Remidia Drug Interactions

No clinical interaction studies have been performed with Remdesivir. The overall potential for interactions is currently unknown; patients should remain under close observation during the days of Remdesivir administration. Due to antagonism observed in vitro, concomitant use of Remdesivir with chloroquine phosphate or hydroxychloroquine sulphate is not recommended.
Effects of other medicinal products on Remdesivir: In vitro, Remdesivir is a substrate for esterases in plasma and tissue, drug metabolizing enzymes CYP2C8, CYP2D6, and CYP3A4, and is a substrate for Organic Anion Transporting Polypeptides 1B1 (OATP1B1) and P-glycoprotein (P-gp) transporters.
The potential of interaction of Remdesivir with inhibitors/inducers of the hydrolytic pathway (esterase) or CYP2C8, 2D6 or 3A4 has not been studied. The risk of clinically relevant interaction is unknown. Strong inhibitors may result in increased Remdesivir exposure. The use of strong inducers (e.g. rifampicin) may decrease plasma concentrations of Remdesivir and is not recommended.
Dexamethasone is reported to be a moderate inducer of CYP3A and P-gp. Induction is dose-dependent and occurs after multiple doses. Dexamethasone is unlikely to have a clinically significant effect on Remdesivir as Remdesivir has a moderate-high hepatic extraction ratio, and is used for a short duration in the treatment of COVID-19.
Effects of Remdesivir on other medicinal products: In vitro, Remdesivir is an inhibitor of CYP3A4, OATP1B1 and OATP1B3. The clinical relevance of these in vitro drug interactions has not been established. Remdesivir may transiently increase plasma concentrations of medicinal products that are substrates of CYP3A or OATP 1B1/1B3. No data is available, however it can be suggested that medicinal products that are substrates of CYP3A4 or substrates of OATP1B1/1B3 should be administered at least 2 hours after Remdesivir. Remdesivir induced CYP1A2 and potentially CYP3A in vitro. Co-administration of Remdesivir with CYP1A2 or CYP3A4 substrates with narrow therapeutic index may lead to loss of their efficacy.
Dexamethasone is a substrate of CYP3A4 and although Remdesivir inhibits CYP3A4, due to Remdesivir's rapid clearance after I.V administration, Remdesivir is unlikely to have a significant effect on dexamethasone exposure.