Drug Interaction Report

MONITOR: Coadministration of remdesivir with nephrotoxic agents may increase the plasma concentrations of its metabolites, GS-704277 and GS-441524, as well as the excipient, sulfobutylether-beta-cyclodextrin sodium (SBECD). Both GS-441524 and SBECD are primarily eliminated by the kidneys, thus renal impairment secondary to the use of nephrotoxic agents may reduce their clearance and increase the risk of accumulation. Exposures of GS-441524, GS-704277, and SBECD were up to 7.9-, 2.8-, and 21-fold higher, respectively, in adults with renal impairment compared to adults with normal renal function. However, these changes are not generally considered to be clinically significant. Safety data in pediatric patients with renal impairment is limited. Clinical data evaluating the use of remdesivir concurrently with another agent that causes nephrotoxicity are not available.

MANAGEMENT: Caution and additional monitoring may be advisable if remdesivir is used in patients who have recently received or are currently using potentially nephrotoxic agents. Some authorities recommend avoiding the concomitant use of remdesivir with drugs that can reduce renal function; as well as monitoring renal function prior to starting remdesivir and as clinically appropriate during treatment.

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.