Recommendations for Dosing of Repurposed COVID-19 Medications in Patients with Renal and Hepatic Impairment

Marra, Fiona ORCID: 0000-0003-1326-1149, Smolders, Elise J, El-Sherif, Omar, Boyle, Alison, Davidson, Katherine, Sommerville, Andrew J, Marzolini, Catia, Siccardi, Marco ORCID: 0000-0002-3539-7867, Burger, David, Gibbons, Sara
et al (show 2 more authors) (2021) Recommendations for Dosing of Repurposed COVID-19 Medications in Patients with Renal and Hepatic Impairment. DRUGS IN R&D, 21 (1). pp. 9-27.

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<h4>Introduction</h4>In December 2019, an outbreak of a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began, resulting in a number of antivirals and immune modulators being repurposed to treat the associated coronavirus disease 2019 (COVID-19). Many patients requiring treatment for COVID-19 may have either pre-existing renal or hepatic disease or experience acute renal/hepatic injury as a result of the acute infection. Altered renal or hepatic function can significantly affect drug concentrations of medications due to impaired drug metabolism and excretion, resulting in toxicity or reduced efficacy. The aim of this paper is to review the pharmacokinetics and available study data for the experimental COVID-19 therapies in patients with any degree of renal or hepatic impairment to make recommendations for dosing.<h4>Methods</h4>COVID-19 agents included in these recommendations were listed as primaries on the University of Liverpool COVID-19 drug interaction website ( ), initially identified from and A literature search was performed using PubMed and EMBASE as well as product licences and pharmacokinetic databases.<h4>Findings</h4>Remdesivir, dexamethasone, azithromycin, favipiravir, lopinavir/ritonavir, atazanavir, hydroxychloroquine, interferon beta, ribavirin, tocilizumab, anakinra and sarilumab were identified as experimental drugs being used in COVID-19 trials as of November 2020. Limited study data was found for these drugs in patients with renal or hepatic impairment for COVID-19 or other indications. Recommendations were made based on available data, consideration of pharmacokinetic properties (including variability), the dosing and anticipated treatment duration of each regimen in COVID-19 and known toxicities.<h4>Conclusion</h4>Dosing of drugs used to treat COVID-19 in patients with renal or hepatic impairment is complex. These recommendations were produced to provide guidance to clinicians worldwide who are treating patients with COVID-19, many of whom will have some degree of acute or chronic renal or hepatic impairment.

Item Type: Article
Uncontrolled Keywords: Humans, Liver Diseases, Kidney Diseases, Hydroxychloroquine, Dexamethasone, Alanine, Adenosine Monophosphate, Antiviral Agents, Dose-Response Relationship, Drug, Clinical Trials as Topic, Drug Repositioning, COVID-19, COVID-19 Drug Treatment
Depositing User: Symplectic Admin
Date Deposited: 12 Jan 2021 10:40
Last Modified: 09 Feb 2023 21:15
DOI: 10.1007/s40268-020-00333-0
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