svg\/40px-Commons-logo.svg.png)](https:\/\/en.wikipedia.org\/wiki\/File:Commons-logo.svg)\n\nWikimedia Commons has media related to [Remdesivir](https:\/\/commons.wikimedia.org\/wiki\/Category:Remdesivir \"commons:Category:Remdesivir\").\n\n- Kolata G (1 May 2020). [\"How Remdesivir, New Hope for Covid-19 Patients, Was Resurrected\"](https:\/\/www.nytimes.com\/2020\/05\/01\/health\/coronavirus-remdesivir.html). *[The New York Times](https:\/\/en.wikipedia.org\/wiki\/The_New_York_Times \"The New York Times\")*.","meta_canonical":null}

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Boilerpipe Text	Remdesivir Clinical data Pronunciation rem- DESS -i-veer Trade names Veklury Other names GS-5734, RDV AHFS / Drugs.com Monograph MedlinePlus a620033 License data US DailyMed : Remdesivir Pregnancy category AU : B2 [ 1 ] [ 2 ] Routes of administration Intravenous Drug class Antiviral ATC code J05AB16 ( WHO ) Legal status Legal status AU : S4 (Prescription only) [ 3 ] [ 1 ] [ 4 ] [ 5 ] [ 2 ] CA : ℞-only [ 6 ] [ 7 ] [ 8 ] UK : POM (Prescription only) [ 9 ] [ 10 ] US : ℞-only [ 11 ] EU : Rx-only [ 12 ] [ 13 ] IN : Schedule H (℞-only) [ 14 ] [ 15 ] Identifiers IUPAC name (2 S )-2-{(2 R ,3 S ,4 R ,5 R )-[5-(4-Aminopyrrolo[2,1- f ] [1,2,4]triazin-7-yl)-5-cyano-3,4-dihydroxy-tetrahydro-furan-2-ylmethoxy]phenoxy-( S )-phosphorylamino}propionic acid 2-ethyl-butyl ester CAS Number 1809249-37-3 PubChem CID 121304016 DrugBank DB14761 ChemSpider 58827832 UNII 3QKI37EEHE KEGG D11472 ChEBI CHEBI:145994 ChEMBL ChEMBL4065616 CompTox Dashboard ( EPA ) DTXSID701022537 ECHA InfoCard 100.302.974 Chemical and physical data Formula C 27 H 35 N 6 O 8 P Molar mass 602.585 g·mol −1 3D model ( JSmol ) Interactive image SMILES CCC(COC(=O)[C@@H](NP(=O)(Oc1ccccc1)OC[C@H]1O[C@@]([C@@H]([C@@H]1O)O)(C#N)c1ccc2n1ncnc2N)C)CC InChI InChI=1S/C27H35N6O8P/c1-4-18(5-2)13-38-26(36)17(3)32-42(37,41-19-9-7-6-8-10-19)39-14-21-23(34)24(35)27(15-28,40-21)22-12-11-20-25(29)30-16-31-33(20)22/h6-12,16-18,21,23-24,34-35H,4-5,13-14H2,1-3H3,(H,32,37)(H2,29,30,31)/t17-,21+,23+,24+,27-,42-/m0/s1 Key:RWWYLEGWBNMMLJ-YSOARWBDSA-N Remdesivir , sold under the brand name Veklury , [ 12 ] [ 16 ] is a broad-spectrum antiviral medication developed by the biopharmaceutical company Gilead Sciences . [ 17 ] It is administered via injection into a vein . [ 18 ] [ 19 ] During the COVID‑19 pandemic , remdesivir was approved or authorized for emergency use to treat COVID‑19 in numerous countries. [ 20 ] Remdesivir was originally developed to treat hepatitis C , [ 21 ] and was subsequently investigated for Ebola virus disease and Marburg virus infections [ 22 ] before being studied as a post-infection treatment for COVID‑19. [ 23 ] Remdesivir is a prodrug that is intended to allow intracellular delivery of GS-441524 monophosphate and subsequent biotransformation into GS-441524 triphosphate , a ribo nucleotide analogue inhibitor of viral RNA polymerase . [ 24 ] The most common side effect in healthy volunteers is raised blood levels of liver enzymes . [ 12 ] The most common side effect in people with COVID‑19 is nausea . [ 12 ] Side effects may include liver inflammation and an infusion -related reaction with nausea, low blood pressure , and sweating. [ 25 ] The US Food and Drug Administration (FDA) considers it to be a first-in-class medication . [ 26 ] Medical uses In the European Union, remdesivir is indicated for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) with pneumonia requiring supplemental oxygen and for adults who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID‑19. [ 9 ] [ 12 ] In the United States, remdesivir is indicated for the treatment of COVID‑19 in people 28 days of age and older and weighing at least 3 kilograms (6.6 lb) who are hospitalized; or not hospitalized and have mild-to-moderate COVID‑19, and are at high risk for progression to severe COVID‑19, including hospitalization or death. [ 11 ] [ 27 ] In November 2020, the FDA issued an emergency use authorization (EUA) for the combination of baricitinib with remdesivir, for the treatment of suspected or laboratory confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). [ 28 ] In Australia, it is approved for those aged four weeks of age and older with a body weight at least 3 kilograms (6.6 lb) with pneumonia requiring supplemental oxygen or those aged four weeks of age and older with body weight at least 40 kilograms (88 lb) who do not require supplemental oxygen and who are at high risk of progressing to severe COVID‑19. [ 29 ] [ 2 ] In 2024, a retrospective study found treatment with the antiviral remdesivir plus dexamethasone was associated with fewer deaths in hospitalized COVID-19 patients compared to dexamethasone alone. [ 30 ] The combination led to a 26% reduction in mortality at 14 days and a 24% reduction at 28 days. [ 31 ] Side effects The most common adverse effects in people treated with remdesivir were respiratory failure and blood biomarkers of organ impairment, including low albumin , low potassium , low count of red blood cells , low count of thrombocytes , and elevated bilirubin (jaundice) . [ 32 ] Other reported adverse effects include gastrointestinal distress , elevated transaminase levels in the blood ( liver enzymes ), infusion site reactions, and electrocardiogram abnormalities . [ 19 ] Remdesivir may cause infusion-related reactions, including low blood pressure, nausea, vomiting, sweating or shivering. [ 33 ] Other possible side effects of remdesivir include: Infusion-related reactions. Infusion-related reactions have been seen during a remdesivir infusion or around the time remdesivir was given. [ 33 ] Signs and symptoms of infusion-related reactions may include: low blood pressure, nausea, vomiting, sweating, and shivering. [ 33 ] Increases in levels of liver enzymes, seen in abnormal liver blood tests. [ 33 ] Increases in levels of liver enzymes have been seen in people who have received remdesivir, which may be a sign of inflammation or damage to cells in the liver. [ 33 ] Pharmacology Activation Activation of remdesivir into its active triphosphate metabolite [ 34 ] Remdesivir is a protide ( prodrug of nucleotide) able to diffuse into cells, where it is converted to GS-441524 monophosphate via the actions of esterases ( CES1 and CTSA ) and a phosphoamidase ( HINT1 ); this in turn is further phosphorylated to its active metabolite triphosphate by nucleoside-phosphate kinases . [ 35 ] [ 36 ] This pathway of bioactivation is meant to occur intracellularly , but a substantial amount of remdesivir is prematurely hydrolyzed in plasma, with GS-441524 being the major metabolite in plasma, and the only metabolite remaining two hours after dosing. [ 24 ] Mechanism of action As an adenosine nucleoside triphosphate analog (GS-443902), [ 37 ] the active metabolite of remdesivir interferes with the action of viral RNA-dependent RNA polymerase and evades proofreading by viral exoribonuclease (ExoN), causing a decrease in viral RNA production. [ 17 ] [ 38 ] In some viruses, such as the respiratory syncytial virus , it causes the RNA-dependent RNA polymerases to pause, but its predominant effect (as in Ebola) is to induce an irreversible chain termination . Unlike with many other chain terminators, this is not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain. [ 39 ] For the RNA-dependent RNA polymerases of MERS-CoV , SARS-CoV-1 , and SARS-CoV-2 , arrest of RNA synthesis occurs after incorporation of three additional nucleotides. [ 40 ] [ 36 ] Hence, remdesivir is classified as a direct-acting antiviral agent that works as a delayed chain terminator. [ 34 ] [ 36 ] Pharmacokinetics In non-human primates, the plasma half-life of the prodrug is 20 minutes, with the main metabolite being the nucleoside , GS-441524 . Two hours post injection, the main metabolite GS-441524 is present at micromolar concentrations, whilst intact Remdesivir is no longer detectable. Because of this rapid extracellular conversion to the nucleoside GS-441524, some researchers have questioned whether the active nucleotide triphosphate is truly derived from remdesivir pro-drug removal or whether it occurs by GS-441524 phosphorylation, and whether direct administration of GS-441524 would constitute a cheaper and easier to administer COVID‑19 drug compared to remdesivir. [ 41 ] [ 24 ] The activated nucleotide triphosphate form has sustained intracellular levels in PBMC and presumably in other cells as well. [ 34 ] Resistance Mutations in the mouse hepatitis virus RNA replicase that cause partial resistance to remdesivir were identified in 2018. These mutations make the viruses less effective in nature, and the researchers believe they will likely not persist where the drug is not being used. [ 42 ] Interactions Remdesivir is at least partially metabolized by the cytochrome P450 enzymes CYP2C8 , CYP2D6 , and CYP3A4 . [ 43 ] [ 25 ] Blood plasma concentrations of remdesivir are expected to decrease if it is administered together with cytochrome P450 inducers such as rifampicin , carbamazepine , phenobarbital , phenytoin , primidone , and St John's wort . [ 44 ] Using chloroquine or hydroxychloroquine with remdesivir may reduce the antiviral activity of remdesivir. [ 11 ] [ 9 ] [ 45 ] Coadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on in vitro data demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir. [ 11 ] Synthesis Synthesis of remdesivir in structural formulae Remdesivir can be synthesized in multiple steps from ribose derivatives. The figure to the right is one of the synthesis routes of remdesivir invented by Chun and coauthors from Gilead Sciences. [ 46 ] [ 47 ] In vitro experiments An in vitro study of remdesivir assessing antiviral activity against SARS-CoV-2 was performed. [ 48 ] Cells were pre-treated with the different doses of remdesivir for 1 hour, and the virus (MOI of 0.05) was subsequently added to allow infection for 2 hours. [ 48 ] The results found that remdesivir functioned well as an inhibitor of the infection. [ 48 ] The study was published as a letter to the editor, and as such did not undergo peer review. Manufacturing Remdesivir requires "70 raw materials, reagents, and catalysts" to make, and approximately "25 chemical steps." [ 49 ] Some of the ingredients are extremely dangerous to humans, especially trimethylsilyl cyanide . [ 49 ] The original end-to-end manufacturing process required 9 to 12 months to go from raw materials at contract manufacturers to finished product, but after restarting production in January 2020, Gilead Sciences was able to find ways to reduce the production time to six months. [ 49 ] In January 2020, Gilead began working on restarting remdesivir production in glass-lined steel chemical reactors at its manufacturing plant in Edmonton, Alberta . [ 49 ] On 2 February 2020, the company flew its entire stock of remdesivir, 100 kilograms in powder form (left over from Ebola research), to its filling plant in La Verne, California , to start filling vials. [ 49 ] The Edmonton plant finished its first new batch of remdesivir in April 2020. [ 49 ] Around the same time, fresh raw materials began to arrive from contract manufacturers reactivated by Gilead in January. [ 49 ] Another challenge is getting remdesivir into patients despite the drug's "poor predicted solubility and poor stability." [ 50 ] In June 2020, Ligand Pharmaceuticals revealed that Gilead has been managing those issues by mixing Ligand's proprietary excipient Captisol (based on University of Kansas research into cyclodextrin ) with remdesivir at a 30:1 ratio. [ 50 ] Since that implies an enormous amount of Captisol is needed to stabilize and deliver remdesivir (on top of amounts needed for several other drugs for which the excipient is already in regular use), Ligand announced that it is trying to boost Captisol annual manufacturing capacity to as much as 500 metric tons. [ 50 ] On 12 May 2020, Gilead announced that it had granted non-exclusive voluntary licenses to five generic drug companies in India and Pakistan to manufacture remdesivir for distribution to 127 countries. [ 51 ] [ 52 ] [ 53 ] The agreements were structured so that the licensees can set their own prices and will not have to pay royalties to Gilead until the WHO declares an end to the COVID‑19 emergency or another medicine or vaccine is approved for COVID‑19, whichever comes first. [ 51 ] On 23 June 2020, India granted emergency marketing approval of generic remdesivir manufactured by two Gilead licensees, Cipla and Hetero Drugs . [ 54 ] Society and culture Legal status Remdesivir is approved, or authorized for emergency use, to treat COVID‑19 in many countries. [ 20 ] Remdesivir has been authorized for emergency use in India, [ 55 ] Singapore, [ 56 ] and approved for use in Japan, [ 57 ] the European Union, the United States, and Australia for people with severe symptoms. [ 12 ] [ 16 ] [ 58 ] [ 59 ] [ 60 ] [ 61 ] [ 62 ] [ 63 ] [ 64 ] Remdesivir is the first treatment for COVID‑19 to be approved by the US Food and Drug Administration (FDA). [ 64 ] The approval by the FDA does not include the entire population that had been authorized to use remdesivir under an Emergency Use Authorization (EUA) originally issued in May 2020. [ 64 ] In order to ensure continued access to the pediatric population previously covered under the EUA, the FDA revised the EUA for remdesivir to authorize the drug's use for treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized pediatric patients weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized pediatric patients less than twelve years of age weighing at least 3.5 kilograms (7.7 lb). [ 64 ] Australia In July 2020, remdesivir was provisionally approved for use in Australia for use in adults and adolescents with severe COVID‑19 symptoms who have been hospitalized. [ 61 ] [ 65 ] Australia claims to have a sufficient supply of remdesivir in its national stockpile. [ 66 ] Canada As of 11 April 2020, access in Canada was available only through clinical trials. [ 67 ] Health Canada approved requests to treat twelve people with remdesivir under the department's special-access program (SAP). [ 68 ] Additional doses of remdesivir are not available through the SAP except for pregnant women or children with confirmed COVID‑19 and severe illness. [ 67 ] In June 2020, Health Canada received an application from Gilead for the use of remdesivir for treating COVID‑19. [ 67 ] On 27 July 2020, Health Canada conditionally approved the application. [ 69 ] [ 6 ] In September 2020, Minister of Public Services and Procurement Anita Anand announced that Canada had entered into a deal to obtain up to 150,000 vials of remdesivir from Gilead starting in October. [ 70 ] As of 8 October, remdesivir was still not widely available in Alberta , because Alberta Health Services was undertaking a " formulary review" to be completed by mid-November. [ 71 ] Czech Republic In March 2020, the drug was provisionally approved for use for COVID‑19 patients in a serious condition as a result of the outbreak in the Czech Republic . [ 72 ] European Union In February 2016, orphan designation (EU/3/16/1615) was granted by the European Commission to Gilead Sciences International Ltd, United Kingdom, for remdesivir for the treatment of Ebola virus disease. [ 73 ] In April 2020, the European Medicines Agency (EMA) provided recommendations on compassionate use of remdesivir for COVID‑19 in the EU. [ 74 ] In May 2020, the Committee for Medicinal Products for Human Use (CHMP) of the EMA recommended expanding the compassionate use of remdesivir to those not on mechanical ventilation. [ 75 ] In addition to those undergoing invasive mechanical ventilation, the compassionate use recommendations cover the treatment of hospitalized individuals requiring supplemental oxygen, non-invasive ventilation, high-flow oxygen devices or ECMO (extracorporeal membrane oxygenation). [ 75 ] The updated recommendations were based on preliminary results from the NIAID-ACTT study, [ 76 ] which suggested a beneficial effect of remdesivir in the treatment of hospitalized individuals with severe COVID‑19. [ 75 ] [ 77 ] In addition, a treatment duration of five days was introduced alongside the longer ten-day course, based on preliminary results from another study (GS-US-540-5773) suggesting that for those not requiring mechanical ventilation or ECMO, the treatment course may be shortened from ten to five days without any loss of efficacy. [ 75 ] Individuals who receive a five-day treatment course but do not show clinical improvement will be eligible to continue receiving remdesivir for an additional five days. [ 75 ] In July 2020, the European Union granted a conditional marketing authorization for remdesivir with an indication for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms [88 lb]) with pneumonia requiring supplemental oxygen. [ 12 ] [ 78 ] In August 2022, the European Union granted a full marketing authorization for remdesivir. [ 12 ] [ 78 ] [ 79 ] Iran Remdesivir has been also produced in Iran by Barakat ; Iran is planning to increase the productions of Remdesivir ampoules from 20,000 to 150,000 ampoules per month. It has also the permission of the "Food and Drug Administration" of MOHME . [ 80 ] Japan In May 2020, Japan's Ministry of Health, Labour and Welfare approved the drug for use in Japan, in a fast-tracked process, based on the US emergency authorization. [ 16 ] [ 60 ] Mexico In October 2020, Deputy Secretary of Prevention and Health Promotion Hugo López-Gatell Ramírez stated at a news conference that Mexico would not necessarily follow the United States in approving the drug for use in Mexico. López-Gatell explained that the Federal Commission for the Protection against Sanitary Risk (Cofepris) had already twice denied the approval of remdesivir because, in that agency's view, the evidence does not suggest "sufficient efficacy". [ 81 ] In March 2020, Cofepris authorized the drug for emergency cases, advising to give continuous surveillance of the integral health of the patient. [ 82 ] Singapore In June 2020, Singapore's Health Sciences Authority conditionally approved the usage of remdesivir in Singapore. [ 56 ] United States In March 2020, United States President Donald Trump announced that remdesivir was available for " compassionate use " for people with COVID‑19; FDA Commissioner Stephen Hahn confirmed the statement at the same press conference. [ 83 ] It was later revealed that Gilead had been providing remdesivir in response to compassionate use requests since 25 January. [ 21 ] [ 84 ] On 23 March 2020, Gilead voluntarily suspended access for compassionate use (excepting cases of critically ill children and pregnant women), for reasons related to supply, citing the need to continue to provide the agent for testing in clinical trials. [ 85 ] [ 86 ] In May 2020, the US Food and Drug Administration granted Gilead emergency use authorization (EUA) for remdesivir to be distributed and used by licensed healthcare providers to treat adults and children hospitalized with severe COVID‑19. [ 59 ] [ 33 ] Severe COVID‑19 is defined as patients with an oxygen saturation (SpO2) <= 94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring extracorporeal membrane oxygenation (ECMO), a heart–lung bypass machine. [ 25 ] [ 33 ] [ 87 ] [ 88 ] Distribution of remdesivir under the EUA was controlled by the US government for use consistent with the terms and conditions of the EUA. [ 33 ] Gilead supplied remdesivir to authorized distributors, or directly to a US government agency, who distributed it to hospitals and other healthcare facilities as directed by the US government, in collaboration with state and local government authorities, as needed. [ 33 ] Gilead stated they were donating 1.5 million vials for emergency use [ 87 ] and estimated, as of April 2020, they had enough remdesivir for 140,000 treatment courses and expect to have 500,000 courses by October 2020, and one million courses by the end of 2020. [ 89 ] [ 90 ] The initial distribution of the drug in the US was tripped up by seemingly capricious decision-making and finger-pointing, resulting in over a week of confusion and frustration among healthcare providers and patients alike. [ 91 ] [ 92 ] [ 93 ] On 9 May 2020, the United States Department of Health and Human Services (HHS) explained in a statement that it would be distributing remdesivir vials to state health departments , then would allow each department to redistribute vials to hospitals in their respective states based upon each department's insight into "community-level needs." [ 94 ] HHS also clarified that only 607,000 vials of Gilead's promised donation of 1.5 million vials would be going to American patients. [ 94 ] However, HHS did not explain why several states with some of the highest caseloads had been omitted from the first two distribution rounds, including California, Florida, and Pennsylvania. [ 94 ] In May 2020, Gilead indicated they would increase the number of doses donated to the US from 607,000 to around 940,000. [ 95 ] [ 93 ] Some of the initial distribution was sent to the wrong hospitals, to hospitals with no intensive care units, and to facilities without the needed refrigeration to store it. [ 93 ] In June 2020, HHS announced an unusual agreement with Gilead in which HHS agreed to Gilead's wholesale acquisition price , HHS would continue to work together with state governments and drug wholesaler AmerisourceBergen to allocate shipments of remdesivir vials to American hospitals through the end of September 2020, and in exchange, during that three-month timeframe (July, August, and September), American patients would be allocated over 90% of Gilead's projected remdesivir output of more than 500,000 treatment courses. [ 96 ] [ 97 ] Absent from these announcements was any discussion of allocation of remdesivir production to the approximately 70 countries omitted from Gilead's generic drug licensing agreements—including much of Europe [ 98 ] and countries as populous as Brazil, China, and Mexico—or the 127 countries listed on those agreements (during the time it will take for Gilead's generic licensees to ramp up their own production). [ 99 ] As the implications of this began to sink in, several countries publicly confirmed the next day that they already had adequate supplies of remdesivir to cover current needs, including Australia, [ 100 ] Germany, [ 101 ] and the United Kingdom. [ 102 ] In August 2020, the FDA broadened the Emergency Use Authorization (EUA) for remdesivir to include all hospitalized patients with suspected or laboratory-confirmed COVID‑19, irrespective of the severity of their disease. [ 103 ] [ 104 ] The Fact Sheet was updated to reflect the new guidance. [ 25 ] In October 2020, Gilead and HHS announced that HHS was relinquishing control over remdesivir allocation because production of the drug had finally caught