Last update Jan. 7, 2021
A nucleoside analog and RNA polymerase inhibitor. Used in the treatment of Ebola virus infection (Martínez 2020). It is also active against other viruses.
Used experimentally and authorized in the treatment of the COVID-19 coronavirus (Aleissa 2020, Dong 2020, Martínez 2020, SEFH 2020).
Since the last update we have not found any published data on its excretion in breastmilk.
Its pharmacokinetic characteristics (moderately elevated molecular weight, high plasma protein binding and high pKa) make it very unlikely its excretion into breast milk in significant concentration.
Furthermore, remdesivir has very low oral absorption due to extensive first-pass metabolism (Hale, Aleissa 2020). This low oral bioavailability hinders transfer to infant plasma from breastmilk,
A 19-day-old premature newborn infected with Ebola was treated with intravenous Remdesivir for 12 days without experiencing any side effects and recovered from the infection. Growth and psychomotor development were normal throughout the first year of life (Dörnemann 2017). Two infants younger than 7 days old and six younger than 5 years old who received remdesivir for the treatment of Ebola (Mulangu 2019) did not experience any adverse events (Aleissa 2020).
The FDA authorizes the use for the treatment of COVID-19 in children over 3.5 kg (FDA 2020).
If direct administration to newborns, even premature infants, does not cause problems, it is very unlikely that it will do so through breast milk, especially when a minimum concentration in milk and no oral absorption is expected.
We do not have alternatives for Remdesivir.
Suggestions made at e-lactancia are done by APILAM team, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it.
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