The Potential of Melatonin and N-Acetylcysteine on Remdesivir Induced Liver Injury in Covid 19 Patients

Karimi et al., Advances in Animal and Veterinary Sciences, doi:10.17582/journal.aavs/2023/11.3.404.409, IRCT20210926052586N2

Feb 2023

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RCT 70 hospitalized COVID-19 patients evaluating the effects of N-acetylcysteine (NAC) and melatonin on liver injury induced by remdesivir treatment. NAC 600mg twice daily and melatonin 6mg daily. All patients received remdesivir. Liver enzymes (AST, ALT, ALP) and CBC levels were measured on days 1, 3 and 6. Levels were lower in the treatment group but the differences were not statistically significant. The treatment group was older (63 vs. 55) and had more severe patients (24% vs. 8%). Authors recommend further studies with longer duration and different doses to establish if these antioxidants can reduce remdesivir hepatotoxicity.

Gérard, Zhou, Wu, Kamo, Choi, Kim show significantly increased risk of acute kidney injury with remdesivir.

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Study covers remdesivir, melatonin, and N-acetylcysteine.

1. Gérard et al., Remdesivir and Acute Renal Failure: A Potential Safety Signal From Disproportionality Analysis of the WHO Safety Database, Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2145.wiley.com, doi.org.

2. Zhou et al., Acute Kidney Injury and Drugs Prescribed for COVID-19 in Diabetes Patients: A Real-World Disproportionality Analysis, Frontiers in Pharmacology, doi:10.3389/fphar.2022.833679.frontiersin.org, doi.org.

3. Wu et al., Acute Kidney Injury Associated With Remdesivir: A Comprehensive Pharmacovigilance Analysis of COVID-19 Reports in FAERS, Frontiers in Pharmacology, doi:10.3389/fphar.2022.692828.frontiersin.org, doi.org.

4. Kamo et al., Association of Antiviral Drugs for the Treatment of COVID-19 With Acute Renal Failure, In Vivo, doi:10.21873/invivo.13637.iiarjournals.org, doi.org.

5. Choi et al., Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study, The Lancet Infectious Diseases, doi:10.1016/S1473-3099(24)00353-0.sciencedirect.com, doi.org.

6. Kim et al., Investigating the Safety Profile of Fast‐Track COVID‐19 Drugs Using the FDA Adverse Event Reporting System Database: A Comparative Observational Study, Pharmacoepidemiology and Drug Safety, doi:10.1002/pds.70043.wiley.com, doi.org.

Karimi et al., 13 Feb 2023, Double Blind Randomized Controlled Trial, placebo-controlled, Iran, peer-reviewed, mean age 63.4, 5 authors, trial IRCT20210926052586N2. Contact: mohamdarvishii@gmail.com.

This Paper Remdesivir All

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