up with US domestic demand. [ 105 ] [ 106 ] [ 107 ] AmerisourceBergen will remain the sole distributor of Veklury in the US through the end of 2020. [ 107 ] On 22 October 2020, the FDA approved remdesivir and also revised the EUA to permit the use of remdesivir for treatment of suspected or laboratory confirmed COVID‑19 in hospitalized children weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized children less than twelve years of age weighing at least 3.5 kilograms (7.7 lb). [ 64 ] [ 25 ] [ 108 ] [ 109 ] This decision was criticized for an alleged lack of previous consultation on part of the FDA given the complications of antiviral drug issues. [ 110 ] In November 2020, the FDA issued an EUA for the combination of baricitinib with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). [ 28 ] The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID). [ 28 ] The EUA was issued to Eli Lilly and Company. [ 28 ] Remdesivir received approval from the US Food and Drug Administration (FDA) in October 2020, for use in adults and children twelve years and older requiring hospitalization for treatment of severe COVID‑19 infections. [ 64 ] In January 2022, the FDA gave regulatory approval to remdesivir for use in adults and children (twelve years of age and older who weigh at least 40 kilograms (88 lb) and are positive for COVID‑19, not hospitalized, and are ill with COVID‑19 having high risk for developing severe COVID‑19, including hospitalization or death. [ 111 ] In April 2022, the FDA expanded the approval of remdesivir to include people 28 days of age and older weighing at least 3 kilograms (6.6 lb). [ 27 ] The FDA also provided emergency use authorization in 2022, for remdesivir treatment of children under age twelve who are COVID‑positive and not hospitalized, but have mild-to-moderate COVID‑19 with high risk of developing severe infection, including hospitalization or death. [ 111 ] Economics In June 2020, Gilead announced that it had set the price of remdesivir at US$390 per vial for the governments of developed countries, including the United States, and US$520 for US private health insurance companies. [ 112 ] The expected course of treatment is six vials over five days for a total cost of US$2,340 . [ 112 ] Being a repurposed drug , the minimum production cost for remdesivir is estimated at US$0.93 per day of treatment. [ 113 ] In July 2020, the European Union secured a €63 million ( US$74 million ) contract with Gilead, to make the drug available there in early August 2020. [ 114 ] In October 2020, Gilead Sciences and the European Commission announced they had signed a joint procurement framework contract in which Gilead agreed to provide up to 500,000 remdesivir treatment courses over the next six months to 37 European countries. Among the contracting countries were all 27 EU member states plus the United Kingdom, "Albania, Bosnia & Herzegovina, Iceland, Kosovo, Montenegro, North Macedonia, Norway, and Serbia". [ 115 ] At the time, the price per treatment course was not disclosed; Reuters reported the price was 2,070 euros, thereby implying the total value of the contract (if all 500,000 courses are ordered) is approximately €1.035 billion. [ 116 ] Under the contract, each participating country will directly place orders with Gilead and pay Gilead directly for its own orders. [ 116 ] Names Remdesivir is the international nonproprietary name (INN) [ 117 ] while the development code name was GS-5734. [ 118 ] Research Remdesivir was originally created and developed by Gilead Sciences in 2009, to treat hepatitis C and respiratory syncytial virus (RSV). [ 21 ] [ 119 ] It did not work against hepatitis C or RSV, [ 21 ] [ 119 ] but was then repurposed and studied as a potential treatment for Ebola virus disease and Marburg virus infections. [ 120 ] [ 119 ] According to the Czech News Agency , this new line of research was carried out under the direction of scientist Tomáš Cihlář . [ 121 ] A collaboration of researchers from the Centers for Disease Control and Prevention (CDC) and Gilead Sciences subsequently discovered that remdesivir had antiviral activity in vitro against multiple filoviruses , pneumoviruses , paramyxoviruses, and coronaviruses . [ 122 ] Preclinical and clinical research and development was done in collaboration between Gilead Sciences and various US government agencies and academic institutions. [ 34 ] [ 123 ] [ 124 ] [ 125 ] During the mid-2010s, the Mintz Levin law firm prosecuted various patent applications for remdesivir on behalf of Gilead Sciences before the United States Patent and Trademark Office (USPTO). The USPTO granted two patents on remdesivir to Gilead Sciences on 9 April 2019: one for filoviruses, [ 126 ] and one which covered both arenaviruses and coronaviruses. [ 127 ] Ebola In October 2015, the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) announced preclinical results that remdesivir had blocked the Ebola virus in Rhesus monkeys . Travis Warren, who has been a USAMRIID principal investigator since 2007, said that the "work is a result of the continuing collaboration between USAMRIID and Gilead Sciences". [ 128 ] The "initial screening" of the "Gilead Sciences compound library to find molecules with promising antiviral activity" was performed by scientists at the Centers for Disease Control and Prevention (CDC). [ 128 ] As a result of this work, it was recommended that remdesivir "should be further developed as a potential treatment." [ 120 ] [ 128 ] Remdesivir was rapidly pushed through clinical trials due to the West African Ebola virus epidemic of 2013–2016, eventually being used in people with the disease. Preliminary results were promising; it was used in the emergency setting during the Kivu Ebola epidemic that started in 2018, along with further clinical trials, until August 2019, when Congolese health officials announced that it was significantly less effective than monoclonal antibody treatments such as ansuvimab and atoltivimab/maftivimab/odesivimab . The trials, however, established its safety profile. [ 129 ] COVID-19 Hospitalized patients Remdesivir was approved for medical use in the United States in October 2020. [ 62 ] [ 63 ] [ 64 ] [ 109 ] The US Food and Drug Administration (FDA) approved remdesivir based on the agency's analysis of data from three randomized, controlled clinical trials that included participants hospitalized with mild-to-severe COVID‑19. [ 64 ] [ 109 ] The FDA granted approval and reissued the revised EUA to Gilead Sciences Inc. [ 64 ] The FDA approved remdesivir based primarily on evidence from three clinical trials (NCT04280705, NCT04292899, and NCT04292730) of 2043 hospitalized participants with COVID‑19. [ 109 ] The trials were conducted at 226 sites in 17 countries including the United States. [ 109 ] In November 2020, the World Health Organization (WHO) updated its guideline on therapeutics for COVID‑19 to include a conditional recommendation against the use of remdesivir, triggered by results from the WHO Solidarity trial . [ 130 ] [ 131 ] [ 132 ] [ 133 ] Meanwhile, the Public Health Agency of Canada 's COVID‑19 Clinical Pharmacology Task Group recommended that remdesivir only be administered to hospitalized patients as part of a randomized controlled trial due to limited information on risks and benefits. [ 134 ] In January 2022, the Canadian component of the WHO Solidarity Trial reported that in-hospital people with COVID‑19 treated with remdesivir had 17% lower relative risk of death (18.7% versus 22.6% death rates) and 47% reduced relative risk for needing oxygen and mechanical ventilation (8.0% versus 15.0%) compared to people receiving standard-of-care treatments. [ 135 ] In September 2022, the WHO updated their guidelines to recommend use of remdesivir for both non-hospitalized and hospitalized patients. [ 136 ] This was based on final results from the SOLIDARITY trial that showed a reduction in mortality or progression to mechanical ventilation for non-ventilated patients. Nonhospitalized outpatients In January 2022, a study indicated that nonhospitalized people who were at high risk for COVID‑19 progression had an 87% lower risk of hospitalization or death after a 3-day course of intravenous remdesivir. [ 137 ] Remdesivir/baricitinib In May 2020, the National Institute of Allergy and Infectious Diseases (NIAID) started the Adaptive COVID‑19 Treatment Trial 2 (ACTT-2) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus baricitinib for treating hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation. [ 138 ] [ 139 ] [ 140 ] In November 2020, the US Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the drug baricitinib, in combination with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). [ 28 ] The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID). [ 28 ] The EUA was issued to Eli Lilly and Company. [ 28 ] Remdesivir/interferon beta-1a In August 2020, the NIAID started the Adaptive COVID‑19 Treatment Trial 3 (ACTT 3) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus interferon beta-1a for hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation. [ 139 ] [ 141 ] Veterinary uses In 2019, GS-441524 was shown to have promise for treating feline infectious peritonitis caused by a coronavirus . 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Retrieved 6 July 2020 . External links Wikimedia Commons has media related to Remdesivir . Kolata G (1 May 2020). "How Remdesivir, New Hope for Covid-19 Patients, Was Resurrected" . The New York Times .
Markdown	[Jump to content](https://en.wikipedia.org/wiki/Remdesivir#bodyContent) Main menu Main menu move to sidebar hide Navigation - [Main page](https://en.wikipedia.org/wiki/Main_Page "Visit the main page [z]") - [Contents](https://en.wikipedia.org/wiki/Wikipedia:Contents "Guides to browsing Wikipedia") - [Current events](https://en.wikipedia.org/wiki/Portal:Current_events "Articles related to current events") - [Random article](https://en.wikipedia.org/wiki/Special:Random "Visit a randomly selected article [x]") - [About Wikipedia](https://en.wikipedia.org/wiki/Wikipedia:About "Learn about Wikipedia and how it works") - [Contact us](https://en.wikipedia.org/wiki/Wikipedia:Contact_us "How to contact Wikipedia") Contribute - [Help](https://en.wikipedia.org/wiki/Help:Contents "Guidance on how to use and edit Wikipedia") - [Learn to edit](https://en.wikipedia.org/wiki/Help:Introduction "Learn how to edit Wikipedia") - [Community portal](https://en.wikipedia.org/wiki/Wikipedia:Community_portal "The hub for editors") - [Recent changes](https://en.wikipedia.org/wiki/Special:RecentChanges "A list of recent changes to Wikipedia [r]") - [Upload file](https://en.wikipedia.org/wiki/Wikipedia:File_upload_wizard "Add images or other media for use on Wikipedia") - [Special pages](https://en.wikipedia.org/wiki/Special:SpecialPages "A list of all special pages [q]") [![](https://en.wikipedia.org/static/images/icons/enwiki-25.svg) ![Wikipedia](https://en.wikipedia.org/static/images/mobile/copyright/wikipedia-wordmark-en-25.svg) ![The Free Encyclopedia](https://en.wikipedia.org/static/images/mobile/copyright/wikipedia-tagline-en-25.svg)](https://en.wikipedia.org/wiki/Main_Page) [Search](https://en.wikipedia.org/wiki/Special:Search "Search Wikipedia [f]") Appearance - [Donate](https://donate.wikimedia.org/?wmf_source=donate&wmf_medium=sidebar&wmf_campaign=en.wikipedia.org&uselang=en) - [Create account](https://en.wikipedia.org/w/index.php?title=Special:CreateAccount&returnto=Remdesivir "You are encouraged to create an account and log in; however, it is not mandatory") - [Log in](https://en.wikipedia.org/w/index.php?title=Special:UserLogin&returnto=Remdesivir "You're encouraged to log in; however, it's not mandatory. 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[o]") ## Contents move to sidebar hide - [(Top)](https://en.wikipedia.org/wiki/Remdesivir) - [1 Medical uses](https://en.wikipedia.org/wiki/Remdesivir#Medical_uses) - [2 Side effects](https://en.wikipedia.org/wiki/Remdesivir#Side_effects) - [3 Pharmacology](https://en.wikipedia.org/wiki/Remdesivir#Pharmacology) Toggle Pharmacology subsection - [3\.1 Activation](https://en.wikipedia.org/wiki/Remdesivir#Activation) - [3\.2 Mechanism of action](https://en.wikipedia.org/wiki/Remdesivir#Mechanism_of_action) - [3\.3 Pharmacokinetics](https://en.wikipedia.org/wiki/Remdesivir#Pharmacokinetics) - [3\.4 Resistance](https://en.wikipedia.org/wiki/Remdesivir#Resistance) - [4 Interactions](https://en.wikipedia.org/wiki/Remdesivir#Interactions) - [5 Synthesis](https://en.wikipedia.org/wiki/Remdesivir#Synthesis) - [6 In vitro experiments](https://en.wikipedia.org/wiki/Remdesivir#In_vitro_experiments) - [7 Manufacturing](https://en.wikipedia.org/wiki/Remdesivir#Manufacturing) - [8 Society and culture](https://en.wikipedia.org/wiki/Remdesivir#Society_and_culture) Toggle Society and culture subsection - [8\.1 Legal status](https://en.wikipedia.org/wiki/Remdesivir#Legal_status) - [8\.1.1 Australia](https://en.wikipedia.org/wiki/Remdesivir#Australia) - [8\.1.2 Canada](https://en.wikipedia.org/wiki/Remdesivir#Canada) - [8\.1.3 Czech Republic](https://en.wikipedia.org/wiki/Remdesivir#Czech_Republic) - [8\.1.4 European Union](https://en.wikipedia.org/wiki/Remdesivir#European_Union) - [8\.1.5 Iran](https://en.wikipedia.org/wiki/Remdesivir#Iran) - [8\.1.6 Japan](https://en.wikipedia.org/wiki/Remdesivir#Japan) - [8\.1.7 Mexico](https://en.wikipedia.org/wiki/Remdesivir#Mexico) - [8\.1.8 Singapore](https://en.wikipedia.org/wiki/Remdesivir#Singapore) - [8\.1.9 United States](https://en.wikipedia.org/wiki/Remdesivir#United_States) - [8\.2 Economics](https://en.wikipedia.org/wiki/Remdesivir#Economics) - [8\.3 Names](https://en.wikipedia.org/wiki/Remdesivir#Names) - [9 Research](https://en.wikipedia.org/wiki/Remdesivir#Research) Toggle Research subsection - [9\.1 Ebola](https://en.wikipedia.org/wiki/Remdesivir#Ebola) - [9\.2 COVID-19](https://en.wikipedia.org/wiki/Remdesivir#COVID-19) - [9\.2.1 Hospitalized patients](https://en.wikipedia.org/wiki/Remdesivir#Hospitalized_patients) - [9\.2.2 Nonhospitalized outpatients](https://en.wikipedia.org/wiki/Remdesivir#Nonhospitalized_outpatients) - [9\.2.3 Remdesivir/baricitinib](https://en.wikipedia.org/wiki/Remdesivir#Remdesivir/baricitinib) - [9\.2.4 Remdesivir/interferon beta-1a](https://en.wikipedia.org/wiki/Remdesivir#Remdesivir/interferon_beta-1a) - [10 Veterinary uses](https://en.wikipedia.org/wiki/Remdesivir#Veterinary_uses) - [11 References](https://en.wikipedia.org/wiki/Remdesivir#References) - [12 External links](https://en.wikipedia.org/wiki/Remdesivir#External_links) Toggle the table of contents # Remdesivir 49 languages - [العربية](https://ar.wikipedia.org/wiki/%D8%B1%D9%8A%D9%85%D8%AF%D9%8A%D8%B3%D9%8A%D9%81%D9%8A%D8%B1 "ريمديسيفير – Arabic") - [বাংলা](https://bn.wikipedia.org/wiki/%E0%A6%B0%E0%A7%87%E0%A6%AE%E0%A6%A1%E0%A7%87%E0%A6%B8%E0%A6%BF%E0%A6%AD%E0%A6%BF%E0%A6%B0 "রেমডেসিভির – Bangla") - [Català](https://ca.wikipedia.org/wiki/Remdesivir "Remdesivir – Catalan") - [Čeština](https://cs.wikipedia.org/wiki/Remdesivir "Remdesivir – Czech") - [Dansk](https://da.wikipedia.org/wiki/Remdesivir "Remdesivir – Danish") - [Deutsch](https://de.wikipedia.org/wiki/Remdesivir "Remdesivir – German") - [Ελληνικά](https://el.wikipedia.org/wiki/%CE%A1%CE%B5%CE%BC%CE%BD%CF%84%CE%B5%CF%83%CE%B9%CE%B2%CE%AF%CF%81%CE%B7 "Ρεμντεσιβίρη – Greek") - [Español](https://es.wikipedia.org/wiki/Remdesivir "Remdesivir – Spanish") - [Euskara](https://eu.wikipedia.org/wiki/Remdesivir "Remdesivir – Basque") - [فارسی](https://fa.wikipedia.org/wiki/%D8%B1%D9%85%D8%AF%D8%B3%DB%8C%D9%88%DB%8C%D8%B1 "رمدسیویر – Persian") - [Suomi](https://fi.wikipedia.org/wiki/Remdesiviiri "Remdesiviiri – Finnish") - [Français](https://fr.wikipedia.org/wiki/Remd%C3%A9sivir "Remdésivir – French") - [עברית](https://he.wikipedia.org/wiki/%D7%A8%D7%9E%D7%93%D7%A1%D7%99%D7%91%D7%99%D7%A8 "רמדסיביר – Hebrew") - [हिन्दी](https://hi.wikipedia.org/wiki/%E0%A4%B0%E0%A5%87%E0%A4%AE%E0%A4%A1%E0%A5%87%E0%A4%B8%E0%A4%BF%E0%A4%B5%E0%A4%BF%E0%A4%B0 "रेमडेसिविर – Hindi") - [Hrvatski](https://hr.wikipedia.org/wiki/Remdesivir "Remdesivir – Croatian") - [Magyar](https://hu.wikipedia.org/wiki/Remdezivir "Remdezivir – Hungarian") - [Հայերեն](https://hy.wikipedia.org/wiki/%D5%8C%D5%A5%D5%B4%D5%A4%D5%A5%D5%BD%D5%AB%D5%BE%D5%AB%D6%80 "Ռեմդեսիվիր – Armenian") - [Bahasa Indonesia](https://id.wikipedia.org/wiki/Remdesivir "Remdesivir – Indonesian") - [Íslenska](https://is.wikipedia.org/wiki/Remdesivir "Remdesivir – Icelandic") - [Italiano](https://it.wikipedia.org/wiki/Remdesivir "Remdesivir – Italian") - [日本語](https://ja.wikipedia.org/wiki/%E3%83%AC%E3%83%A0%E3%83%87%E3%82%B7%E3%83%93%E3%83%AB "レムデシビル – Japanese") - [ქართული](https://ka.wikipedia.org/wiki/%E1%83%A0%E1%83%94%E1%83%9B%E1%83%93%E1%83%94%E1%83%A1%E1%83%98%E1%83%95%E1%83%98%E1%83%A0%E1%83%98 "რემდესივირი – Georgian") - [한국어](https://ko.wikipedia.org/wiki/%EB%A0%98%EB%8D%B0%EC%8B%9C%EB%B9%84%EB%A5%B4 "렘데시비르 – Korean") - [Lietuvių](https://lt.wikipedia.org/wiki/Remdesiviras "Remdesiviras – Lithuanian") - [മലയാളം](https://ml.wikipedia.org/wiki/%E0%B4%B1%E0%B5%86%E0%B4%82%E0%B4%A1%E0%B5%86%E0%B4%B8%E0%B4%BF%E0%B4%B5%E0%B4%BF%E0%B5%BC "റെംഡെസിവിർ – Malayalam") - [Bahasa Melayu](https://ms.wikipedia.org/wiki/Remdesivir "Remdesivir – Malay") - [မြန်မာဘာသာ](https://my.wikipedia.org/wiki/Remdesivir "Remdesivir – Burmese") - [Nederlands](https://nl.wikipedia.org/wiki/Remdesivir "Remdesivir – Dutch") - [Norsk bokmål](https://no.wikipedia.org/wiki/Remdesivir "Remdesivir – Norwegian Bokmål") - [ଓଡ଼ିଆ](https://or.wikipedia.org/wiki/%E0%AC%B0%E0%AD%87%E0%AC%AE%E0%AC%A1%E0%AD%87%E0%AC%B8%E0%AC%BF%E0%AC%AD%E0%AC%BF%E0%AC%B0 "ରେମଡେସିଭିର – Odia") - [Polski](https://pl.wikipedia.org/wiki/Remdesiwir "Remdesiwir – Polish") - [پنجابی](https://pnb.wikipedia.org/wiki/%D8%B1%DB%8C%D9%85%DA%88%DB%8C%D8%B3%DB%8C%D9%88%DB%8C%D8%B1 "ریمڈیسیویر – Western Punjabi") - [Português](https://pt.wikipedia.org/wiki/Remdesivir "Remdesivir – Portuguese") - [Română](https://ro.wikipedia.org/wiki/Remdesivir "Remdesivir – Romanian") - [Русский](https://ru.wikipedia.org/wiki/%D0%A0%D0%B5%D0%BC%D0%B4%D0%B5%D1%81%D0%B8%D0%B2%D0%B8%D1%80 "Ремдесивир – Russian") - [Simple English](https://simple.wikipedia.org/wiki/Remdesivir "Remdesivir – Simple English") - [Shqip](https://sq.wikipedia.org/wiki/Remdesivir "Remdesivir – Albanian") - [Српски / srpski](https://sr.wikipedia.org/wiki/Remdesivir "Remdesivir – Serbian") - [Svenska](https://sv.wikipedia.org/wiki/Remdesivir "Remdesivir – Swedish") - [தமிழ்](https://ta.wikipedia.org/wiki/%E0%AE%B0%E0%AF%86%E0%AE%AE%E0%AF%8D%E0%AE%9F%E0%AE%BF%E0%AE%9A%E0%AE%BF%E0%AE%B5%E0%AE%BF%E0%AE%AF%E0%AE%B0%E0%AF%8D "ரெம்டிசிவியர் – Tamil") - [Türkçe](https://tr.wikipedia.org/wiki/Remdesivir "Remdesivir – Turkish") - [ئۇيغۇرچە / Uyghurche](https://ug.wikipedia.org/wiki/%D8%B1%DB%90%D9%85%D8%AF%DB%90%D8%B3%D9%89%DB%8B%D9%89%D8%B1$%DB%8B%D8%A7%D9%83%D8%B3%D9%89%D9%86$ "رېمدېسىۋىر(ۋاكسىن) – Uyghur") - [Українська](https://uk.wikipedia.org/wiki/%D0%A0%D0%B5%D0%BC%D0%B4%D0%B5%D1%81%D0%B8%D0%B2%D1%96%D1%80 "Ремдесивір – Ukrainian") - [اردو](https://ur.wikipedia.org/wiki/%D8%B1%DB%8C%D9%85%DA%88%DB%8C%D8%B3%DB%8C%D9%88%DB%8C%D8%B1 "ریمڈیسیویر – Urdu") - [Tiếng Việt](https://vi.wikipedia.org/wiki/Remdesivir "Remdesivir – Vietnamese") - [吴语](https://wuu.wikipedia.org/wiki/%E7%91%9E%E5%BE%B7%E8%A5%BF%E9%9F%A6 "瑞德西韦 – Wu") - [მარგალური](https://xmf.wikipedia.org/wiki/%E1%83%A0%E1%83%94%E1%83%9B%E1%83%93%E1%83%94%E1%83%A1%E1%83%98%E1%83%95%E1%83%98%E1%83%A0%E1%83%98 "რემდესივირი – Mingrelian") - [粵語](https://zh-yue.wikipedia.org/wiki/%E7%91%9E%E5%BE%B7%E8%A5%BF%E9%9F%8B "瑞德西韋 – Cantonese") - [中文](https://zh.wikipedia.org/wiki/%E7%91%9E%E5%BE%B7%E8%A5%BF%E9%9F%A6 "瑞德西韦 – Chinese") [Edit links](https://www.wikidata.org/wiki/Special:EntityPage/Q28209496#sitelinks-wikipedia "Edit interlanguage links") - [Article](https://en.wikipedia.org/wiki/Remdesivir "View the content page [c]") - [Talk](https://en.wikipedia.org/wiki/Talk:Remdesivir "Discuss improvements to the content page [t]") English - [Read](https://en.wikipedia.org/wiki/Remdesivir) - [View source](https://en.wikipedia.org/w/index.php?title=Remdesivir&action=edit "This page is protected. 