COVID-19 has already created havoc all around the globe, since past two years, the second wave of the pandemic has bought some thought-provoking events in it. Drastically increasing covid cases along with the over burdened and collapsing healthcare system , Indian market is facing shotage/black-marketing of the drug –‘REMDESIVIR’ . So lets get into the depth of it to understand; Is it worh the hype?
- What is Remdesivir?-It is an FDA approved antiviral drug which is currently being in extensive demand for treatment of severe cases of COVID-19; as it is speculated/found to be active against SARSCOV-2 i.e., corona virus.
-How does it works?-It is an intravenous nucleotide prodrug of adenosine analogue, which binds itself with the viral RNA Dependent RNA polymerase (an enzyme present in the RNA based Virus) and thus help in decreasing the replication of genetic material of virus by terminating its RNA transcription; and help in decreasing the multiplication of the virus in the patient’s body and hence helps in reducing the chances of fatal pneumonia in COVID cases.
-When is it used ?-On the date of appearance of first symptom or on the date when RTPCR comes positive and can be efficacious till next 7-10 days, when the virus is in initial replication phase where virus replicates and increases its number. In the RTPCR report ‘CT value’ /cycle threshold value is also got mentioned, which is inversely proportional to the viral load ..and if the viral load is very high remdesivir is seen to be efficacious but only when given in combination with some cortecosteroids like dexamethasone .,It is effective when virus made its inception in the blood of host.
-What are its side effects?-Normal gastrointestinal symptoms like nausea and vomiting, increased prothrombin time and several hypersensitivity reactions are its side effects. Hence, it is not an easy drug to handel.
-Who in the population can take it? – The drug is safe in the patients above 12 years and weighing more than 40kgs. As said, it increases the prothrombin time so liver function tests are must to be examined when the patient is on remdesivir, and it is to be discontinued if ALT (Alanine transaminase-an enzyme produced by liver) increases 10 times to the normal value. The drug is not safe for the liver patients .Each 100 mg vial of remdesivir contain 3g of Sulfo butyl ether beta cyclodextrin sodium (SBECD), the SBECD accumulation can cause both renal and liver toxicity. Hence, it is not recommended for patients with estimated GFR<30ml/min as in this case the benefit outweighs the risks.
-What does WHO says? As per the statement release on November.20.2020, WHO does not recomend the use of remdesivir in covid cases. The evidence suggests that it has’t have any major effect on mortality and its benefit and risk ratio is less certain, so there is conditional recommendation against use of this drug.
-REMDESIVIR NOT FOR ALL THE PATIENTS- Dr. Raja Rao, Supretendent of Gandhi Hospital , said that remdesivir should be only given during first week, along with convalescent plasma, to moderate and severe COVID patients.
-Why are we facing its shortage?- Antiviral drugs are only to be used when virus is in the blood that too under doctors prescription, but patients with mild symptoms and home isolation are ignorantly stocking and procuring it. This irrational usage of the drug has resulted the shortage and black-marketing of the drug and thereby devoiding the patients in critical conditions, who actually need it. Moreover, considering its limited supply, the currently published Government Guidelines that the drug is to be supplied directly to the hospitals and limiting its supply to the medical stores has made it unavailable over the chemist shop counter. The limited supply and the uninformed public has exaggerated its demand and unstabilized the market supply and demand ratio resulted in the shortage of the drug. Subsequently, the rates have been increased many folds and fake remdesivir injections racket started mushrooming to make big profit out of situation.
-What the government is doing?- To meet the raised demand of the drug, the Government has decided to import 450000 remdesivir vials and has also increased the in-house production capacity of the drug.Besides this, the Government has also put a ban on the export of the same to increase its availability in country. The department of revenue has also exempted customs duty on the import of remdesivir injections till October 31st.
UP government has decided to make it free for the patients, on doctor’s prescription and also made provisions that if the drug is not available in the private hospitals and it is essential for survival of patients, DM and CMO will assure that it will be provided to patients on request of such hospitals .
-Conclusion – Remdesivir is not a COVID miracle drug and is also not something that can be taken without prescription. It is also not recommended in all the phases of COVID infected patient. The sideeffects associated with the usage of the drug are also important factor to be considered before going for it. Hence, it is not worth the hype to procure it, without consulting doctor.
Swati Tiwari,
MBBS Student(3rd year), AIIMS Patna
Room No-109, Girls Hostel No-7
AIIMS Patna, Phulwari Sharif, Patna, Bihar.