Remdesivir

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, FDA 2020)}. Intravenous administration.

Its pharmacokinetic characteristics (moderately elevated molecular weight and high plasma protein binding) explain the negligible excretion observed in mother's milk. ^{(Wada 2022)}

Furthermore, remdesivir has very low oral bioavailability due to extensive first-pass metabolism ^{(Hale, Jorgensen 2021, Aleissa 2020)}, minimizing transfer to infant plasma from ingested breast milk.

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)}. A 5-week-old premature infant with severe acute respiratory syndrome due to coronavirus infection was treated with remdesivir without experiencing drug-related side effects. ^{(Frauenfelder 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. ^{(Anderson 2021)}

See below the information of these related products:

• Ebola Virus Disease (Unsafe. Moderate/severe adverse effects. Compatible under certain circumstances. Follow-up recommended. Use safer alternative or discontinue breastfeeding from 5 to 7 T ½ . Read Commentary.)
• Maternal Coronavirus 2019-nCoV infection (COVID-19) (Safe substance and/or breastfeeding is the best option.)