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From Wikipedia, the free encyclopedia Antiviral drug Pharmaceutical compound \| \| \| \|---\|---\| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/bc/Remdesivir.svg/250px-Remdesivir.svg.png)](https://en.wikipedia.org/wiki/File:Remdesivir.svg) \| \| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png/250px-Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png)](https://en.wikipedia.org/wiki/File:Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png) \| \| \| Clinical data \| \| \| Pronunciation \| [/rɛmˈdɛsɪvɪər/](https://en.wikipedia.org/wiki/Help:IPA/English "Help:IPA/English") [rem-DESS\-i-veer](https://en.wikipedia.org/wiki/Help:Pronunciation_respelling_key "Help:Pronunciation respelling key") \| \| [Trade names](https://en.wikipedia.org/wiki/Drug_nomenclature#Trade_names "Drug nomenclature") \| Veklury \| \| Other names \| GS-5734, RDV \| \| [AHFS](https://en.wikipedia.org/wiki/American_Society_of_Health-System_Pharmacists "American Society of Health-System Pharmacists")/[Drugs.com](https://en.wikipedia.org/wiki/Drugs.com "Drugs.com") \| [Monograph](https://www.drugs.com/monograph/remdesivir.html) \| \| [MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus") \| [a620033](https://medlineplus.gov/druginfo/meds/a620033.html) \| \| [License data](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") \| US [DailyMed](https://en.wikipedia.org/wiki/DailyMed "DailyMed"): [Remdesivir](https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Remdesivir) \| \| [Pregnancy category](https://en.wikipedia.org/wiki/Pregnancy_category "Pregnancy category") \| AU : B2[\[1\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_APM_summary-1)[\[2\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-AusPAR:_Remdesivir-2) \| \| [Routes of administration](https://en.wikipedia.org/wiki/Route_of_administration "Route of administration") \| [Intravenous](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") \| \| [Drug class](https://en.wikipedia.org/wiki/Drug_class "Drug class") \| [Antiviral](https://en.wikipedia.org/wiki/Antiviral "Antiviral") \| \| [ATC code](https://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System "Anatomical Therapeutic Chemical Classification System") \| [J05AB16](https://en.wikipedia.org/wiki/ATC_code_J05 "ATC code J05") ([WHO](https://www.whocc.no/atc_ddd_index/?code=J05AB16)) \| \| Legal status \| \| \| [Legal status](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") \| AU : [S4](https://en.wikipedia.org/wiki/Standard_for_the_Uniform_Scheduling_of_Medicines_and_Poisons#Schedule_4 "Standard for the Uniform Scheduling of Medicines and Poisons") (Prescription only)[\[3\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-3)[\[1\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_APM_summary-1)[\[4\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-4)[\[5\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-5)[\[2\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-AusPAR:_Remdesivir-2) CA : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug")[\[6\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-CA_Veklury_Product_information-6)[\[7\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-7)[\[8\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-8) UK : [POM](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") (Prescription only)[\[9\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_SmPC-9)[\[10\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-10) US : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug")[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11) EU : Rx-only[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[13\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-13) IN : [Schedule H](https://en.wikipedia.org/wiki/Schedule_H "Schedule H") (℞-only) [\[14\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-14)[\[15\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-15) \| \| Identifiers \| \| \| [IUPAC name](https://en.wikipedia.org/wiki/IUPAC_nomenclature_of_chemistry "IUPAC nomenclature of chemistry") (2S)-2-{(2R,3S,4R,5R)-\[5-(4-Aminopyrrolo\[2,1-f\] \[1,2,4\]triazin-7-yl)-5-cyano-3,4-dihydroxy-tetrahydro-furan-2-ylmethoxy\]phenoxy-(S)-phosphorylamino}propionic acid 2-ethyl-butyl ester \| \| \| [CAS Number](https://en.wikipedia.org/wiki/CAS_Registry_Number "CAS Registry Number") \| [1809249-37-3](https://commonchemistry.cas.org/detail?cas_rn=1809249-37-3) \| \| [PubChem](https://en.wikipedia.org/wiki/PubChem#CID "PubChem") CID \| [121304016](https://pubchem.ncbi.nlm.nih.gov/compound/121304016) \| \| [DrugBank](https://en.wikipedia.org/wiki/DrugBank "DrugBank") \| [DB14761](https://www.drugbank.ca/drugs/DB14761) \| \| [ChemSpider](https://en.wikipedia.org/wiki/ChemSpider "ChemSpider") \| [58827832](https://www.chemspider.com/Chemical-Structure.58827832.html) \| \| [UNII](https://en.wikipedia.org/wiki/Unique_Ingredient_Identifier "Unique Ingredient Identifier") \| [3QKI37EEHE](https://precision.fda.gov/uniisearch/srs/unii/3QKI37EEHE) \| \| [KEGG](https://en.wikipedia.org/wiki/KEGG "KEGG") \| [D11472](https://www.kegg.jp/entry/D11472) \| \| [ChEBI](https://en.wikipedia.org/wiki/ChEBI "ChEBI") \| [CHEBI:145994](https://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:145994) \| \| [ChEMBL](https://en.wikipedia.org/wiki/ChEMBL "ChEMBL") \| [ChEMBL4065616](https://www.ebi.ac.uk/chembl/explore/compound/ChEMBL4065616) \| \| [CompTox Dashboard](https://en.wikipedia.org/wiki/CompTox_Chemicals_Dashboard "CompTox Chemicals Dashboard") ( EPA ) \| [DTXSID701022537](https://comptox.epa.gov/dashboard/chemical/details/DTXSID701022537) [![Edit this at Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q28209496#P3117 "Edit this at Wikidata") \| \| [ECHA InfoCard](https://en.wikipedia.org/wiki/ECHA_InfoCard "ECHA InfoCard") \| [100\.302.974](https://echa.europa.eu/substance-information/-/substanceinfo/100.302.974) [![Edit this at Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q28209496#P2566 "Edit this at Wikidata") \| \| Chemical and physical data \| \| \| [Formula](https://en.wikipedia.org/wiki/Chemical_formula "Chemical formula") \| C27H35N6O8P \| \| [Molar mass](https://en.wikipedia.org/wiki/Molar_mass "Molar mass") \| 602\.585 g·mol−1 \| \| 3D model ([JSmol](https://en.wikipedia.org/wiki/JSmol "JSmol")) \| [Interactive image](https://chemapps.stolaf.edu/jmol/jmol.php?model=CCC%28COC%28%3DO%29%5BC%40%40H%5D%28NP%28%3DO%29%28Oc1ccccc1%29OC%5BC%40H%5D1O%5BC%40%40%5D%28%5BC%40%40H%5D%28%5BC%40%40H%5D1O%29O%29%28C%23N%29c1ccc2n1ncnc2N%29C%29CC) \| \| [SMILES](https://en.wikipedia.org/wiki/Simplified_molecular-input_line-entry_system "Simplified molecular-input line-entry system") CCC(COC(=O)\[C@@H\](NP(=O)(Oc1ccccc1)OC\[C@H\]1O\[C@@\](\[C@@H\](\[C@@H\]1O)O)(C\#N)c1ccc2n1ncnc2N)C)CC \| \| \| [InChI](https://en.wikipedia.org/wiki/International_Chemical_Identifier "International Chemical Identifier") InChI=1S/C27H35N6O8P/c1-4-18(5-2)13-38-26(36)17(3)32-42(37,41-19-9-7-6-8-10-19)39-14-21-23(34)24(35)27(15-28,40-21)22-12-11-20-25(29)30-16-31-33(20)22/h6-12,16-18,21,23-24,34-35H,4-5,13-14H2,1-3H3,(H,32,37)(H2,29,30,31)/t17-,21+,23+,24+,27-,42-/m0/s1 Key:RWWYLEGWBNMMLJ-YSOARWBDSA-N \| \| Remdesivir, sold under the brand name Veklury,[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[16\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR-16) is a [broad-spectrum antiviral medication](https://en.wikipedia.org/wiki/Broad-spectrum_antiviral_drug "Broad-spectrum antiviral drug") developed by the [biopharmaceutical](https://en.wikipedia.org/wiki/Biopharmaceutical "Biopharmaceutical") company [Gilead Sciences](https://en.wikipedia.org/wiki/Gilead_Sciences "Gilead Sciences").[\[17\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Scavone_2020-17) It is administered via [injection into a vein](https://en.wikipedia.org/wiki/Intravenous "Intravenous").[\[18\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-18)[\[19\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Mehta2020-19) During the [COVID‑19 pandemic](https://en.wikipedia.org/wiki/COVID-19_pandemic "COVID-19 pandemic"), remdesivir was approved or authorized for emergency use to treat [COVID‑19](https://en.wikipedia.org/wiki/Coronavirus_disease_2019 "Coronavirus disease 2019") in numerous countries.[\[20\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20201022-20) Remdesivir was originally developed to treat [hepatitis C](https://en.wikipedia.org/wiki/Hepatitis_C "Hepatitis C"),[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21) and was subsequently investigated for [Ebola virus disease](https://en.wikipedia.org/wiki/Ebola "Ebola") and [Marburg virus](https://en.wikipedia.org/wiki/Marburg_virus_disease "Marburg virus disease") infections[\[22\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pmid269342202-22) before being studied as a post-infection treatment for COVID‑19.[\[23\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-kai2-23) Remdesivir is a [prodrug](https://en.wikipedia.org/wiki/Prodrug "Prodrug") that is intended to allow intracellular delivery of [GS-441524](https://en.wikipedia.org/wiki/GS-441524 "GS-441524") monophosphate and subsequent biotransformation into GS-441524 [triphosphate](https://en.wikipedia.org/wiki/Triphosphate "Triphosphate"), a ribo[nucleotide analogue](https://en.wikipedia.org/wiki/Nucleotide_analogue "Nucleotide analogue") inhibitor of viral [RNA polymerase](https://en.wikipedia.org/wiki/RNA_polymerase "RNA polymerase").[\[24\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020-24) The most common side effect in healthy volunteers is raised blood levels of [liver enzymes](https://en.wikipedia.org/wiki/Liver_enzymes "Liver enzymes").[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12) The most common side effect in people with COVID‑19 is [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea").[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12) Side effects may include liver inflammation and an [infusion](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy")\-related reaction with nausea, [low blood pressure](https://en.wikipedia.org/wiki/Hypotension "Hypotension"), and sweating.[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) The US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) considers it to be a [first-in-class medication](https://en.wikipedia.org/wiki/First-in-class_medication "First-in-class medication").[\[26\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-26) ## Medical uses In the European Union, remdesivir is [indicated](https://en.wikipedia.org/wiki/Indication_$medicine$ "Indication (medicine)") for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) with [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia") requiring supplemental oxygen and for adults who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID‑19.[\[9\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_SmPC-9)[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12) In the United States, remdesivir is indicated for the treatment of COVID‑19 in people 28 days of age and older and weighing at least 3 kilograms (6.6 lb) who are hospitalized; or not hospitalized and have mild-to-moderate COVID‑19, and are at high risk for progression to severe COVID‑19, including hospitalization or death.[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11)[\[27\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20220425-27) In November 2020, the FDA issued an emergency use authorization (EUA) for the combination of [baricitinib](https://en.wikipedia.org/wiki/Baricitinib "Baricitinib") with remdesivir, for the treatment of suspected or laboratory confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") (ECMO).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) In Australia, it is approved for those aged four weeks of age and older with a body weight at least 3 kilograms (6.6 lb) with [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia") requiring supplemental oxygen or those aged four weeks of age and older with body weight at least 40 kilograms (88 lb) who do not require supplemental oxygen and who are at high risk of progressing to severe COVID‑19.[\[29\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-29)[\[2\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-AusPAR:_Remdesivir-2) In 2024, a retrospective study found treatment with the antiviral remdesivir plus dexamethasone was associated with fewer deaths in hospitalized COVID-19 patients compared to dexamethasone alone.[\[30\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-30) The combination led to a 26% reduction in mortality at 14 days and a 24% reduction at 28 days.[\[31\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-31) ## Side effects The most common adverse effects in people treated with remdesivir were [respiratory failure](https://en.wikipedia.org/wiki/Respiratory_failure "Respiratory failure") and blood [biomarkers](https://en.wikipedia.org/wiki/Biomarker "Biomarker") of [organ](https://en.wikipedia.org/wiki/Organ_$anatomy$ "Organ (anatomy)") impairment, including [low albumin](https://en.wikipedia.org/wiki/Human_serum_albumin#Hypoalbuminemia "Human serum albumin"), [low potassium](https://en.wikipedia.org/wiki/Hypokalemia "Hypokalemia"), [low count of red blood cells](https://en.wikipedia.org/wiki/Anemia "Anemia"), [low count of thrombocytes](https://en.wikipedia.org/wiki/Thrombocytopenia "Thrombocytopenia"), and [elevated bilirubin (jaundice)](https://en.wikipedia.org/wiki/Jaundice "Jaundice").[\[32\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wang-32) Other reported adverse effects include [gastrointestinal distress](https://en.wikipedia.org/wiki/Gastrointestinal_disease "Gastrointestinal disease"), elevated [transaminase](https://en.wikipedia.org/wiki/Transaminase "Transaminase") levels in the blood ([liver enzymes](https://en.wikipedia.org/wiki/Liver_function_tests "Liver function tests")), [infusion](https://en.wikipedia.org/wiki/Infusion_therapy "Infusion therapy") site reactions, and [electrocardiogram abnormalities](https://en.wikipedia.org/wiki/Drug-induced_QT_prolongation "Drug-induced QT prolongation").[\[19\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Mehta2020-19) Remdesivir may cause [infusion-related](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") reactions, including low blood pressure, nausea, vomiting, sweating or shivering.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Other possible side effects of remdesivir include: - Infusion-related reactions. Infusion-related reactions have been seen during a remdesivir infusion or around the time remdesivir was given.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Signs and symptoms of infusion-related reactions may include: low blood pressure, nausea, vomiting, sweating, and shivering.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) - Increases in levels of liver enzymes, seen in abnormal liver blood tests.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Increases in levels of liver enzymes have been seen in people who have received remdesivir, which may be a sign of inflammation or damage to cells in the liver.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) ## Pharmacology ### Activation [![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/08/Remdesivir_activation.svg/500px-Remdesivir_activation.svg.png)](https://en.wikipedia.org/wiki/File:Remdesivir_activation.svg) Activation of remdesivir into its active triphosphate metabolite[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34) Remdesivir is a [protide](https://en.wikipedia.org/wiki/Protide "Protide") ([prodrug](https://en.wikipedia.org/wiki/Prodrug "Prodrug") of nucleotide) able to diffuse into cells, where it is converted to [GS-441524](https://en.wikipedia.org/wiki/GS-441524 "GS-441524") monophosphate via the actions of [esterases](https://en.wikipedia.org/wiki/Esterase "Esterase") ([CES1](https://en.wikipedia.org/wiki/CES1 "CES1") and [CTSA](https://en.wikipedia.org/wiki/Cathepsin_A "Cathepsin A")) and a [phosphoamidase](https://en.wikipedia.org/wiki/Phosphoamidase "Phosphoamidase") ([HINT1](https://en.wikipedia.org/wiki/HINT1 "HINT1")); this in turn is further phosphorylated to its [active metabolite](https://en.wikipedia.org/wiki/Active_metabolite "Active metabolite") triphosphate by [nucleoside-phosphate kinases](https://en.wikipedia.org/wiki/Nucleoside-phosphate_kinase "Nucleoside-phosphate kinase").[\[35\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Sheahan_2017-35)[\[36\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon2020-36) This pathway of bioactivation is meant to occur [intracellularly](https://en.wikipedia.org/wiki/Intracellular "Intracellular"), but a substantial amount of remdesivir is prematurely [hydrolyzed](https://en.wikipedia.org/wiki/Hydrolysis "Hydrolysis") in plasma, with GS-441524 being the major metabolite in plasma, and the only metabolite remaining two hours after dosing.[\[24\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020-24) ### Mechanism of action As an [adenosine](https://en.wikipedia.org/wiki/Adenosine "Adenosine") nucleoside triphosphate analog (GS-443902),[\[37\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pmid22446091-37) the [active metabolite](https://en.wikipedia.org/wiki/Active_metabolite "Active metabolite") of remdesivir interferes with the action of viral [RNA-dependent RNA polymerase](https://en.wikipedia.org/wiki/RNA-dependent_RNA_polymerase "RNA-dependent RNA polymerase") and evades [proofreading](https://en.wikipedia.org/wiki/Proofreading_$biology$ "Proofreading (biology)") by viral [exoribonuclease](https://en.wikipedia.org/wiki/Exoribonuclease "Exoribonuclease") (ExoN), causing a decrease in viral RNA production.[\[17\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Scavone_2020-17)[\[38\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Ferner2020-38) In some viruses, such as the [respiratory syncytial virus](https://en.wikipedia.org/wiki/Respiratory_syncytial_virus "Respiratory syncytial virus"), it causes the RNA-dependent RNA polymerases to pause, but its predominant effect (as in Ebola) is to induce an irreversible [chain termination](https://en.wikipedia.org/wiki/Chain_termination "Chain termination"). Unlike with many other chain terminators, this is not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain.[\[39\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pmid30987343-39) For the RNA-dependent RNA polymerases of [MERS-CoV](https://en.wikipedia.org/wiki/MERS-CoV "MERS-CoV"), [SARS-CoV-1](https://en.wikipedia.org/wiki/SARS-CoV-1 "SARS-CoV-1"), and [SARS-CoV-2](https://en.wikipedia.org/wiki/SARS-CoV-2 "SARS-CoV-2"), arrest of RNA synthesis occurs after incorporation of three additional nucleotides.[\[40\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon_2020-40)[\[36\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon2020-36) Hence, remdesivir is classified as a direct-acting antiviral agent that works as a delayed chain terminator.[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34)[\[36\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon2020-36) ### Pharmacokinetics In non-human primates, the plasma [half-life](https://en.wikipedia.org/wiki/Biological_half-life "Biological half-life") of the prodrug is 20 minutes, with the main metabolite being the [nucleoside](https://en.wikipedia.org/wiki/Nucleoside "Nucleoside"), [GS-441524](https://en.wikipedia.org/wiki/GS-441524 "GS-441524"). Two hours post injection, the main metabolite GS-441524 is present at micromolar concentrations, whilst intact Remdesivir is no longer detectable. Because of this rapid extracellular conversion to the nucleoside GS-441524, some researchers have questioned whether the active nucleotide triphosphate is truly derived from remdesivir pro-drug removal or whether it occurs by GS-441524 phosphorylation, and whether direct administration of GS-441524 would constitute a cheaper and easier to administer COVID‑19 drug compared to remdesivir.[\[41\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020_2-41)[\[24\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020-24) The activated nucleotide triphosphate form has sustained intracellular levels in [PBMC](https://en.wikipedia.org/wiki/PBMC "PBMC") and presumably in other cells as well.[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34) ### Resistance Mutations in the [mouse hepatitis virus](https://en.wikipedia.org/wiki/Mouse_hepatitis_virus "Mouse hepatitis virus") [RNA replicase](https://en.wikipedia.org/wiki/RNA_replicase "RNA replicase") that cause partial resistance to remdesivir were identified in 2018. These mutations make the viruses less effective in nature, and the researchers believe they will likely not persist where the drug is not being used.[\[42\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Chiotos2020-42) ## Interactions Remdesivir is at least partially metabolized by the [cytochrome P450](https://en.wikipedia.org/wiki/Cytochrome_P450 "Cytochrome P450") enzymes [CYP2C8](https://en.wikipedia.org/wiki/CYP2C8 "CYP2C8"), [CYP2D6](https://en.wikipedia.org/wiki/CYP2D6 "CYP2D6"), and [CYP3A4](https://en.wikipedia.org/wiki/CYP3A4 "CYP3A4").[\[43\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_Summary_on_compassionate_use-43)[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) [Blood plasma](https://en.wikipedia.org/wiki/Blood_plasma "Blood plasma") concentrations of remdesivir are expected to decrease if it is administered together with cytochrome P450 [inducers](https://en.wikipedia.org/wiki/List_of_cytochrome_P450_modulators "List of cytochrome P450 modulators") such as [rifampicin](https://en.wikipedia.org/wiki/Rifampicin "Rifampicin"), [carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine"), [phenobarbital](https://en.wikipedia.org/wiki/Phenobarbital "Phenobarbital"), [phenytoin](https://en.wikipedia.org/wiki/Phenytoin "Phenytoin"), [primidone](https://en.wikipedia.org/wiki/Primidone "Primidone"), and [St John's wort](https://en.wikipedia.org/wiki/St_John%27s_wort "St John's wort").[\[44\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-44) Using chloroquine or [hydroxychloroquine](https://en.wikipedia.org/wiki/Hydroxychloroquine "Hydroxychloroquine") with remdesivir may reduce the antiviral activity of remdesivir.[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11)[\[9\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_SmPC-9)[\[45\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-45) Coadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on in vitro data demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir.[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11) ## Synthesis [![](https://upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Synthesis_of_Remdesivir.png/500px-Synthesis_of_Remdesivir.png)](https://en.wikipedia.org/wiki/File:Synthesis_of_Remdesivir.png) Synthesis of remdesivir in [structural formulae](https://en.wikipedia.org/wiki/Structural_formula "Structural formula") Remdesivir can be synthesized in multiple steps from [ribose](https://en.wikipedia.org/wiki/Ribose "Ribose") derivatives. The figure to the right is one of the synthesis routes of remdesivir invented by Chun and coauthors from Gilead Sciences.[\[46\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-46)[\[47\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-47) ## In vitro experiments An [in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro") study of remdesivir assessing antiviral activity against SARS-CoV-2 was performed.[\[48\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wangc:20-48) Cells were pre-treated with the different doses of remdesivir for 1 hour, and the virus (MOI of 0.05) was subsequently added to allow infection for 2 hours.[\[48\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wangc:20-48) The results found that remdesivir functioned well as an inhibitor of the infection.[\[48\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wangc:20-48) The study was published as a letter to the editor, and as such did not undergo peer review. ## Manufacturing Remdesivir requires "70 raw materials, reagents, and catalysts" to make, and approximately "25 chemical steps."[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) Some of the ingredients are extremely dangerous to humans, especially [trimethylsilyl cyanide](https://en.wikipedia.org/wiki/Trimethylsilyl_cyanide "Trimethylsilyl cyanide").[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) The original end-to-end manufacturing process required 9 to 12 months to go from raw materials at contract manufacturers to finished product, but after restarting production in January 2020, Gilead Sciences was able to find ways to reduce the production time to six months.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) In January 2020, Gilead began working on restarting remdesivir production in glass-lined steel [chemical reactors](https://en.wikipedia.org/wiki/Chemical_reactor "Chemical reactor") at its manufacturing plant in [Edmonton, Alberta](https://en.wikipedia.org/wiki/Edmonton "Edmonton").[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) On 2 February 2020, the company flew its entire stock of remdesivir, 100 kilograms in powder form (left over from Ebola research), to its filling plant in [La Verne, California](https://en.wikipedia.org/wiki/La_Verne,_California "La Verne, California"), to start filling vials.