Drug Interactions between Levaquin and remdesivir

GENERALLY AVOID: Concomitant use of remdesivir with other agents that are known to induce hepatotoxicity may theoretically increase the risk of liver injury. Data from investigational use and clinical studies suggest that remdesivir may be associated with hepatotoxic effects. Transient treatment-emergent Grade 1 or Grade 2 elevations in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were observed during multiple-dose Phase 1 studies in healthy volunteers. Some ALT and AST elevations were associated with graded PT elevations, but there were no graded changes in international normalized ratio (INR). Laboratory results for these subjects indicated no systemic sign of drug reaction. Liver transaminase elevations, including grade 3 or higher, were also observed in some participants during compassionate or investigational use of remdesivir and clinical studies for the treatment of COVID-19. The mechanism of potential hepatotoxicity is unknown and the contribution of remdesivir is difficult to determine, as transaminase elevations have also been reported as a component of COVID-19, including in patients receiving placebo in clinical trials of remdesivir.

MANAGEMENT: Until more information is available, concomitant use of remdesivir with known hepatotoxic drugs should be avoided when possible. Liver function should be evaluated prior to starting remdesivir and monitored during treatment as clinically appropriate. Remdesivir should not be initiated in patients with ALT greater than or equal to 5 times the upper limit of normal (ULN) at baseline. Likewise, remdesivir should be discontinued immediately if ALT increases to 5 times ULN or greater during treatment (may be restarted when ALT falls below 5 times ULN), or if ALT elevation is accompanied by signs or symptoms of liver inflammation or increasing conjugated bilirubin, alkaline phosphatase, or INR.

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