Acetylcysteine for the Treatment of Suspected Remdesivir-Associated Acute Liver Failure in COVID-19: A Case Series.
Pharmacotherapy
; 40(11): 1166-1171, 2020 11.
Article
in English
| MEDLINE | ID: covidwho-812649
ABSTRACT
Remdesivir is a direct-acting nucleoside RNA polymerase inhibitor with activity against the novel severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) virus used in the treatment of coronavirus disease 2019 (COVID-19) pneumonia. Here, we present two cases of suspected remdesivir-associated acute liver failure (ALF) in which the liver failure improved after continuous infusion acetylcysteine and withdrawal of remdesivir. Both patients had significant increases in transaminases between day 3 and day 10 of remdesivir therapy accompanied by coagulopathy and encephalopathy. After initiation of continuous infusion acetylcysteine, the transaminases of both patients rapidly improved. Ultimately, one patient fully recovered while the other died of suspected septic shock. Due to its novel nature and only recent widespread use, there are very little data on the risk of ALF from remdesivir. Additionally, the data for the use of acetylcysteine to manage non-acetaminophen-induced ALF are limited. It is important to consider the risk of remdesivir-associated ALF when weighing the risk versus benefits of use, and acetylcysteine may have a role in its management.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Antiviral Agents
/
Acetylcysteine
/
Adenosine Monophosphate
/
Liver Failure, Acute
/
Alanine
/
COVID-19 Drug Treatment
Type of study:
Case report
/
Diagnostic study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
Language:
English
Journal:
Pharmacotherapy
Year:
2020
Document Type:
Article
Affiliation country:
Phar.2464
Similar
MEDLINE
...
LILACS
LIS