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) The Edmonton plant finished its first new batch of remdesivir in April 2020.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) Around the same time, fresh raw materials began to arrive from contract manufacturers reactivated by Gilead in January.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) Another challenge is getting remdesivir into patients despite the drug's "poor predicted solubility and poor stability."[\[50\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Pipkin-50) In June 2020, [Ligand Pharmaceuticals](https://en.wikipedia.org/wiki/Ligand_Pharmaceuticals "Ligand Pharmaceuticals") revealed that Gilead has been managing those issues by mixing Ligand's proprietary [excipient](https://en.wikipedia.org/wiki/Excipient "Excipient") Captisol (based on [University of Kansas](https://en.wikipedia.org/wiki/University_of_Kansas "University of Kansas") research into [cyclodextrin](https://en.wikipedia.org/wiki/Cyclodextrin "Cyclodextrin")) with remdesivir at a 30:1 ratio.[\[50\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Pipkin-50) Since that implies an enormous amount of Captisol is needed to stabilize and deliver remdesivir (on top of amounts needed for several other drugs for which the excipient is already in regular use), Ligand announced that it is trying to boost Captisol annual manufacturing capacity to as much as 500 metric tons.[\[50\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Pipkin-50) On 12 May 2020, Gilead announced that it had granted non-exclusive voluntary licenses to five [generic drug](https://en.wikipedia.org/wiki/Generic_drug "Generic drug") companies in India and Pakistan to manufacture remdesivir for distribution to 127 countries.[\[51\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Silverman-51)[\[52\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-52)[\[53\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_licensing-53) The agreements were structured so that the licensees can set their own prices and will not have to pay royalties to Gilead until the WHO declares an end to the COVID‑19 emergency or another medicine or vaccine is approved for COVID‑19, whichever comes first.[\[51\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Silverman-51) On 23 June 2020, India granted emergency marketing approval of generic remdesivir manufactured by two Gilead licensees, [Cipla](https://en.wikipedia.org/wiki/Cipla "Cipla") and [Hetero Drugs](https://en.wikipedia.org/wiki/Hetero_Drugs "Hetero Drugs").[\[54\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Rajagopal-54) ## Society and culture ### Legal status Remdesivir is approved, or authorized for emergency use, to treat COVID‑19 in many countries.[\[20\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20201022-20) Remdesivir has been authorized for emergency use in India,[\[55\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-55) Singapore,[\[56\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Reuters_20200620-56) and approved for use in Japan,[\[57\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-57) the European Union, the United States, and Australia for people with severe symptoms.[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[16\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR-16)[\[58\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_EUA-58)[\[59\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_EUA_PR-59)[\[60\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-:0-60)[\[61\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-TGA_approval-61)[\[62\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Veklury-62)[\[63\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) Remdesivir is the first treatment for COVID‑19 to be approved by the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA).[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) The approval by the FDA does not include the entire population that had been authorized to use remdesivir under an Emergency Use Authorization (EUA) originally issued in May 2020.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) In order to ensure continued access to the pediatric population previously covered under the EUA, the FDA revised the EUA for remdesivir to authorize the drug's use for treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized pediatric patients weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized pediatric patients less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) #### Australia In July 2020, remdesivir was provisionally approved for use in Australia for use in adults and adolescents with severe COVID‑19 symptoms who have been hospitalized.[\[61\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-TGA_approval-61)[\[65\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-65) Australia claims to have a sufficient supply of remdesivir in its national stockpile.[\[66\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-66) #### Canada As of 11 April 2020, access in Canada was available only through clinical trials.[\[67\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Health_Canada-67) [Health Canada](https://en.wikipedia.org/wiki/Health_Canada "Health Canada") approved requests to treat twelve people with remdesivir under the department's special-access program (SAP).[\[68\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-68) Additional doses of remdesivir are not available through the SAP except for pregnant women or children with confirmed COVID‑19 and severe illness.[\[67\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Health_Canada-67) In June 2020, Health Canada received an application from Gilead for the use of remdesivir for treating COVID‑19.[\[67\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Health_Canada-67) On 27 July 2020, Health Canada conditionally approved the application.[\[69\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Weikle-69)[\[6\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-CA_Veklury_Product_information-6) In September 2020, [Minister of Public Services and Procurement](https://en.wikipedia.org/wiki/Minister_of_Public_Services_and_Procurement "Minister of Public Services and Procurement") [Anita Anand](https://en.wikipedia.org/wiki/Anita_Anand "Anita Anand") announced that Canada had entered into a deal to obtain up to 150,000 vials of remdesivir from Gilead starting in October.[\[70\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Grant-70) As of 8 October, remdesivir was still not widely available in [Alberta](https://en.wikipedia.org/wiki/Alberta "Alberta"), because [Alberta Health Services](https://en.wikipedia.org/wiki/Alberta_Health_Services "Alberta Health Services") was undertaking a "[formulary](https://en.wikipedia.org/wiki/Formulary_$pharmacy$ "Formulary (pharmacy)") review" to be completed by mid-November.[\[71\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Kury_de_Castillo-71) #### Czech Republic In March 2020, the drug was provisionally approved for use for COVID‑19 patients in a serious condition as a result of [the outbreak in the Czech Republic](https://en.wikipedia.org/wiki/COVID%E2%80%9119_pandemic_in_the_Czech_Republic#Policies_to_fight_the_contagion "COVID‑19 pandemic in the Czech Republic").[\[72\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-72) #### European Union In February 2016, [orphan designation](https://en.wikipedia.org/wiki/Orphan_drug "Orphan drug") (EU/3/16/1615) was granted by the European Commission to Gilead Sciences International Ltd, United Kingdom, for remdesivir for the treatment of Ebola virus disease.[\[73\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-73) In April 2020, the [European Medicines Agency](https://en.wikipedia.org/wiki/European_Medicines_Agency "European Medicines Agency") (EMA) provided recommendations on compassionate use of remdesivir for COVID‑19 in the EU.[\[74\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-74) In May 2020, the [Committee for Medicinal Products for Human Use](https://en.wikipedia.org/wiki/Committee_for_Medicinal_Products_for_Human_Use "Committee for Medicinal Products for Human Use") (CHMP) of the EMA recommended expanding the compassionate use of remdesivir to those not on mechanical ventilation.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) In addition to those undergoing invasive mechanical ventilation, the compassionate use recommendations cover the treatment of hospitalized individuals requiring supplemental oxygen, non-invasive ventilation, high-flow oxygen devices or ECMO (extracorporeal membrane oxygenation).[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) The updated recommendations were based on preliminary results from the NIAID-ACTT study,[\[76\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIAID_ACTT-76) which suggested a beneficial effect of remdesivir in the treatment of hospitalized individuals with severe COVID‑19.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75)[\[77\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_PR-77) In addition, a treatment duration of five days was introduced alongside the longer ten-day course, based on preliminary results from another study (GS-US-540-5773) suggesting that for those not requiring mechanical ventilation or ECMO, the treatment course may be shortened from ten to five days without any loss of efficacy.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) Individuals who receive a five-day treatment course but do not show clinical improvement will be eligible to continue receiving remdesivir for an additional five days.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) In July 2020, the European Union granted a conditional marketing authorization for remdesivir with an indication for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms \[88 lb\]) with pneumonia requiring supplemental oxygen.[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[78\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EC_Veklury-78) In August 2022, the European Union granted a full marketing authorization for remdesivir.[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[78\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EC_Veklury-78)[\[79\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-79) #### Iran Remdesivir has been also produced in Iran by [Barakat](https://en.wikipedia.org/wiki/Barakat_Pharmaceutical_Group "Barakat Pharmaceutical Group"); Iran is planning to increase the productions of Remdesivir ampoules from 20,000 to 150,000 ampoules per month. It has also the permission of the "Food and Drug Administration" of [MOHME](https://en.wikipedia.org/wiki/Ministry_of_Health_and_Medical_Education "Ministry of Health and Medical Education").[\[80\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-80) #### Japan In May 2020, [Japan's Ministry of Health, Labour and Welfare](https://en.wikipedia.org/wiki/Ministry_of_Health,_Labour_and_Welfare "Ministry of Health, Labour and Welfare") approved the drug for use in Japan, in a fast-tracked process, based on the US emergency authorization.[\[16\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR-16)[\[60\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-:0-60) #### Mexico In October 2020, Deputy Secretary of Prevention and Health Promotion [Hugo López-Gatell Ramírez](https://en.wikipedia.org/wiki/Hugo_L%C3%B3pez-Gatell_Ram%C3%ADrez "Hugo López-Gatell Ramírez") stated at a news conference that Mexico would not necessarily follow the United States in approving the drug for use in Mexico. López-Gatell explained that the [Federal Commission for the Protection against Sanitary Risk](https://en.wikipedia.org/wiki/Federal_Commission_for_the_Protection_against_Sanitary_Risk "Federal Commission for the Protection against Sanitary Risk") (Cofepris) had already twice denied the approval of remdesivir because, in that agency's view, the evidence does not suggest "sufficient efficacy".[\[81\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Reuters_Mexico-81) In March 2020, Cofepris authorized the drug for emergency cases, advising to give continuous surveillance of the integral health of the patient.[\[82\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Cofepris_Mexico-82) #### Singapore In June 2020, Singapore's [Health Sciences Authority](https://en.wikipedia.org/wiki/Health_Sciences_Authority "Health Sciences Authority") conditionally approved the usage of remdesivir in Singapore.[\[56\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Reuters_20200620-56) #### United States In March 2020, United States President [Donald Trump](https://en.wikipedia.org/wiki/Donald_Trump "Donald Trump") announced that remdesivir was available for "[compassionate use](https://en.wikipedia.org/wiki/Compassionate_use "Compassionate use")" for people with COVID‑19; FDA Commissioner [Stephen Hahn](https://en.wikipedia.org/wiki/Stephen_Hahn_$oncologist$ "Stephen Hahn (oncologist)") confirmed the statement at the same press conference.[\[83\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-83) It was later revealed that Gilead had been providing remdesivir in response to compassionate use requests since 25 January.[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21)[\[84\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-84) On 23 March 2020, Gilead voluntarily suspended access for compassionate use (excepting cases of critically ill children and pregnant women), for reasons related to supply, citing the need to continue to provide the agent for testing in clinical trials.[\[85\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Hopkins-85)[\[86\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-86) In May 2020, the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") granted Gilead [emergency use authorization](https://en.wikipedia.org/wiki/Emergency_use_authorization "Emergency use authorization") (EUA) for remdesivir to be distributed and used by licensed healthcare providers to treat adults and children hospitalized with severe COVID‑19.[\[59\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_EUA_PR-59)[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Severe COVID‑19 is defined as patients with an oxygen saturation (SpO2) \<= 94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") (ECMO), a heart–lung bypass machine.[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33)[\[87\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NYT_EUA-87)[\[88\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-88) Distribution of remdesivir under the EUA was controlled by the US government for use consistent with the terms and conditions of the EUA.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Gilead supplied remdesivir to authorized distributors, or directly to a US government agency, who distributed it to hospitals and other healthcare facilities as directed by the US government, in collaboration with state and local government authorities, as needed.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Gilead stated they were donating 1.5 million vials for emergency use[\[87\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NYT_EUA-87) and estimated, as of April 2020, they had enough remdesivir for 140,000 treatment courses and expect to have 500,000 courses by October 2020, and one million courses by the end of 2020.[\[89\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-89)[\[90\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-90) The initial distribution of the drug in the US was tripped up by seemingly capricious decision-making and finger-pointing, resulting in over a week of confusion and frustration among healthcare providers and patients alike.[\[91\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-91)[\[92\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Swan-92)[\[93\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WaPo20200528-93) On 9 May 2020, the [United States Department of Health and Human Services](https://en.wikipedia.org/wiki/United_States_Department_of_Health_and_Human_Services "United States Department of Health and Human Services") (HHS) explained in a statement that it would be distributing remdesivir vials to [state health departments](https://en.wikipedia.org/wiki/State_health_agency "State health agency"), then would allow each department to redistribute vials to hospitals in their respective states based upon each department's insight into "community-level needs."[\[94\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Facher-94) HHS also clarified that only 607,000 vials of Gilead's promised donation of 1.5 million vials would be going to American patients.[\[94\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Facher-94) However, HHS did not explain why several states with some of the highest caseloads had been omitted from the first two distribution rounds, including California, Florida, and Pennsylvania.[\[94\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Facher-94) In May 2020, Gilead indicated they would increase the number of doses donated to the US from 607,000 to around 940,000.[\[95\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stat_20200519-95)[\[93\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WaPo20200528-93) Some of the initial distribution was sent to the wrong hospitals, to hospitals with no intensive care units, and to facilities without the needed refrigeration to store it.[\[93\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WaPo20200528-93) In June 2020, HHS announced an unusual agreement with Gilead in which HHS agreed to Gilead's [wholesale acquisition price](https://en.wikipedia.org/wiki/Wholesale_acquisition_cost "Wholesale acquisition cost"), HHS would continue to work together with state governments and drug wholesaler [AmerisourceBergen](https://en.wikipedia.org/wiki/AmerisourceBergen "AmerisourceBergen") to allocate shipments of remdesivir vials to American hospitals through the end of September 2020, and in exchange, during that three-month timeframe (July, August, and September), American patients would be allocated over 90% of Gilead's projected remdesivir output of more than 500,000 treatment courses.[\[96\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Kolata-96)[\[97\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-HHSPressRelease_29June2020-97) Absent from these announcements was any discussion of allocation of remdesivir production to the approximately 70 countries omitted from Gilead's generic drug licensing agreements—including much of Europe[\[98\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Boseley-98) and countries as populous as Brazil, China, and Mexico—or the 127 countries listed on those agreements (during the time it will take for Gilead's generic licensees to ramp up their own production).[\[99\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Baragona-99) As the implications of this began to sink in, several countries publicly confirmed the next day that they already had adequate supplies of remdesivir to cover current needs, including Australia,[\[100\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Davey-100) Germany,[\[101\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Rinke-101) and the United Kingdom.[\[102\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stout-102) In August 2020, the FDA broadened the Emergency Use Authorization (EUA) for remdesivir to include all hospitalized patients with suspected or laboratory-confirmed COVID‑19, irrespective of the severity of their disease.[\[103\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-103)[\[104\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-104) The Fact Sheet was updated to reflect the new guidance.[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) In October 2020, Gilead and HHS announced that HHS was relinquishing control over remdesivir allocation because production of the drug had finally caught up with US domestic demand.[\[105\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Walker-105)[\[106\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-106)[\[107\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-HHS_PR_20201001-107) AmerisourceBergen will remain the sole distributor of Veklury in the US through the end of 2020.[\[107\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-HHS_PR_20201001-107) On 22 October 2020, the FDA approved remdesivir and also revised the EUA to permit the use of remdesivir for treatment of suspected or laboratory confirmed COVID‑19 in hospitalized children weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized children less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64)[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\[108\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-108)[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) This decision was criticized for an alleged lack of previous consultation on part of the FDA given the complications of antiviral drug issues.[\[110\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-110) In November 2020, the FDA issued an EUA for the combination of [baricitinib](https://en.wikipedia.org/wiki/Baricitinib "Baricitinib") with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) Remdesivir received approval from the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) in October 2020, for use in adults and children twelve years and older requiring hospitalization for treatment of severe COVID‑19 infections.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) In January 2022, the FDA gave regulatory approval to remdesivir for use in adults and children (twelve years of age and older who weigh at least 40 kilograms (88 lb) and are positive for COVID‑19, not hospitalized, and are ill with COVID‑19 having high risk for developing severe COVID‑19, including hospitalization or death.[\[111\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20221021-111) In April 2022, the FDA expanded the approval of remdesivir to include people 28 days of age and older weighing at least 3 kilograms (6.6 lb).[\[27\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20220425-27) The FDA also provided [emergency use authorization](https://en.wikipedia.org/wiki/Emergency_use_authorization "Emergency use authorization") in 2022, for remdesivir treatment of children under age twelve who are COVID‑positive and not hospitalized, but have mild-to-moderate COVID‑19 with high risk of developing severe infection, including hospitalization or death.[\[111\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20221021-111) ### Economics In June 2020, Gilead announced that it had set the price of remdesivir at US\$390 per vial for the governments of developed countries, including the United States, and US\$520 for US private health insurance companies.