24 June: we have updated the Clinical Guidance section of this alert to
include updated information on the interaction between remdesivir and
dexamethasone. The updated alert is attached, the reworded section is in blue below.
Coadministration
has not been studied but based on metabolism and clearance a clinically
significant interaction is unlikely (University of Liverpool COVID-19 Drug
Interactions). 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.
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. Remdesivir is currently available
as an EAMS.
Dexamethasone has been demonstrated to have a clear place in the management of hospitalised patients with COVID-19. There were no excess harms identified in using this dose of dexamethasone in this patient population. Dexamethasone was not used in pregnant women.
Clinicians should therefore consider dexamethasone for the management of hospitalised patients with COVID-19 who require oxygen or ventilation.
Out of hospital treatment is not appropriate.
There is no current or anticipated constraint on supply of the medicine in the UK.
Please see the attached alert for further information.