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Acetylcysteine for the Treatment of Suspected Remdesivir‐Associated Acute Liver Failure in COVID‐19: A Case Series
Author(s) -
Carothers Chancey,
Birrer Kara,
Vo Mai
Publication year - 2020
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2464
Subject(s) - medicine , acetylcysteine , coagulopathy , septic shock , acetaminophen , coronavirus , liver failure , pneumonia , respiratory failure , encephalopathy , hepatic encephalopathy , coronaviridae , gastroenterology , covid-19 , anesthesia , disease , cirrhosis , sepsis , infectious disease (medical specialty) , biochemistry , chemistry , antioxidant
Remdesivir is a direct‐acting nucleoside RNA polymerase inhibitor with activity against the novel severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) virus used in the treatment of coronavirus disease 2019 (COVID‐19) pneumonia. Here, we present two cases of suspected remdesivir‐associated acute liver failure (ALF) in which the liver failure improved after continuous infusion acetylcysteine and withdrawal of remdesivir. Both patients had significant increases in transaminases between day 3 and day 10 of remdesivir therapy accompanied by coagulopathy and encephalopathy. After initiation of continuous infusion acetylcysteine, the transaminases of both patients rapidly improved. Ultimately, one patient fully recovered while the other died of suspected septic shock. Due to its novel nature and only recent widespread use, there are very little data on the risk of ALF from remdesivir. Additionally, the data for the use of acetylcysteine to manage non‐acetaminophen‐induced ALF are limited. It is important to consider the risk of remdesivir‐associated ALF when weighing the risk versus benefits of use, and acetylcysteine may have a role in its management.