[\[112\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20200629-112) The expected course of treatment is six vials over five days for a total cost of US\$2,340.[\[112\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20200629-112) Being a [repurposed drug](https://en.wikipedia.org/wiki/Drug_repositioning "Drug repositioning"), the minimum production cost for remdesivir is estimated at US\$0.93 per day of treatment.[\[113\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-113) In July 2020, the European Union secured a €63 million (US\$74 million) contract with Gilead, to make the drug available there in early August 2020.[\[114\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-114) In October 2020, Gilead Sciences and the European Commission announced they had signed a joint procurement framework contract in which Gilead agreed to provide up to 500,000 remdesivir treatment courses over the next six months to 37 European countries. Among the contracting countries were all 27 EU member states plus the United Kingdom, "Albania, Bosnia & Herzegovina, Iceland, Kosovo, Montenegro, North Macedonia, Norway, and Serbia".[\[115\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Saigol-115) At the time, the price per treatment course was not disclosed; Reuters reported the price was 2,070 euros, thereby implying the total value of the contract (if all 500,000 courses are ordered) is approximately €1.035 billion.[\[116\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Guarascio-116) Under the contract, each participating country will directly place orders with Gilead and pay Gilead directly for its own orders.[\[116\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Guarascio-116) ### Names Remdesivir is the [international nonproprietary name](https://en.wikipedia.org/wiki/International_nonproprietary_name "International nonproprietary name") (INN)[\[117\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-117) while the development code name was GS-5734.[\[118\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-118) ## Research Remdesivir was originally created and developed by [Gilead Sciences](https://en.wikipedia.org/wiki/Gilead_Sciences "Gilead Sciences") in 2009, to treat [hepatitis C](https://en.wikipedia.org/wiki/Hepatitis_C "Hepatitis C") and [respiratory syncytial virus](https://en.wikipedia.org/wiki/Respiratory_syncytial_virus "Respiratory syncytial virus") (RSV).[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21)[\[119\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_20201023-119) It did not work against hepatitis C or RSV,[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21)[\[119\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_20201023-119) but was then repurposed and studied as a potential treatment for [Ebola virus disease](https://en.wikipedia.org/wiki/Ebola_virus_disease "Ebola virus disease") and [Marburg virus](https://en.wikipedia.org/wiki/Marburg_virus "Marburg virus") infections.[\[120\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Warren_2016-120)[\[119\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_20201023-119) According to the [Czech News Agency](https://en.wikipedia.org/wiki/Czech_News_Agency "Czech News Agency"), this new line of research was carried out under the direction of scientist [Tomáš Cihlář](https://en.wikipedia.org/wiki/Tom%C3%A1%C5%A1_Cihl%C3%A1%C5%99 "Tomáš Cihlář").[\[121\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-121) A collaboration of researchers from the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC) and [Gilead Sciences](https://en.wikipedia.org/wiki/Gilead_Sciences "Gilead Sciences") subsequently discovered that remdesivir had antiviral activity in vitro against multiple [filoviruses](https://en.wikipedia.org/wiki/Filovirus "Filovirus"), [pneumoviruses](https://en.wikipedia.org/wiki/Pneumovirus "Pneumovirus"), paramyxoviruses, and [coronaviruses](https://en.wikipedia.org/wiki/Coronavirus "Coronavirus").[\[122\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Lo_2017-122) Preclinical and clinical research and development was done in collaboration between Gilead Sciences and various US government agencies and academic institutions.[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34)[\[123\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-123)[\[124\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-124)[\[125\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-125) During the mid-2010s, the [Mintz Levin](https://en.wikipedia.org/wiki/Mintz,_Levin,_Cohn,_Ferris,_Glovsky,_and_Popeo "Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo") law firm prosecuted various patent applications for remdesivir on behalf of Gilead Sciences before the [United States Patent and Trademark Office](https://en.wikipedia.org/wiki/United_States_Patent_and_Trademark_Office "United States Patent and Trademark Office") (USPTO). The USPTO granted two patents on remdesivir to Gilead Sciences on 9 April 2019: one for filoviruses,[\[126\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-126) and one which covered both [arenaviruses](https://en.wikipedia.org/wiki/Arenavirus "Arenavirus") and coronaviruses.[\[127\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-127) ### Ebola In October 2015, the [United States Army Medical Research Institute of Infectious Diseases](https://en.wikipedia.org/wiki/United_States_Army_Medical_Research_Institute_of_Infectious_Diseases "United States Army Medical Research Institute of Infectious Diseases") (USAMRIID) announced preclinical results that remdesivir had blocked the [Ebola virus](https://en.wikipedia.org/wiki/Ebola_virus "Ebola virus") in [Rhesus monkeys](https://en.wikipedia.org/wiki/Rhesus_monkeys "Rhesus monkeys"). Travis Warren, who has been a USAMRIID principal investigator since 2007, said that the "work is a result of the continuing collaboration between USAMRIID and Gilead Sciences".[\[128\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-USAMRIID_20151009-128) The "initial screening" of the "Gilead Sciences compound library to find molecules with promising antiviral activity" was performed by scientists at the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC).[\[128\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-USAMRIID_20151009-128) As a result of this work, it was recommended that remdesivir "should be further developed as a potential treatment."[\[120\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Warren_2016-120)[\[128\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-USAMRIID_20151009-128) Remdesivir was rapidly pushed through clinical trials due to the [West African Ebola virus epidemic](https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic "West African Ebola virus epidemic") of 2013–2016, eventually being used in people with the disease. Preliminary results were promising; it was used in the emergency setting during the [Kivu Ebola epidemic](https://en.wikipedia.org/wiki/Kivu_Ebola_epidemic "Kivu Ebola epidemic") that started in 2018, along with further clinical trials, until August 2019, when Congolese health officials announced that it was significantly less effective than [monoclonal antibody](https://en.wikipedia.org/wiki/Monoclonal_antibody "Monoclonal antibody") treatments such as [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab") and [atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab"). The trials, however, established its safety profile.[\[129\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-129) ### COVID-19 #### Hospitalized patients Remdesivir was approved for medical use in the United States in October 2020.[\[62\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Veklury-62)[\[63\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64)[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) The US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approved remdesivir based on the agency's analysis of data from three randomized, controlled clinical trials that included participants hospitalized with mild-to-severe COVID‑19.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64)[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) The FDA granted approval and reissued the revised EUA to Gilead Sciences Inc.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) The FDA approved remdesivir based primarily on evidence from three clinical trials (NCT04280705, NCT04292899, and NCT04292730) of 2043 hospitalized participants with COVID‑19.[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) The trials were conducted at 226 sites in 17 countries including the United States.[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) In November 2020, the World Health Organization (WHO) updated its guideline on therapeutics for COVID‑19 to include a conditional recommendation against the use of remdesivir, triggered by results from the WHO [Solidarity trial](https://en.wikipedia.org/wiki/Solidarity_trial "Solidarity trial").[\[130\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WHO_guidelines-130)[\[131\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-131)[\[132\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-who-lg-132)[\[133\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-133) Meanwhile, the [Public Health Agency of Canada](https://en.wikipedia.org/wiki/Public_Health_Agency_of_Canada "Public Health Agency of Canada")'s COVID‑19 Clinical Pharmacology Task Group recommended that remdesivir only be administered to hospitalized patients as part of a [randomized controlled trial](https://en.wikipedia.org/wiki/Randomized_controlled_trial "Randomized controlled trial") due to limited information on risks and benefits.[\[134\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-134) In January 2022, the Canadian component of the WHO Solidarity Trial reported that in-hospital people with COVID‑19 treated with remdesivir had 17% lower relative risk of death (18.7% versus 22.6% death rates) and 47% reduced relative risk for needing oxygen and mechanical ventilation (8.0% versus 15.0%) compared to people receiving standard-of-care treatments.[\[135\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Ali-135) In September 2022, the WHO updated their guidelines to recommend use of remdesivir for both non-hospitalized and hospitalized patients.[\[136\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-136) This was based on final results from the SOLIDARITY trial that showed a reduction in mortality or progression to mechanical ventilation for non-ventilated patients. #### Nonhospitalized outpatients In January 2022, a study indicated that nonhospitalized people who were at high risk for COVID‑19 progression had an 87% lower risk of hospitalization or death after a 3-day course of intravenous remdesivir.[\[137\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-137) #### Remdesivir/baricitinib In May 2020, the [National Institute of Allergy and Infectious Diseases](https://en.wikipedia.org/wiki/National_Institute_of_Allergy_and_Infectious_Diseases "National Institute of Allergy and Infectious Diseases") (NIAID) started the Adaptive COVID‑19 Treatment Trial 2 (ACTT-2) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [baricitinib](https://en.wikipedia.org/wiki/Baricitinib "Baricitinib") for treating hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\[138\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-138)[\[139\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-ACTT_3_PR-139)[\[140\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-140) In November 2020, the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) issued an [emergency use authorization](https://en.wikipedia.org/wiki/Emergency_use_authorization "Emergency use authorization") (EUA) for the drug baricitinib, in combination with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") (ECMO).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) #### Remdesivir/interferon beta-1a In August 2020, the NIAID started the Adaptive COVID‑19 Treatment Trial 3 (ACTT 3) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [interferon beta-1a](https://en.wikipedia.org/wiki/Interferon_beta-1a "Interferon beta-1a") for hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\[139\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-ACTT_3_PR-139)[\[141\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-141) ## Veterinary uses In 2019, GS-441524 was shown to have promise for treating [feline infectious peritonitis](https://en.wikipedia.org/wiki/Feline_infectious_peritonitis "Feline infectious peritonitis") caused by a [coronavirus](https://en.wikipedia.org/wiki/Feline_coronavirus "Feline coronavirus").[\[142\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pedersen-142) It has not been evaluated or approved by the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) for the treatment of [feline coronavirus](https://en.wikipedia.org/wiki/Feline_coronavirus "Feline coronavirus") or feline infectious peritonitis but has been available since 2019, through websites and social media as an unregulated black market substance.[\[143\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-143) Because GS-441524 is the main circulating metabolite of remdesivir and because GS-441524 has similar potency against SARS-CoV-2 in vitro, some researchers have argued for the direct administration of GS-441524 as a COVID‑19 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[![logo](https://upload.wikimedia.org/wikipedia/commons/thumb/3/32/Scholia_logo.svg/40px-Scholia_logo.svg.png)](https://en.wikipedia.org/wiki/File:Scholia_logo.svg) [Scholia](https://www.wikidata.org/wiki/Wikidata:Scholia "d:Wikidata:Scholia") has a profile for [remdesivir (Q28209496)](https://iw.toolforge.org/scholia/Q28209496 "toolforge:scholia/Q28209496"). - Kolata G (1 May 2020). ["How Remdesivir, New Hope for Covid-19 Patients, Was Resurrected"](https://www.nytimes.com/2020/05/01/health/coronavirus-remdesivir.html). [The New York Times](https://en.wikipedia.org/wiki/The_New_York_Times "The New York Times"). \| [v](https://en.wikipedia.org/wiki/Template:RNA_antivirals "Template:RNA antivirals") [t](https://en.wikipedia.org/wiki/Template_talk:RNA_antivirals "Template talk:RNA antivirals") [e](https://en.wikipedia.org/wiki/Special:EditPage/Template:RNA_antivirals "Special:EditPage/Template:RNA antivirals")[RNA virus](https://en.wikipedia.org/wiki/RNA_virus "RNA virus") [antivirals](https://en.wikipedia.org/wiki/Antiviral_drug "Antiviral drug") (primarily [J05](https://en.wikipedia.org/wiki/ATC_code_J05 "ATC code J05"), also [S01AD](https://en.wikipedia.org/wiki/ATC_code_S01#S01AD "ATC code S01") and [D06BB](https://en.wikipedia.org/wiki/ATC_code_D06#D06BB "ATC code D06")) \| \| \|---\|---\| \| [Hepatitis C](https://en.wikipedia.org/wiki/Hepatitis_C "Hepatitis C") \| \| \| \| \| \| [NS3](https://en.wikipedia.org/wiki/NS3_$HCV$ "NS3 (HCV)")/[4A](https://en.wikipedia.org/wiki/NS4A "NS4A") protease inhibitors (–previr) \| [Asunaprevir](https://en.wikipedia.org/wiki/Asunaprevir "Asunaprevir") [Boceprevir](https://en.wikipedia.org/wiki/Boceprevir "Boceprevir")‡ [Ciluprevir](https://en.wikipedia.org/wiki/Ciluprevir "Ciluprevir")§ [Danoprevir](https://en.wikipedia.org/wiki/Danoprevir "Danoprevir")† [Faldaprevir](https://en.wikipedia.org/wiki/Faldaprevir "Faldaprevir")‡ [Glecaprevir](https://en.wikipedia.org/wiki/Glecaprevir "Glecaprevir") [Grazoprevir](https://en.wikipedia.org/wiki/Grazoprevir "Grazoprevir") [Narlaprevir](https://en.wikipedia.org/wiki/Narlaprevir "Narlaprevir") [Paritaprevir](https://en.wikipedia.org/wiki/Paritaprevir "Paritaprevir") [Simeprevir](https://en.wikipedia.org/wiki/Simeprevir "Simeprevir") [Sovaprevir](https://en.wikipedia.org/wiki/Sovaprevir "Sovaprevir")† [Telaprevir](https://en.wikipedia.org/wiki/Telaprevir "Telaprevir")‡ [Vaniprevir](https://en.wikipedia.org/wiki/Vaniprevir "Vaniprevir") [Vedroprevir](https://en.wikipedia.org/w/index.php?title=Vedroprevir&action=edit&redlink=1 "Vedroprevir (page does not exist)")§ [Voxilaprevir](https://en.wikipedia.org/wiki/Voxilaprevir "Voxilaprevir") \| \| [NS5A](https://en.wikipedia.org/wiki/NS5A "NS5A") inhibitors (–asvir) \| [Coblopasvir](https://en.wikipedia.org/wiki/Coblopasvir "Coblopasvir") [Daclatasvir](https://en.wikipedia.org/wiki/Daclatasvir "Daclatasvir")\# [Elbasvir](https://en.wikipedia.org/wiki/Elbasvir "Elbasvir") [Ledipasvir](https://en.wikipedia.org/wiki/Ledipasvir "Ledipasvir") [Netanasvir](https://en.wikipedia.org/wiki/Netanasvir "Netanasvir") [Odalasvir](https://en.wikipedia.org/wiki/Odalasvir "Odalasvir")† [Ombitasvir](https://en.wikipedia.org/wiki/Ombitasvir "Ombitasvir") [Pibrentasvir](https://en.wikipedia.org/wiki/Pibrentasvir "Pibrentasvir") [Ravidasvir](https://en.wikipedia.org/wiki/Ravidasvir "Ravidasvir")† [Ruzasvir](https://en.wikipedia.org/w/index.php?title=Ruzasvir&action=edit&redlink=1 "Ruzasvir (page does not exist)")† [Samatasvir](https://en.wikipedia.org/wiki/Samatasvir "Samatasvir")† [Velpatasvir](https://en.wikipedia.org/wiki/Velpatasvir "Velpatasvir") \| \| [NS5B](https://en.wikipedia.org/wiki/NS5B "NS5B") [RNA polymerase](https://en.wikipedia.org/wiki/RNA_polymerase "RNA polymerase") inhibitors (–buvir) \| [Beclabuvir](https://en.wikipedia.org/wiki/Beclabuvir "Beclabuvir")† [Bemnifosbuvir](https://en.wikipedia.org/wiki/Bemnifosbuvir "Bemnifosbuvir")† [Dasabuvir](https://en.wikipedia.org/wiki/Dasabuvir "Dasabuvir")\# [Deleobuvir](https://en.wikipedia.org/wiki/Deleobuvir "Deleobuvir")§ [Encofosbuvir](https://en.wikipedia.org/wiki/Encofosbuvir "Encofosbuvir") [Filibuvir](https://en.wikipedia.org/wiki/Filibuvir "Filibuvir")§ [GS-6620](https://en.wikipedia.org/wiki/GS-6620 "GS-6620")§ [IDX-184](https://en.wikipedia.org/wiki/IDX-184 "IDX-184")§ [Setrobuvir](https://en.wikipedia.org/wiki/Setrobuvir "Setrobuvir")§ [Sofosbuvir](https://en.wikipedia.org/wiki/Sofosbuvir "Sofosbuvir")\# [Tegobuvir](https://en.wikipedia.org/w/index.php?title=Tegobuvir&action=edit&redlink=1 "Tegobuvir (page does not exist)")§ [TMC-647055](https://en.wikipedia.org/wiki/TMC-647055 "TMC-647055")§ [Radalbuvir](https://en.wikipedia.org/wiki/Radalbuvir "Radalbuvir")† [Uprifosbuvir](https://en.wikipedia.org/wiki/Uprifosbuvir "Uprifosbuvir")† \| \| Combination drugs \| [Elbasvir/grazoprevir](https://en.wikipedia.org/wiki/Elbasvir/grazoprevir "Elbasvir/grazoprevir") [Glecaprevir/pibrentasvir](https://en.wikipedia.org/wiki/Glecaprevir/pibrentasvir "Glecaprevir/pibrentasvir") [Ledipasvir/sofosbuvir](https://en.wikipedia.org/wiki/Ledipasvir/sofosbuvir "Ledipasvir/sofosbuvir")\# [Ombitasvir/paritaprevir/ritonavir](https://en.wikipedia.org/wiki/Ombitasvir/paritaprevir/ritonavir "Ombitasvir/paritaprevir/ritonavir")\# [Sofosbuvir/daclatasvir](https://en.wikipedia.org/wiki/Sofosbuvir/daclatasvir "Sofosbuvir/daclatasvir") [Sofosbuvir/velpatasvir](https://en.wikipedia.org/wiki/Sofosbuvir/velpatasvir "Sofosbuvir/velpatasvir")\# [Sofosbuvir/velpatasvir/voxilaprevir](https://en.wikipedia.org/wiki/Sofosbuvir/velpatasvir/voxilaprevir "Sofosbuvir/velpatasvir/voxilaprevir") \| \| [Hepatitis D](https://en.wikipedia.org/wiki/Hepatitis_D "Hepatitis D") \| [Bulevirtide](https://en.wikipedia.org/wiki/Bulevirtide "Bulevirtide") \| \| [Picornavirus](https://en.wikipedia.org/wiki/Picornavirus "Picornavirus") \| [viral entry](https://en.wikipedia.org/wiki/Viral_entry "Viral entry"): [Pleconaril](https://en.wikipedia.org/wiki/Pleconaril "Pleconaril")† \| \| Anti-[influenza](https://en.wikipedia.org/wiki/Influenza "Influenza") agents \| [Baloxavir marboxil](https://en.wikipedia.org/wiki/Baloxavir_marboxil "Baloxavir marboxil") [Onradivir](https://en.wikipedia.org/wiki/Onradivir "Onradivir") [Pimodivir](https://en.wikipedia.org/wiki/Pimodivir "Pimodivir")† [Umifenovir](https://en.wikipedia.org/wiki/Umifenovir "Umifenovir") [adamantane derivatives](https://en.wikipedia.org/wiki/Adamantane "Adamantane")/[M2 inhibitors](https://en.wikipedia.org/wiki/M2_protein "M2 protein") ([Adapromine](https://en.wikipedia.org/wiki/Adapromine "Adapromine") [Amantadine](https://en.wikipedia.org/wiki/Amantadine "Amantadine") [Rimantadine](https://en.wikipedia.org/wiki/Rimantadine "Rimantadine")) [neuraminidase inhibitors](https://en.wikipedia.org/wiki/Neuraminidase_inhibitor "Neuraminidase inhibitor")/[release phase](https://en.wikipedia.org/wiki/Antiviral_drug#Release_phase "Antiviral drug") ([Oseltamivir](https://en.wikipedia.org/wiki/Oseltamivir "Oseltamivir")\# [Zanamivir](https://en.wikipedia.org/wiki/Zanamivir "Zanamivir") [Peramivir](https://en.wikipedia.org/wiki/Peramivir "Peramivir"), [Laninamivir](https://en.wikipedia.org/wiki/Laninamivir "Laninamivir")†) \| \| Multiple/general \| \| \| \| \| \| [Interferon](https://en.wikipedia.org/wiki/Interferon "Interferon") \| [Interferon alfa 2b](https://en.wikipedia.org/wiki/Interferon_alfa_2b "Interferon alfa 2b") [Peginterferon alfa-2a](https://en.wikipedia.org/wiki/Peginterferon_alfa-2a "Peginterferon alfa-2a")\# [Peginterferon alfa-2b](https://en.wikipedia.org/wiki/Peginterferon_alfa-2b "Peginterferon alfa-2b")\# \| \| [3CL protease](https://en.wikipedia.org/wiki/3C-like_protease "3C-like protease") inhibitors (–trelvir) \| [Atilotrelvir](https://en.wikipedia.org/wiki/Atilotrelvir "Atilotrelvir") [Ensitrelvir](https://en.wikipedia.org/wiki/Ensitrelvir "Ensitrelvir")† [Ibuzatrelvir](https://en.wikipedia.org/wiki/Ibuzatrelvir "Ibuzatrelvir") [Leritrelvir](https://en.wikipedia.org/wiki/Leritrelvir "Leritrelvir") [Lufotrelvir](https://en.wikipedia.org/wiki/Lufotrelvir "Lufotrelvir") [Nirmatrelvir](https://en.wikipedia.org/wiki/Nirmatrelvir "Nirmatrelvir")† ([\+ritonavir](https://en.wikipedia.org/wiki/Nirmatrelvir/ritonavir "Nirmatrelvir/ritonavir"))† [Rupintrivir](https://en.wikipedia.org/wiki/Rupintrivir "Rupintrivir") [Simnotrelvir](https://en.wikipedia.org/wiki/Simnotrelvir "Simnotrelvir") ([\+ritonavir](https://en.wikipedia.org/wiki/Simnotrelvir/ritonavir "Simnotrelvir/ritonavir")†) \| \| RNA pol inhibitors \| [CMX521](https://en.wikipedia.org/wiki/CMX521 "CMX521")§ [Deuremidevir](https://en.wikipedia.org/wiki/Deuremidevir "Deuremidevir")† [Favipiravir](https://en.wikipedia.org/wiki/Favipiravir "Favipiravir") [Galidesivir](https://en.wikipedia.org/wiki/Galidesivir "Galidesivir")† [GS-441524](https://en.wikipedia.org/wiki/GS-441524 "GS-441524")§ [Remdesivir]() [MK-608](https://en.wikipedia.org/wiki/MK-608 "MK-608")§ [Mericitabine](https://en.wikipedia.org/wiki/Mericitabine "Mericitabine")† [Molnupiravir](https://en.wikipedia.org/wiki/Molnupiravir "Molnupiravir") [NITD008](https://en.wikipedia.org/wiki/NITD008 "NITD008")§ [Ribavirin](https://en.wikipedia.org/wiki/Ribavirin "Ribavirin")\# [Taribavirin](https://en.wikipedia.org/wiki/Taribavirin "Taribavirin")† [Triazavirin](https://en.wikipedia.org/wiki/Triazavirin "Triazavirin") [Valopicitabine](https://en.wikipedia.org/wiki/Valopicitabine "Valopicitabine")† \| \| Multiple/Unknown/Other \| [EICAR](https://en.wikipedia.org/wiki/EICAR_$antiviral$ "EICAR (antiviral)")§ [Merimepodib](https://en.wikipedia.org/wiki/Merimepodib "Merimepodib")§ [Moroxydine](https://en.wikipedia.org/wiki/Moroxydine "Moroxydine") [Presatovir](https://en.wikipedia.org/wiki/Presatovir "Presatovir")† \| \| \#[WHO-EM](https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines "WHO Model List of Essential Medicines") ‡[Withdrawn](https://en.wikipedia.org/wiki/List_of_withdrawn_drugs "List of withdrawn drugs") from market [Clinical trials](https://en.wikipedia.org/wiki/Clinical_trial "Clinical trial"): †[Phase III](https://en.wikipedia.org/wiki/Phases_of_clinical_research#Phase_III "Phases of clinical research") §Never to phase III \| \| [Portals](https://en.wikipedia.org/wiki/Wikipedia:Contents/Portals "Wikipedia:Contents/Portals"): - ![icon](https://upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/20px-WHO_Rod.svg.png) [Medicine](https://en.wikipedia.org/wiki/Portal:Medicine "Portal:Medicine") - [![icon](https://upload.wikimedia.org/wikipedia/commons/thumb/2/2f/Sida-aids.png/20px-Sida-aids.png)](https://en.wikipedia.org/wiki/File:Sida-aids.png) [Viruses](https://en.wikipedia.org/wiki/Portal:Viruses "Portal:Viruses") - [![virus icon](https://upload.wikimedia.org/wikipedia/commons/thumb/4/4d/SARS-CoV-2_%28Wikimedia_colors%29.svg/20px-SARS-CoV-2_%28Wikimedia_colors%29.svg.png)](https://en.wikipedia.org/wiki/File:SARS-CoV-2_$Wikimedia_colors$.svg) [COVID-19](https://en.wikipedia.org/wiki/Portal:COVID-19 "Portal:COVID-19") ![](https://en.wikipedia.org/wiki/Special:CentralAutoLogin/start?useformat=desktop&type=1x1&usesul3=1) Retrieved from "<https://en.wikipedia.org/w/index.php?title=Remdesivir&oldid=1342542449>" [Categories](https://en.wikipedia.org/wiki/Help:Category "Help:Category"): - [Anti–RNA virus drugs](https://en.wikipedia.org/wiki/Category:Anti%E2%80%93RNA_virus_drugs "Category:Anti–RNA virus drugs") - [Antiviral drugs](https://en.wikipedia.org/wiki/Category:Antiviral_drugs "Category:Antiviral drugs") - [COVID-19 drug development](https://en.wikipedia.org/wiki/Category:COVID-19_drug_development "Category:COVID-19 drug development") - [Experimental antiviral drugs](https://en.wikipedia.org/wiki/Category:Experimental_antiviral_drugs "Category:Experimental antiviral drugs") - [Gilead Sciences](https://en.wikipedia.org/wiki/Category:Gilead_Sciences "Category:Gilead Sciences") - [Heterocyclic compounds with 2 rings](https://en.wikipedia.org/wiki/Category:Heterocyclic_compounds_with_2_rings "Category:Heterocyclic compounds with 2 rings") - [Nitriles](https://en.wikipedia.org/wiki/Category:Nitriles "Category:Nitriles") - [Nitrogen heterocycles](https://en.wikipedia.org/wiki/Category:Nitrogen_heterocycles "Category:Nitrogen heterocycles") - [Nucleotides](https://en.wikipedia.org/wiki/Category:Nucleotides "Category:Nucleotides") - [Orphan drugs](https://en.wikipedia.org/wiki/Category:Orphan_drugs "Category:Orphan drugs") - [Phenol esters](https://en.wikipedia.org/wiki/Category:Phenol_esters "Category:Phenol esters") - [Phosphoramidates](https://en.wikipedia.org/wiki/Category:Phosphoramidates "Category:Phosphoramidates") Hidden categories: - [Pages with non-numeric formatnum arguments](https://en.wikipedia.org/wiki/Category:Pages_with_non-numeric_formatnum_arguments "Category:Pages with non-numeric formatnum arguments") - [Source attribution](https://en.wikipedia.org/wiki/Category:Source_attribution "Category:Source attribution") - [CS1 Czech-language sources (cs)](https://en.wikipedia.org/wiki/Category:CS1_Czech-language_sources_$cs$ "Category:CS1 Czech-language sources (cs)") - [CS1:Vancouver names with accept markup](https://en.wikipedia.org/wiki/Category:CS1:Vancouver_names_with_accept_markup "Category:CS1:Vancouver 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Readable Markdown	\| \| \| \|---\|---\| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/b/bc/Remdesivir.svg/250px-Remdesivir.svg.png)](https://en.wikipedia.org/wiki/File:Remdesivir.svg) \| \| \| [![](https://upload.wikimedia.org/wikipedia/commons/thumb/5/5b/Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png/250px-Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png)](https://en.wikipedia.org/wiki/File:Remdesivir-from-xtal-Mercury-3D-ball-and-stick-with-bond-orders.png) \| \| \| Clinical data \| \| \| Pronunciation \| [rem-DESS\-i-veer](https://en.wikipedia.org/wiki/Help:Pronunciation_respelling_key "Help:Pronunciation respelling key") \| \| [Trade names](https://en.wikipedia.org/wiki/Drug_nomenclature#Trade_names "Drug nomenclature") \| Veklury \| \| Other names \| GS-5734, RDV \| \| [AHFS](https://en.wikipedia.org/wiki/American_Society_of_Health-System_Pharmacists "American Society of Health-System Pharmacists")/[Drugs.com](https://en.wikipedia.org/wiki/Drugs.com "Drugs.com") \| [Monograph](https://www.drugs.com/monograph/remdesivir.html) \| \| [MedlinePlus](https://en.wikipedia.org/wiki/MedlinePlus "MedlinePlus") \| [a620033](https://medlineplus.gov/druginfo/meds/a620033.html) \| \| [License data](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") \| US [DailyMed](https://en.wikipedia.org/wiki/DailyMed "DailyMed"): [Remdesivir](https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Remdesivir) \| \| [Pregnancy category](https://en.wikipedia.org/wiki/Pregnancy_category "Pregnancy category") \| AU : B2[\[1\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_APM_summary-1)[\[2\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-AusPAR:_Remdesivir-2) \| \| [Routes of administration](https://en.wikipedia.org/wiki/Route_of_administration "Route of administration") \| [Intravenous](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") \| \| [Drug class](https://en.wikipedia.org/wiki/Drug_class "Drug class") \| [Antiviral](https://en.wikipedia.org/wiki/Antiviral "Antiviral") \| \| [ATC code](https://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System "Anatomical Therapeutic Chemical Classification System") \| [J05AB16](https://en.wikipedia.org/wiki/ATC_code_J05 "ATC code J05") ([WHO](https://www.whocc.no/atc_ddd_index/?code=J05AB16)) \| \| Legal status \| \| \| [Legal status](https://en.wikipedia.org/wiki/Regulation_of_therapeutic_goods "Regulation of therapeutic goods") \| AU : [S4](https://en.wikipedia.org/wiki/Standard_for_the_Uniform_Scheduling_of_Medicines_and_Poisons#Schedule_4 "Standard for the Uniform Scheduling of Medicines and Poisons") (Prescription only)[\[3\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-3)[\[1\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_APM_summary-1)[\[4\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-4)[\[5\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-5)[\[2\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-AusPAR:_Remdesivir-2) CA : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug")[\[6\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-CA_Veklury_Product_information-6)[\[7\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-7)[\[8\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-8) UK : [POM](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug") (Prescription only)[\[9\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_SmPC-9)[\[10\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-10) US : [℞-only](https://en.wikipedia.org/wiki/Prescription_drug "Prescription drug")[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11) EU : Rx-only[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[13\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-13) IN : [Schedule H](https://en.wikipedia.org/wiki/Schedule_H "Schedule H") (℞-only) [\[14\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-14)[\[15\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-15) \| \| Identifiers \| \| \| [IUPAC name](https://en.wikipedia.org/wiki/IUPAC_nomenclature_of_chemistry "IUPAC nomenclature of chemistry") (2S)-2-{(2R,3S,4R,5R)-\[5-(4-Aminopyrrolo\[2,1-f\] \[1,2,4\]triazin-7-yl)-5-cyano-3,4-dihydroxy-tetrahydro-furan-2-ylmethoxy\]phenoxy-(S)-phosphorylamino}propionic acid 2-ethyl-butyl ester \| \| \| [CAS Number](https://en.wikipedia.org/wiki/CAS_Registry_Number "CAS Registry Number") \| [1809249-37-3](https://commonchemistry.cas.org/detail?cas_rn=1809249-37-3) \| \| [PubChem](https://en.wikipedia.org/wiki/PubChem#CID "PubChem") CID \| [121304016](https://pubchem.ncbi.nlm.nih.gov/compound/121304016) \| \| [DrugBank](https://en.wikipedia.org/wiki/DrugBank "DrugBank") \| [DB14761](https://www.drugbank.ca/drugs/DB14761) \| \| [ChemSpider](https://en.wikipedia.org/wiki/ChemSpider "ChemSpider") \| [58827832](https://www.chemspider.com/Chemical-Structure.58827832.html) \| \| [UNII](https://en.wikipedia.org/wiki/Unique_Ingredient_Identifier "Unique Ingredient Identifier") \| [3QKI37EEHE](https://precision.fda.gov/uniisearch/srs/unii/3QKI37EEHE) \| \| [KEGG](https://en.wikipedia.org/wiki/KEGG "KEGG") \| [D11472](https://www.kegg.jp/entry/D11472) \| \| [ChEBI](https://en.wikipedia.org/wiki/ChEBI "ChEBI") \| [CHEBI:145994](https://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:145994) \| \| [ChEMBL](https://en.wikipedia.org/wiki/ChEMBL "ChEMBL") \| [ChEMBL4065616](https://www.ebi.ac.uk/chembl/explore/compound/ChEMBL4065616) \| \| [CompTox Dashboard](https://en.wikipedia.org/wiki/CompTox_Chemicals_Dashboard "CompTox Chemicals Dashboard") ( EPA ) \| [DTXSID701022537](https://comptox.epa.gov/dashboard/chemical/details/DTXSID701022537) [![Edit this at Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q28209496#P3117 "Edit this at Wikidata") \| \| [ECHA InfoCard](https://en.wikipedia.org/wiki/ECHA_InfoCard "ECHA InfoCard") \| [100\.302.974](https://echa.europa.eu/substance-information/-/substanceinfo/100.302.974) [![Edit this at Wikidata](https://upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png)](https://www.wikidata.org/wiki/Q28209496#P2566 "Edit this at Wikidata") \| \| Chemical and physical data \| \| \| [Formula](https://en.wikipedia.org/wiki/Chemical_formula "Chemical formula") \| C27H35N6O8P \| \| [Molar mass](https://en.wikipedia.org/wiki/Molar_mass "Molar mass") \| 602\.585 g·mol−1 \| \| 3D model ([JSmol](https://en.wikipedia.org/wiki/JSmol "JSmol")) \| [Interactive image](https://chemapps.stolaf.edu/jmol/jmol.php?model=CCC%28COC%28%3DO%29%5BC%40%40H%5D%28NP%28%3DO%29%28Oc1ccccc1%29OC%5BC%40H%5D1O%5BC%40%40%5D%28%5BC%40%40H%5D%28%5BC%40%40H%5D1O%29O%29%28C%23N%29c1ccc2n1ncnc2N%29C%29CC) \| \| [SMILES](https://en.wikipedia.org/wiki/Simplified_molecular-input_line-entry_system "Simplified molecular-input line-entry system") CCC(COC(=O)\[C@@H\](NP(=O)(Oc1ccccc1)OC\[C@H\]1O\[C@@\](\[C@@H\](\[C@@H\]1O)O)(C\#N)c1ccc2n1ncnc2N)C)CC \| \| \| [InChI](https://en.wikipedia.org/wiki/International_Chemical_Identifier "International Chemical Identifier") InChI=1S/C27H35N6O8P/c1-4-18(5-2)13-38-26(36)17(3)32-42(37,41-19-9-7-6-8-10-19)39-14-21-23(34)24(35)27(15-28,40-21)22-12-11-20-25(29)30-16-31-33(20)22/h6-12,16-18,21,23-24,34-35H,4-5,13-14H2,1-3H3,(H,32,37)(H2,29,30,31)/t17-,21+,23+,24+,27-,42-/m0/s1 Key:RWWYLEGWBNMMLJ-YSOARWBDSA-N \| \| Remdesivir, sold under the brand name Veklury,[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[16\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR-16) is a [broad-spectrum antiviral medication](https://en.wikipedia.org/wiki/Broad-spectrum_antiviral_drug "Broad-spectrum antiviral drug") developed by the [biopharmaceutical](https://en.wikipedia.org/wiki/Biopharmaceutical "Biopharmaceutical") company [Gilead Sciences](https://en.wikipedia.org/wiki/Gilead_Sciences "Gilead Sciences").[\[17\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Scavone_2020-17) It is administered via [injection into a vein](https://en.wikipedia.org/wiki/Intravenous "Intravenous").[\[18\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-18)[\[19\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Mehta2020-19) During the [COVID‑19 pandemic](https://en.wikipedia.org/wiki/COVID-19_pandemic "COVID-19 pandemic"), remdesivir was approved or authorized for emergency use to treat [COVID‑19](https://en.wikipedia.org/wiki/Coronavirus_disease_2019 "Coronavirus disease 2019") in numerous countries.[\[20\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20201022-20) Remdesivir was originally developed to treat [hepatitis C](https://en.wikipedia.org/wiki/Hepatitis_C "Hepatitis C"),[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21) and was subsequently investigated for [Ebola virus disease](https://en.wikipedia.org/wiki/Ebola "Ebola") and [Marburg virus](https://en.wikipedia.org/wiki/Marburg_virus_disease "Marburg virus disease") infections[\[22\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pmid269342202-22) before being studied as a post-infection treatment for COVID‑19.[\[23\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-kai2-23) Remdesivir is a [prodrug](https://en.wikipedia.org/wiki/Prodrug "Prodrug") that is intended to allow intracellular delivery of [GS-441524](https://en.wikipedia.org/wiki/GS-441524 "GS-441524") monophosphate and subsequent biotransformation into GS-441524 [triphosphate](https://en.wikipedia.org/wiki/Triphosphate "Triphosphate"), a ribo[nucleotide analogue](https://en.wikipedia.org/wiki/Nucleotide_analogue "Nucleotide analogue") inhibitor of viral [RNA polymerase](https://en.wikipedia.org/wiki/RNA_polymerase "RNA polymerase").[\[24\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020-24) The most common side effect in healthy volunteers is raised blood levels of [liver enzymes](https://en.wikipedia.org/wiki/Liver_enzymes "Liver enzymes").[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12) The most common side effect in people with COVID‑19 is [nausea](https://en.wikipedia.org/wiki/Nausea "Nausea").[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12) Side effects may include liver inflammation and an [infusion](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy")\-related reaction with nausea, [low blood pressure](https://en.wikipedia.org/wiki/Hypotension "Hypotension"), and sweating.[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) The US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) considers it to be a [first-in-class medication](https://en.wikipedia.org/wiki/First-in-class_medication "First-in-class medication").[\[26\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-26) Medical uses In the European Union, remdesivir is [indicated](https://en.wikipedia.org/wiki/Indication_$medicine$ "Indication (medicine)") for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms (88 lb)) with [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia") requiring supplemental oxygen and for adults who do not require supplemental oxygen and who are at increased risk of progressing to severe COVID‑19.[\[9\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_SmPC-9)[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12) In the United States, remdesivir is indicated for the treatment of COVID‑19 in people 28 days of age and older and weighing at least 3 kilograms (6.6 lb) who are hospitalized; or not hospitalized and have mild-to-moderate COVID‑19, and are at high risk for progression to severe COVID‑19, including hospitalization or death.[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11)[\[27\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20220425-27) In November 2020, the FDA issued an emergency use authorization (EUA) for the combination of [baricitinib](https://en.wikipedia.org/wiki/Baricitinib "Baricitinib") with remdesivir, for the treatment of suspected or laboratory confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") (ECMO).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) In Australia, it is approved for those aged four weeks of age and older with a body weight at least 3 kilograms (6.6 lb) with [pneumonia](https://en.wikipedia.org/wiki/Pneumonia "Pneumonia") requiring supplemental oxygen or those aged four weeks of age and older with body weight at least 40 kilograms (88 lb) who do not require supplemental oxygen and who are at high risk of progressing to severe COVID‑19.[\[29\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-29)[\[2\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-AusPAR:_Remdesivir-2) In 2024, a retrospective study found treatment with the antiviral remdesivir plus dexamethasone was associated with fewer deaths in hospitalized COVID-19 patients compared to dexamethasone alone.[\[30\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-30) The combination led to a 26% reduction in mortality at 14 days and a 24% reduction at 28 days.[\[31\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-31) Side effects The most common adverse effects in people treated with remdesivir were [respiratory failure](https://en.wikipedia.org/wiki/Respiratory_failure "Respiratory failure") and blood [biomarkers](https://en.wikipedia.org/wiki/Biomarker "Biomarker") of [organ](https://en.wikipedia.org/wiki/Organ_$anatomy$ "Organ (anatomy)") impairment, including [low albumin](https://en.wikipedia.org/wiki/Human_serum_albumin#Hypoalbuminemia "Human serum albumin"), [low potassium](https://en.wikipedia.org/wiki/Hypokalemia "Hypokalemia"), [low count of red blood cells](https://en.wikipedia.org/wiki/Anemia "Anemia"), [low count of thrombocytes](https://en.wikipedia.org/wiki/Thrombocytopenia "Thrombocytopenia"), and [elevated bilirubin (jaundice)](https://en.wikipedia.org/wiki/Jaundice "Jaundice").[\[32\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wang-32) Other reported adverse effects include [gastrointestinal distress](https://en.wikipedia.org/wiki/Gastrointestinal_disease "Gastrointestinal disease"), elevated [transaminase](https://en.wikipedia.org/wiki/Transaminase "Transaminase") levels in the blood ([liver enzymes](https://en.wikipedia.org/wiki/Liver_function_tests "Liver function tests")), [infusion](https://en.wikipedia.org/wiki/Infusion_therapy "Infusion therapy") site reactions, and [electrocardiogram abnormalities](https://en.wikipedia.org/wiki/Drug-induced_QT_prolongation "Drug-induced QT prolongation").[\[19\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Mehta2020-19) Remdesivir may cause [infusion-related](https://en.wikipedia.org/wiki/Intravenous_therapy "Intravenous therapy") reactions, including low blood pressure, nausea, vomiting, sweating or shivering.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Other possible side effects of remdesivir include: - Infusion-related reactions. Infusion-related reactions have been seen during a remdesivir infusion or around the time remdesivir was given.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Signs and symptoms of infusion-related reactions may include: low blood pressure, nausea, vomiting, sweating, and shivering.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) - Increases in levels of liver enzymes, seen in abnormal liver blood tests.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Increases in levels of liver enzymes have been seen in people who have received remdesivir, which may be a sign of inflammation or damage to cells in the liver.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Pharmacology Activation [![](https://upload.wikimedia.org/wikipedia/commons/thumb/0/08/Remdesivir_activation.svg/500px-Remdesivir_activation.svg.png)](https://en.wikipedia.org/wiki/File:Remdesivir_activation.svg) Activation of remdesivir into its active triphosphate metabolite[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34) Remdesivir is a [protide](https://en.wikipedia.org/wiki/Protide "Protide") ([prodrug](https://en.wikipedia.org/wiki/Prodrug "Prodrug") of nucleotide) able to diffuse into cells, where it is converted to [GS-441524](https://en.wikipedia.org/wiki/GS-441524 "GS-441524") monophosphate via the actions of [esterases](https://en.wikipedia.org/wiki/Esterase "Esterase") ([CES1](https://en.wikipedia.org/wiki/CES1 "CES1") and [CTSA](https://en.wikipedia.org/wiki/Cathepsin_A "Cathepsin A")) and a [phosphoamidase](https://en.wikipedia.org/wiki/Phosphoamidase "Phosphoamidase") ([HINT1](https://en.wikipedia.org/wiki/HINT1 "HINT1")); this in turn is further phosphorylated to its [active metabolite](https://en.wikipedia.org/wiki/Active_metabolite "Active metabolite") triphosphate by [nucleoside-phosphate kinases](https://en.wikipedia.org/wiki/Nucleoside-phosphate_kinase "Nucleoside-phosphate kinase").[\[35\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Sheahan_2017-35)[\[36\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon2020-36) This pathway of bioactivation is meant to occur [intracellularly](https://en.wikipedia.org/wiki/Intracellular "Intracellular"), but a substantial amount of remdesivir is prematurely [hydrolyzed](https://en.wikipedia.org/wiki/Hydrolysis "Hydrolysis") in plasma, with GS-441524 being the major metabolite in plasma, and the only metabolite remaining two hours after dosing.[\[24\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020-24) Mechanism of action As an [adenosine](https://en.wikipedia.org/wiki/Adenosine "Adenosine") nucleoside triphosphate analog (GS-443902),[\[37\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pmid22446091-37) the [active metabolite](https://en.wikipedia.org/wiki/Active_metabolite "Active metabolite") of remdesivir interferes with the action of viral [RNA-dependent RNA polymerase](https://en.wikipedia.org/wiki/RNA-dependent_RNA_polymerase "RNA-dependent RNA polymerase") and evades [proofreading](https://en.wikipedia.org/wiki/Proofreading_$biology$ "Proofreading (biology)") by viral [exoribonuclease](https://en.wikipedia.org/wiki/Exoribonuclease "Exoribonuclease") (ExoN), causing a decrease in viral RNA production.[\[17\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Scavone_2020-17)[\[38\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Ferner2020-38) In some viruses, such as the [respiratory syncytial virus](https://en.wikipedia.org/wiki/Respiratory_syncytial_virus "Respiratory syncytial virus"), it causes the RNA-dependent RNA polymerases to pause, but its predominant effect (as in Ebola) is to induce an irreversible [chain termination](https://en.wikipedia.org/wiki/Chain_termination "Chain termination"). Unlike with many other chain terminators, this is not mediated by preventing addition of the immediately subsequent nucleotide, but is instead delayed, occurring after five additional bases have been added to the growing RNA chain.[\[39\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pmid30987343-39) For the RNA-dependent RNA polymerases of [MERS-CoV](https://en.wikipedia.org/wiki/MERS-CoV "MERS-CoV"), [SARS-CoV-1](https://en.wikipedia.org/wiki/SARS-CoV-1 "SARS-CoV-1"), and [SARS-CoV-2](https://en.wikipedia.org/wiki/SARS-CoV-2 "SARS-CoV-2"), arrest of RNA synthesis occurs after incorporation of three additional nucleotides.