A Case Series on Suspected Remdesivir Induced Hyperammonemia

Abstract

Remdesivir is a broad spectrum anti-viral drug that has shown to inhibit SARS-CoV-2. In absence of any effective treatment for SARS-CoV-2 infection (COVID-19), Remdesivir has been tried for a compassionate use in severe COVID-19. Remdesivir has shown promise in the management of patients with COVID-19 although recent studies have shown concerns with its effectiveness and safety in practice. Despite this there is a need to document potential Adverse drug Reaction (ADR) to guide future decisions. We describe 2 cases of Suspected Remdesivir-induced hyperammonemia (SRIH) in patients with normal liver function. Serum ammonia levels was raised much above the baseline after a fortnight of therapy. After completion of the therapy, there was gradual improvement and normalization of serum ammonia levels. This suggested a causal relationship which was possibly due to the administration of Remdesivir drug. With the increasing use, physicians should be aware of this potential ADR of Remdesivir and evaluate ammonia levels in patients taking Remdesivir who present with alterations in mental status.