Remdesivir a kind of antiviral drug that is currently being discussed by a wide society. BPOM has now released the distribution approval for this antiviral drug for the community's consumption given to Covid-19 patients in Indonesia.
"The distribution permit given in this drug is in the form of" Emergency Use Authorization (EUA)." These words mean that permission to consume this drug is given on an emergency basis because there is no definitive and approved Covid-19 drug. The meaning of emergency here is not because the patient is in an emergency," said Prof. Dr. Zullies Ikawati, Apt., as the Expert of Pharmacology and Clinical Pharmacy on Monday (5/10).
Zullies said that the community could not obtain Remdesivir easily in the market. The drugs were distributed directly to the hospital and also not available in pharmacies. WHO has used this drug in several trials in recent months. Several countries also used the drug, and the results showed good effectiveness in treating Covid-19 patients. Consuming Remdesivir for Covid-19 patients, it was believed to fasten the healing process for them.
"Remdesivir is an antiviral drug. It was formed to deal with RNA viruses and had been tried during the Ebola and MERS outbreaks," he said.
The professor of the UGM Faculty of Pharmacy revealed that Remdesivir is an analog compound (similar) to adenosine and can infiltrate the RNA chain. This drug works by inhibiting viral replication in the body.
Besides, Zullies also revealed the uniqueness of Remdesivir is a prodrug where the drug will change into an active substance when it is in the patient's body. This form can increase the drug's entry into the cells and protect the drug from reaching its area of action. An important modification to Remdesivir is a carbon-nitrogen (CN) group appended to the sugar. Accordingly, once Remdesivir is incorporated into the RNA growth chain, the CN group's presence will cause sugar to shrink.
"In the end, this obstructs the production of RNA strands and sabotages viral replication," he explained.
The change in the C-N bonds to C-C causes Remdesivir to be unable to be released by its target enzyme, namely RNA-dependent RNA Polymerase, which makes it remain in the growing RNA chain blocks viral replication.
Furthermore, Zullies conveyed that Remdesivir should only be used in patients who were confirmed positive for Covid-19 with age over 12 years and a minimum body weight of 40 Kg. Injection through infusion is one of the ways for its drug administration. The first day as much as 200 milligrams, then on the second day and the next given as much as 100 milligrams/day. The drug administration is carried out for 5 to 10 days.
Although it can help in the treatment of Covid-19, Zullies said Remdesivir has several side effects. Some of them are nausea and vomiting. Besides, Remdesivir can increase the transaminase enzyme in the liver, potentially damaging the liver. Hence, there must be a caution use of this drug for patients who are indicated to have impaired liver function.
Then, does Remdesivir have drug interplays with other drugs? Zullies said that there had not been any reports of drug interplays between Remdesivir and other drugs until now. However, the use of other drugs may affect the availability of Remdesivir in the blood.
"There was a report that several antibiotics, such as Rifampin and Clarithromycin, can affect the availability of Remdesivir in the blood. However, it's still unsure what else type of drugs that might have interplayed with Remdesivir, presumably there could be more drugs that interplay if there occurs more information about their use," he said.
Zullies said the safety of consuming Remdesivir for pregnant and breastfeeding women is also still unknown. However, in pre-clinical trials in mice and monkeys, it is discovered that Remdesivir's use can affect the kidneys in the fetus.
Translator: Natasa A