[\[40\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon_2020-40)[\[36\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon2020-36) Hence, remdesivir is classified as a direct-acting antiviral agent that works as a delayed chain terminator.[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34)[\[36\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gordon2020-36) Pharmacokinetics In non-human primates, the plasma [half-life](https://en.wikipedia.org/wiki/Biological_half-life "Biological half-life") of the prodrug is 20 minutes, with the main metabolite being the [nucleoside](https://en.wikipedia.org/wiki/Nucleoside "Nucleoside"), [GS-441524](https://en.wikipedia.org/wiki/GS-441524 "GS-441524"). Two hours post injection, the main metabolite GS-441524 is present at micromolar concentrations, whilst intact Remdesivir is no longer detectable. Because of this rapid extracellular conversion to the nucleoside GS-441524, some researchers have questioned whether the active nucleotide triphosphate is truly derived from remdesivir pro-drug removal or whether it occurs by GS-441524 phosphorylation, and whether direct administration of GS-441524 would constitute a cheaper and easier to administer COVID‑19 drug compared to remdesivir.[\[41\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020_2-41)[\[24\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Yan_2020-24) The activated nucleotide triphosphate form has sustained intracellular levels in [PBMC](https://en.wikipedia.org/wiki/PBMC "PBMC") and presumably in other cells as well.[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34) Resistance Mutations in the [mouse hepatitis virus](https://en.wikipedia.org/wiki/Mouse_hepatitis_virus "Mouse hepatitis virus") [RNA replicase](https://en.wikipedia.org/wiki/RNA_replicase "RNA replicase") that cause partial resistance to remdesivir were identified in 2018. These mutations make the viruses less effective in nature, and the researchers believe they will likely not persist where the drug is not being used.[\[42\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Chiotos2020-42) Interactions Remdesivir is at least partially metabolized by the [cytochrome P450](https://en.wikipedia.org/wiki/Cytochrome_P450 "Cytochrome P450") enzymes [CYP2C8](https://en.wikipedia.org/wiki/CYP2C8 "CYP2C8"), [CYP2D6](https://en.wikipedia.org/wiki/CYP2D6 "CYP2D6"), and [CYP3A4](https://en.wikipedia.org/wiki/CYP3A4 "CYP3A4").[\[43\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_Summary_on_compassionate_use-43)[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) [Blood plasma](https://en.wikipedia.org/wiki/Blood_plasma "Blood plasma") concentrations of remdesivir are expected to decrease if it is administered together with cytochrome P450 [inducers](https://en.wikipedia.org/wiki/List_of_cytochrome_P450_modulators "List of cytochrome P450 modulators") such as [rifampicin](https://en.wikipedia.org/wiki/Rifampicin "Rifampicin"), [carbamazepine](https://en.wikipedia.org/wiki/Carbamazepine "Carbamazepine"), [phenobarbital](https://en.wikipedia.org/wiki/Phenobarbital "Phenobarbital"), [phenytoin](https://en.wikipedia.org/wiki/Phenytoin "Phenytoin"), [primidone](https://en.wikipedia.org/wiki/Primidone "Primidone"), and [St John's wort](https://en.wikipedia.org/wiki/St_John%27s_wort "St John's wort").[\[44\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-44) Using chloroquine or [hydroxychloroquine](https://en.wikipedia.org/wiki/Hydroxychloroquine "Hydroxychloroquine") with remdesivir may reduce the antiviral activity of remdesivir.[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11)[\[9\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_SmPC-9)[\[45\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-45) Coadministration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended based on in vitro data demonstrating an antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir.[\[11\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_FDA_label-11) Synthesis [![](https://upload.wikimedia.org/wikipedia/commons/thumb/a/ab/Synthesis_of_Remdesivir.png/500px-Synthesis_of_Remdesivir.png)](https://en.wikipedia.org/wiki/File:Synthesis_of_Remdesivir.png) Synthesis of remdesivir in [structural formulae](https://en.wikipedia.org/wiki/Structural_formula "Structural formula") Remdesivir can be synthesized in multiple steps from [ribose](https://en.wikipedia.org/wiki/Ribose "Ribose") derivatives. The figure to the right is one of the synthesis routes of remdesivir invented by Chun and coauthors from Gilead Sciences.[\[46\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-46)[\[47\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-47) In vitro experiments An [in vitro](https://en.wikipedia.org/wiki/In_vitro "In vitro") study of remdesivir assessing antiviral activity against SARS-CoV-2 was performed.[\[48\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wangc:20-48) Cells were pre-treated with the different doses of remdesivir for 1 hour, and the virus (MOI of 0.05) was subsequently added to allow infection for 2 hours.[\[48\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wangc:20-48) The results found that remdesivir functioned well as an inhibitor of the infection.[\[48\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-wangc:20-48) The study was published as a letter to the editor, and as such did not undergo peer review. Manufacturing Remdesivir requires "70 raw materials, reagents, and catalysts" to make, and approximately "25 chemical steps."[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) Some of the ingredients are extremely dangerous to humans, especially [trimethylsilyl cyanide](https://en.wikipedia.org/wiki/Trimethylsilyl_cyanide "Trimethylsilyl cyanide").[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) The original end-to-end manufacturing process required 9 to 12 months to go from raw materials at contract manufacturers to finished product, but after restarting production in January 2020, Gilead Sciences was able to find ways to reduce the production time to six months.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) In January 2020, Gilead began working on restarting remdesivir production in glass-lined steel [chemical reactors](https://en.wikipedia.org/wiki/Chemical_reactor "Chemical reactor") at its manufacturing plant in [Edmonton, Alberta](https://en.wikipedia.org/wiki/Edmonton "Edmonton").[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) On 2 February 2020, the company flew its entire stock of remdesivir, 100 kilograms in powder form (left over from Ebola research), to its filling plant in [La Verne, California](https://en.wikipedia.org/wiki/La_Verne,_California "La Verne, California"), to start filling vials.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) The Edmonton plant finished its first new batch of remdesivir in April 2020.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) Around the same time, fresh raw materials began to arrive from contract manufacturers reactivated by Gilead in January.[\[49\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Langreth-49) Another challenge is getting remdesivir into patients despite the drug's "poor predicted solubility and poor stability."[\[50\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Pipkin-50) In June 2020, [Ligand Pharmaceuticals](https://en.wikipedia.org/wiki/Ligand_Pharmaceuticals "Ligand Pharmaceuticals") revealed that Gilead has been managing those issues by mixing Ligand's proprietary [excipient](https://en.wikipedia.org/wiki/Excipient "Excipient") Captisol (based on [University of Kansas](https://en.wikipedia.org/wiki/University_of_Kansas "University of Kansas") research into [cyclodextrin](https://en.wikipedia.org/wiki/Cyclodextrin "Cyclodextrin")) with remdesivir at a 30:1 ratio.[\[50\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Pipkin-50) Since that implies an enormous amount of Captisol is needed to stabilize and deliver remdesivir (on top of amounts needed for several other drugs for which the excipient is already in regular use), Ligand announced that it is trying to boost Captisol annual manufacturing capacity to as much as 500 metric tons.[\[50\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Pipkin-50) On 12 May 2020, Gilead announced that it had granted non-exclusive voluntary licenses to five [generic drug](https://en.wikipedia.org/wiki/Generic_drug "Generic drug") companies in India and Pakistan to manufacture remdesivir for distribution to 127 countries.[\[51\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Silverman-51)[\[52\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-52)[\[53\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_licensing-53) The agreements were structured so that the licensees can set their own prices and will not have to pay royalties to Gilead until the WHO declares an end to the COVID‑19 emergency or another medicine or vaccine is approved for COVID‑19, whichever comes first.[\[51\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Silverman-51) On 23 June 2020, India granted emergency marketing approval of generic remdesivir manufactured by two Gilead licensees, [Cipla](https://en.wikipedia.org/wiki/Cipla "Cipla") and [Hetero Drugs](https://en.wikipedia.org/wiki/Hetero_Drugs "Hetero Drugs").[\[54\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Rajagopal-54) Society and culture Legal status Remdesivir is approved, or authorized for emergency use, to treat COVID‑19 in many countries.[\[20\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20201022-20) Remdesivir has been authorized for emergency use in India,[\[55\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-55) Singapore,[\[56\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Reuters_20200620-56) and approved for use in Japan,[\[57\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-57) the European Union, the United States, and Australia for people with severe symptoms.[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[16\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR-16)[\[58\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_EUA-58)[\[59\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_EUA_PR-59)[\[60\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-:0-60)[\[61\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-TGA_approval-61)[\[62\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Veklury-62)[\[63\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) Remdesivir is the first treatment for COVID‑19 to be approved by the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA).[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) The approval by the FDA does not include the entire population that had been authorized to use remdesivir under an Emergency Use Authorization (EUA) originally issued in May 2020.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) In order to ensure continued access to the pediatric population previously covered under the EUA, the FDA revised the EUA for remdesivir to authorize the drug's use for treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized pediatric patients weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized pediatric patients less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) Australia In July 2020, remdesivir was provisionally approved for use in Australia for use in adults and adolescents with severe COVID‑19 symptoms who have been hospitalized.[\[61\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-TGA_approval-61)[\[65\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-65) Australia claims to have a sufficient supply of remdesivir in its national stockpile.[\[66\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-66) Canada As of 11 April 2020, access in Canada was available only through clinical trials.[\[67\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Health_Canada-67) [Health Canada](https://en.wikipedia.org/wiki/Health_Canada "Health Canada") approved requests to treat twelve people with remdesivir under the department's special-access program (SAP).[\[68\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-68) Additional doses of remdesivir are not available through the SAP except for pregnant women or children with confirmed COVID‑19 and severe illness.[\[67\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Health_Canada-67) In June 2020, Health Canada received an application from Gilead for the use of remdesivir for treating COVID‑19.[\[67\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Health_Canada-67) On 27 July 2020, Health Canada conditionally approved the application.[\[69\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Weikle-69)[\[6\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-CA_Veklury_Product_information-6) In September 2020, [Minister of Public Services and Procurement](https://en.wikipedia.org/wiki/Minister_of_Public_Services_and_Procurement "Minister of Public Services and Procurement") [Anita Anand](https://en.wikipedia.org/wiki/Anita_Anand "Anita Anand") announced that Canada had entered into a deal to obtain up to 150,000 vials of remdesivir from Gilead starting in October.[\[70\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Grant-70) As of 8 October, remdesivir was still not widely available in [Alberta](https://en.wikipedia.org/wiki/Alberta "Alberta"), because [Alberta Health Services](https://en.wikipedia.org/wiki/Alberta_Health_Services "Alberta Health Services") was undertaking a "[formulary](https://en.wikipedia.org/wiki/Formulary_$pharmacy$ "Formulary (pharmacy)") review" to be completed by mid-November.[\[71\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Kury_de_Castillo-71) Czech Republic In March 2020, the drug was provisionally approved for use for COVID‑19 patients in a serious condition as a result of [the outbreak in the Czech Republic](https://en.wikipedia.org/wiki/COVID%E2%80%9119_pandemic_in_the_Czech_Republic#Policies_to_fight_the_contagion "COVID‑19 pandemic in the Czech Republic").[\[72\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-72) European Union In February 2016, [orphan designation](https://en.wikipedia.org/wiki/Orphan_drug "Orphan drug") (EU/3/16/1615) was granted by the European Commission to Gilead Sciences International Ltd, United Kingdom, for remdesivir for the treatment of Ebola virus disease.[\[73\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-73) In April 2020, the [European Medicines Agency](https://en.wikipedia.org/wiki/European_Medicines_Agency "European Medicines Agency") (EMA) provided recommendations on compassionate use of remdesivir for COVID‑19 in the EU.[\[74\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-74) In May 2020, the [Committee for Medicinal Products for Human Use](https://en.wikipedia.org/wiki/Committee_for_Medicinal_Products_for_Human_Use "Committee for Medicinal Products for Human Use") (CHMP) of the EMA recommended expanding the compassionate use of remdesivir to those not on mechanical ventilation.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) In addition to those undergoing invasive mechanical ventilation, the compassionate use recommendations cover the treatment of hospitalized individuals requiring supplemental oxygen, non-invasive ventilation, high-flow oxygen devices or ECMO (extracorporeal membrane oxygenation).[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) The updated recommendations were based on preliminary results from the NIAID-ACTT study,[\[76\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIAID_ACTT-76) which suggested a beneficial effect of remdesivir in the treatment of hospitalized individuals with severe COVID‑19.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75)[\[77\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_PR-77) In addition, a treatment duration of five days was introduced alongside the longer ten-day course, based on preliminary results from another study (GS-US-540-5773) suggesting that for those not requiring mechanical ventilation or ECMO, the treatment course may be shortened from ten to five days without any loss of efficacy.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) Individuals who receive a five-day treatment course but do not show clinical improvement will be eligible to continue receiving remdesivir for an additional five days.[\[75\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EU_compassionate-75) In July 2020, the European Union granted a conditional marketing authorization for remdesivir with an indication for the treatment of COVID‑19 in adults and adolescents (aged twelve years and older with body weight at least 40 kilograms \[88 lb\]) with pneumonia requiring supplemental oxygen.[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[78\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EC_Veklury-78) In August 2022, the European Union granted a full marketing authorization for remdesivir.[\[12\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury_EPAR-12)[\[78\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EC_Veklury-78)[\[79\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-79) Iran Remdesivir has been also produced in Iran by [Barakat](https://en.wikipedia.org/wiki/Barakat_Pharmaceutical_Group "Barakat Pharmaceutical Group"); Iran is planning to increase the productions of Remdesivir ampoules from 20,000 to 150,000 ampoules per month. It has also the permission of the "Food and Drug Administration" of [MOHME](https://en.wikipedia.org/wiki/Ministry_of_Health_and_Medical_Education "Ministry of Health and Medical Education").[\[80\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-80) Japan In May 2020, [Japan's Ministry of Health, Labour and Welfare](https://en.wikipedia.org/wiki/Ministry_of_Health,_Labour_and_Welfare "Ministry of Health, Labour and Welfare") approved the drug for use in Japan, in a fast-tracked process, based on the US emergency authorization.[\[16\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR-16)[\[60\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-:0-60) Mexico In October 2020, Deputy Secretary of Prevention and Health Promotion [Hugo López-Gatell Ramírez](https://en.wikipedia.org/wiki/Hugo_L%C3%B3pez-Gatell_Ram%C3%ADrez "Hugo López-Gatell Ramírez") stated at a news conference that Mexico would not necessarily follow the United States in approving the drug for use in Mexico. López-Gatell explained that the [Federal Commission for the Protection against Sanitary Risk](https://en.wikipedia.org/wiki/Federal_Commission_for_the_Protection_against_Sanitary_Risk "Federal Commission for the Protection against Sanitary Risk") (Cofepris) had already twice denied the approval of remdesivir because, in that agency's view, the evidence does not suggest "sufficient efficacy".[\[81\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Reuters_Mexico-81) In March 2020, Cofepris authorized the drug for emergency cases, advising to give continuous surveillance of the integral health of the patient.[\[82\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Cofepris_Mexico-82) Singapore In June 2020, Singapore's [Health Sciences Authority](https://en.wikipedia.org/wiki/Health_Sciences_Authority "Health Sciences Authority") conditionally approved the usage of remdesivir in Singapore.[\[56\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Reuters_20200620-56) United States In March 2020, United States President [Donald Trump](https://en.wikipedia.org/wiki/Donald_Trump "Donald Trump") announced that remdesivir was available for "[compassionate use](https://en.wikipedia.org/wiki/Compassionate_use "Compassionate use")" for people with COVID‑19; FDA Commissioner [Stephen Hahn](https://en.wikipedia.org/wiki/Stephen_Hahn_$oncologist$ "Stephen Hahn (oncologist)") confirmed the statement at the same press conference.[\[83\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-83) It was later revealed that Gilead had been providing remdesivir in response to compassionate use requests since 25 January.[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21)[\[84\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-84) On 23 March 2020, Gilead voluntarily suspended access for compassionate use (excepting cases of critically ill children and pregnant women), for reasons related to supply, citing the need to continue to provide the agent for testing in clinical trials.[\[85\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Hopkins-85)[\[86\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-86) In May 2020, the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") granted Gilead [emergency use authorization](https://en.wikipedia.org/wiki/Emergency_use_authorization "Emergency use authorization") (EUA) for remdesivir to be distributed and used by licensed healthcare providers to treat adults and children hospitalized with severe COVID‑19.[\[59\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_EUA_PR-59)[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Severe COVID‑19 is defined as patients with an oxygen saturation (SpO2) \<= 94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") (ECMO), a heart–lung bypass machine.[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33)[\[87\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NYT_EUA-87)[\[88\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-88) Distribution of remdesivir under the EUA was controlled by the US government for use consistent with the terms and conditions of the EUA.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Gilead supplied remdesivir to authorized distributors, or directly to a US government agency, who distributed it to hospitals and other healthcare facilities as directed by the US government, in collaboration with state and local government authorities, as needed.[\[33\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-EUA_FAQ2-33) Gilead stated they were donating 1.5 million vials for emergency use[\[87\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NYT_EUA-87) and estimated, as of April 2020, they had enough remdesivir for 140,000 treatment courses and expect to have 500,000 courses by October 2020, and one million courses by the end of 2020.[\[89\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-89)[\[90\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-90) The initial distribution of the drug in the US was tripped up by seemingly capricious decision-making and finger-pointing, resulting in over a week of confusion and frustration among healthcare providers and patients alike.[\[91\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-91)[\[92\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Swan-92)[\[93\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WaPo20200528-93) On 9 May 2020, the [United States Department of Health and Human Services](https://en.wikipedia.org/wiki/United_States_Department_of_Health_and_Human_Services "United States Department of Health and Human Services") (HHS) explained in a statement that it would be distributing remdesivir vials to [state health departments](https://en.wikipedia.org/wiki/State_health_agency "State health agency"), then would allow each department to redistribute vials to hospitals in their respective states based upon each department's insight into "community-level needs."[\[94\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Facher-94) HHS also clarified that only 607,000 vials of Gilead's promised donation of 1.5 million vials would be going to American patients.[\[94\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Facher-94) However, HHS did not explain why several states with some of the highest caseloads had been omitted from the first two distribution rounds, including California, Florida, and Pennsylvania.[\[94\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Facher-94) In May 2020, Gilead indicated they would increase the number of doses donated to the US from 607,000 to around 940,000.[\[95\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stat_20200519-95)[\[93\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WaPo20200528-93) Some of the initial distribution was sent to the wrong hospitals, to hospitals with no intensive care units, and to facilities without the needed refrigeration to store it.[\[93\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WaPo20200528-93) In June 2020, HHS announced an unusual agreement with Gilead in which HHS agreed to Gilead's [wholesale acquisition price](https://en.wikipedia.org/wiki/Wholesale_acquisition_cost "Wholesale acquisition cost"), HHS would continue to work together with state governments and drug wholesaler [AmerisourceBergen](https://en.wikipedia.org/wiki/AmerisourceBergen "AmerisourceBergen") to allocate shipments of remdesivir vials to American hospitals through the end of September 2020, and in exchange, during that three-month timeframe (July, August, and September), American patients would be allocated over 90% of Gilead's projected remdesivir output of more than 500,000 treatment courses.[\[96\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Kolata-96)[\[97\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-HHSPressRelease_29June2020-97) Absent from these announcements was any discussion of allocation of remdesivir production to the approximately 70 countries omitted from Gilead's generic drug licensing agreements—including much of Europe[\[98\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Boseley-98) and countries as populous as Brazil, China, and Mexico—or the 127 countries listed on those agreements (during the time it will take for Gilead's generic licensees to ramp up their own production).[\[99\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Baragona-99) As the implications of this began to sink in, several countries publicly confirmed the next day that they already had adequate supplies of remdesivir to cover current needs, including Australia,[\[100\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Davey-100) Germany,[\[101\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Rinke-101) and the United Kingdom.[\[102\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stout-102) In August 2020, the FDA broadened the Emergency Use Authorization (EUA) for remdesivir to include all hospitalized patients with suspected or laboratory-confirmed COVID‑19, irrespective of the severity of their disease.[\[103\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-103)[\[104\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-104) The Fact Sheet was updated to reflect the new guidance.[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25) In October 2020, Gilead and HHS announced that HHS was relinquishing control over remdesivir allocation because production of the drug had finally caught up with US domestic demand.[\[105\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Walker-105)[\[106\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-106)[\[107\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-HHS_PR_20201001-107) AmerisourceBergen will remain the sole distributor of Veklury in the US through the end of 2020.[\[107\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-HHS_PR_20201001-107) On 22 October 2020, the FDA approved remdesivir and also revised the EUA to permit the use of remdesivir for treatment of suspected or laboratory confirmed COVID‑19 in hospitalized children weighing 3.5 kilograms (7.7 lb) to less than 40 kilograms (88 lb) or hospitalized children less than twelve years of age weighing at least 3.5 kilograms (7.7 lb).[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64)[\[25\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Remdesivir_EUA_Fact_Sheet-25)[\[108\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-108)[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) This decision was criticized for an alleged lack of previous consultation on part of the FDA given the complications of antiviral drug issues.[\[110\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-110) In November 2020, the FDA issued an EUA for the combination of [baricitinib](https://en.wikipedia.org/wiki/Baricitinib "Baricitinib") with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) Remdesivir received approval from the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) in October 2020, for use in adults and children twelve years and older requiring hospitalization for treatment of severe COVID‑19 infections.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) In January 2022, the FDA gave regulatory approval to remdesivir for use in adults and children (twelve years of age and older who weigh at least 40 kilograms (88 lb) and are positive for COVID‑19, not hospitalized, and are ill with COVID‑19 having high risk for developing severe COVID‑19, including hospitalization or death.[\[111\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20221021-111) In April 2022, the FDA expanded the approval of remdesivir to include people 28 days of age and older weighing at least 3 kilograms (6.6 lb).[\[27\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20220425-27) The FDA also provided [emergency use authorization](https://en.wikipedia.org/wiki/Emergency_use_authorization "Emergency use authorization") in 2022, for remdesivir treatment of children under age twelve who are COVID‑positive and not hospitalized, but have mild-to-moderate COVID‑19 with high risk of developing severe infection, including hospitalization or death.[\[111\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20221021-111) Economics In June 2020, Gilead announced that it had set the price of remdesivir at US\$390 per vial for the governments of developed countries, including the United States, and US\$520 for US private health insurance companies.[\[112\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20200629-112) The expected course of treatment is six vials over five days for a total cost of US\$2,340.[\[112\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Gilead_PR_20200629-112) Being a [repurposed drug](https://en.wikipedia.org/wiki/Drug_repositioning "Drug repositioning"), the minimum production cost for remdesivir is estimated at US\$0.93 per day of treatment.[\[113\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-113) In July 2020, the European Union secured a €63 million (US\$74 million) contract with Gilead, to make the drug available there in early August 2020.[\[114\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-114) In October 2020, Gilead Sciences and the European Commission announced they had signed a joint procurement framework contract in which Gilead agreed to provide up to 500,000 remdesivir treatment courses over the next six months to 37 European countries. Among the contracting countries were all 27 EU member states plus the United Kingdom, "Albania, Bosnia & Herzegovina, Iceland, Kosovo, Montenegro, North Macedonia, Norway, and Serbia".[\[115\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Saigol-115) At the time, the price per treatment course was not disclosed; Reuters reported the price was 2,070 euros, thereby implying the total value of the contract (if all 500,000 courses are ordered) is approximately €1.035 billion.[\[116\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Guarascio-116) Under the contract, each participating country will directly place orders with Gilead and pay Gilead directly for its own orders.[\[116\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Guarascio-116) Names Remdesivir is the [international nonproprietary name](https://en.wikipedia.org/wiki/International_nonproprietary_name "International nonproprietary name") (INN)[\[117\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-117) while the development code name was GS-5734.[\[118\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-118) Research Remdesivir was originally created and developed by [Gilead Sciences](https://en.wikipedia.org/wiki/Gilead_Sciences "Gilead Sciences") in 2009, to treat [hepatitis C](https://en.wikipedia.org/wiki/Hepatitis_C "Hepatitis C") and [respiratory syncytial virus](https://en.wikipedia.org/wiki/Respiratory_syncytial_virus "Respiratory syncytial virus") (RSV).[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21)[\[119\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_20201023-119) It did not work against hepatitis C or RSV,[\[21\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Stephens2-21)[\[119\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_20201023-119) but was then repurposed and studied as a potential treatment for [Ebola virus disease](https://en.wikipedia.org/wiki/Ebola_virus_disease "Ebola virus disease") and [Marburg virus](https://en.wikipedia.org/wiki/Marburg_virus "Marburg virus") infections.[\[120\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Warren_2016-120)[\[119\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-NIH_20201023-119) According to the [Czech News Agency](https://en.wikipedia.org/wiki/Czech_News_Agency "Czech News Agency"), this new line of research was carried out under the direction of scientist [Tomáš Cihlář](https://en.wikipedia.org/wiki/Tom%C3%A1%C5%A1_Cihl%C3%A1%C5%99 "Tomáš Cihlář").[\[121\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-121) A collaboration of researchers from the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC) and [Gilead Sciences](https://en.wikipedia.org/wiki/Gilead_Sciences "Gilead Sciences") subsequently discovered that remdesivir had antiviral activity in vitro against multiple [filoviruses](https://en.wikipedia.org/wiki/Filovirus "Filovirus"), [pneumoviruses](https://en.wikipedia.org/wiki/Pneumovirus "Pneumovirus"), paramyxoviruses, and [coronaviruses](https://en.wikipedia.org/wiki/Coronavirus "Coronavirus").[\[122\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Lo_2017-122) Preclinical and clinical research and development was done in collaboration between Gilead Sciences and various US government agencies and academic institutions.[\[34\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Eastman_2020-34)[\[123\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-123)[\[124\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-124)[\[125\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-125) During the mid-2010s, the [Mintz Levin](https://en.wikipedia.org/wiki/Mintz,_Levin,_Cohn,_Ferris,_Glovsky,_and_Popeo "Mintz, Levin, Cohn, Ferris, Glovsky, and Popeo") law firm prosecuted various patent applications for remdesivir on behalf of Gilead Sciences before the [United States Patent and Trademark Office](https://en.wikipedia.org/wiki/United_States_Patent_and_Trademark_Office "United States Patent and Trademark Office") (USPTO). The USPTO granted two patents on remdesivir to Gilead Sciences on 9 April 2019: one for filoviruses,[\[126\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-126) and one which covered both [arenaviruses](https://en.wikipedia.org/wiki/Arenavirus "Arenavirus") and coronaviruses.[\[127\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-127) Ebola In October 2015, the [United States Army Medical Research Institute of Infectious Diseases](https://en.wikipedia.org/wiki/United_States_Army_Medical_Research_Institute_of_Infectious_Diseases "United States Army Medical Research Institute of Infectious Diseases") (USAMRIID) announced preclinical results that remdesivir had blocked the [Ebola virus](https://en.wikipedia.org/wiki/Ebola_virus "Ebola virus") in [Rhesus monkeys](https://en.wikipedia.org/wiki/Rhesus_monkeys "Rhesus monkeys"). Travis Warren, who has been a USAMRIID principal investigator since 2007, said that the "work is a result of the continuing collaboration between USAMRIID and Gilead Sciences".[\[128\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-USAMRIID_20151009-128) The "initial screening" of the "Gilead Sciences compound library to find molecules with promising antiviral activity" was performed by scientists at the [Centers for Disease Control and Prevention](https://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention "Centers for Disease Control and Prevention") (CDC).[\[128\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-USAMRIID_20151009-128) As a result of this work, it was recommended that remdesivir "should be further developed as a potential treatment."[\[120\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Warren_2016-120)[\[128\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-USAMRIID_20151009-128) Remdesivir was rapidly pushed through clinical trials due to the [West African Ebola virus epidemic](https://en.wikipedia.org/wiki/West_African_Ebola_virus_epidemic "West African Ebola virus epidemic") of 2013–2016, eventually being used in people with the disease. Preliminary results were promising; it was used in the emergency setting during the [Kivu Ebola epidemic](https://en.wikipedia.org/wiki/Kivu_Ebola_epidemic "Kivu Ebola epidemic") that started in 2018, along with further clinical trials, until August 2019, when Congolese health officials announced that it was significantly less effective than [monoclonal antibody](https://en.wikipedia.org/wiki/Monoclonal_antibody "Monoclonal antibody") treatments such as [ansuvimab](https://en.wikipedia.org/wiki/Ansuvimab "Ansuvimab") and [atoltivimab/maftivimab/odesivimab](https://en.wikipedia.org/wiki/Atoltivimab/maftivimab/odesivimab "Atoltivimab/maftivimab/odesivimab"). The trials, however, established its safety profile.[\[129\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-129) COVID-19 Hospitalized patients Remdesivir was approved for medical use in the United States in October 2020.[\[62\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_Veklury-62)[\[63\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Veklury:_Summary_Review-63)[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64)[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) The US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) approved remdesivir based on the agency's analysis of data from three randomized, controlled clinical trials that included participants hospitalized with mild-to-severe COVID‑19.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64)[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) The FDA granted approval and reissued the revised EUA to Gilead Sciences Inc.[\[64\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_20201022-64) The FDA approved remdesivir based primarily on evidence from three clinical trials (NCT04280705, NCT04292899, and NCT04292730) of 2043 hospitalized participants with COVID‑19.[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) The trials were conducted at 226 sites in 17 countries including the United States.[\[109\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_snapshot-109) In November 2020, the World Health Organization (WHO) updated its guideline on therapeutics for COVID‑19 to include a conditional recommendation against the use of remdesivir, triggered by results from the WHO [Solidarity trial](https://en.wikipedia.org/wiki/Solidarity_trial "Solidarity trial").[\[130\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-WHO_guidelines-130)[\[131\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-131)[\[132\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-who-lg-132)[\[133\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-133) Meanwhile, the [Public Health Agency of Canada](https://en.wikipedia.org/wiki/Public_Health_Agency_of_Canada "Public Health Agency of Canada")'s COVID‑19 Clinical Pharmacology Task Group recommended that remdesivir only be administered to hospitalized patients as part of a [randomized controlled trial](https://en.wikipedia.org/wiki/Randomized_controlled_trial "Randomized controlled trial") due to limited information on risks and benefits.[\[134\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-134) In January 2022, the Canadian component of the WHO Solidarity Trial reported that in-hospital people with COVID‑19 treated with remdesivir had 17% lower relative risk of death (18.7% versus 22.6% death rates) and 47% reduced relative risk for needing oxygen and mechanical ventilation (8.0% versus 15.0%) compared to people receiving standard-of-care treatments.[\[135\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-Ali-135) In September 2022, the WHO updated their guidelines to recommend use of remdesivir for both non-hospitalized and hospitalized patients.[\[136\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-136) This was based on final results from the SOLIDARITY trial that showed a reduction in mortality or progression to mechanical ventilation for non-ventilated patients. Nonhospitalized outpatients In January 2022, a study indicated that nonhospitalized people who were at high risk for COVID‑19 progression had an 87% lower risk of hospitalization or death after a 3-day course of intravenous remdesivir.[\[137\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-137) Remdesivir/baricitinib In May 2020, the [National Institute of Allergy and Infectious Diseases](https://en.wikipedia.org/wiki/National_Institute_of_Allergy_and_Infectious_Diseases "National Institute of Allergy and Infectious Diseases") (NIAID) started the Adaptive COVID‑19 Treatment Trial 2 (ACTT-2) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [baricitinib](https://en.wikipedia.org/wiki/Baricitinib "Baricitinib") for treating hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\[138\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-138)[\[139\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-ACTT_3_PR-139)[\[140\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-140) In November 2020, the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) issued an [emergency use authorization](https://en.wikipedia.org/wiki/Emergency_use_authorization "Emergency use authorization") (EUA) for the drug baricitinib, in combination with remdesivir, for the treatment of suspected or laboratory-confirmed COVID‑19 in hospitalized people two years of age or older requiring supplemental oxygen, invasive mechanical ventilation, or [extracorporeal membrane oxygenation](https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation "Extracorporeal membrane oxygenation") (ECMO).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The data supporting the EUA for baricitinib combined with remdesivir are based on a randomized, double-blind, placebo-controlled clinical trial (ACTT-2), which was conducted by the National Institute of Allergy and Infectious Diseases (NIAID).[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) The EUA was issued to Eli Lilly and Company.[\[28\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-FDA_PR_202011192-28) Remdesivir/interferon beta-1a In August 2020, the NIAID started the Adaptive COVID‑19 Treatment Trial 3 (ACTT 3) to evaluate the safety and efficacy of a treatment regimen consisting of remdesivir plus [interferon beta-1a](https://en.wikipedia.org/wiki/Interferon_beta-1a "Interferon beta-1a") for hospitalized adults who have a laboratory-confirmed SARS-CoV-2 infection with evidence of lung involvement, including a need for supplemental oxygen, abnormal chest X-rays, or illness requiring mechanical ventilation.[\[139\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-ACTT_3_PR-139)[\[141\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-141) Veterinary uses In 2019, GS-441524 was shown to have promise for treating [feline infectious peritonitis](https://en.wikipedia.org/wiki/Feline_infectious_peritonitis "Feline infectious peritonitis") caused by a [coronavirus](https://en.wikipedia.org/wiki/Feline_coronavirus "Feline coronavirus").[\[142\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-pedersen-142) It has not been evaluated or approved by the US [Food and Drug Administration](https://en.wikipedia.org/wiki/Food_and_Drug_Administration "Food and Drug Administration") (FDA) for the treatment of [feline coronavirus](https://en.wikipedia.org/wiki/Feline_coronavirus "Feline coronavirus") or feline infectious peritonitis but has been available since 2019, through websites and social media as an unregulated black market substance.[\[143\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-143) Because GS-441524 is the main circulating metabolite of remdesivir and because GS-441524 has similar potency against SARS-CoV-2 in vitro, some researchers have argued for the direct administration of GS-441524 as a COVID‑19 treatment.[\[144\]](https://en.wikipedia.org/wiki/Remdesivir#cite_note-144) References 1. ^ [*a](https://en.wikipedia.org/wiki/Remdesivir#cite_ref-Veklury_APM_summary_1-0) [b](https://en.wikipedia.org/wiki/Remdesivir#cite_ref-Veklury_APM_summary_1-1) ["Veklury Australian prescription medicine decision summary"](https://www.tga.gov.au/apm-summary/veklury). [Therapeutic Goods Administration](https://en.wikipedia.org/wiki/Therapeutic_Goods_Administration "Therapeutic Goods Administration") (TGA). 13 July 2020. [Archived](https://web.archive.org/web/20200813151939/https://www.tga.gov.au/apm-summary/veklury) from the original on 13 August 2020. Retrieved 16 August 2020. 2. ^ [a](https://en.wikipedia.org/wiki/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-0) [b](https://en.wikipedia.org/wiki/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-1) [c](https://en.wikipedia.org/wiki/Remdesivir#cite_ref-AusPAR:_Remdesivir_2-2) ["AusPAR: Remdesivir"](https://www.tga.gov.au/auspar/auspar-remdesivir-0). [Therapeutic Goods Administration](https://en.wikipedia.org/wiki/Therapeutic_Goods_Administration "Therapeutic Goods Administration") (TGA). 10 May 2022. [Archived](https://web.archive.org/web/20220510022413/https://www.tga.gov.au/auspar/auspar-remdesivir-0) from the original on 10 May 2022. Retrieved 10 May 2022. 3. 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