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So far, only two drugs have been approved for the treatment of COVID-19 in the EU and, like all other drugs, they have side effects.
The antiviral drug remdesivir has been fully developed and approved by the European Medicines Agency, EMA, this summer. In studies, the drug has been shown to cause common side effects such as nausea, headache, and rash. One in ten test subjects experienced transient increases in liver enzymes, indicating liver damage.
So far it has entered 1,500 reports of suspected adverse reactions to EMA affecting patients with covid. The most common are elevated liver enzymes, acute kidney damage, skin rash, and lung failure. The EMA has initiated an investigation into the suspected renal involvement of remdesivir.
According to Karl-Mikael Kälkner, developer of subject areas in the drug safety unit of the Agency for Medical Products, the number of notifications is usually higher for new substances compared to older ones. The system is there to find new unknown side effects.
– You can’t find all the unusual side effects in a study population, but you only see them when the drug starts to be used, he says.
The second drug covid, dexamethasone, is a cortisone preparation that suppresses inflammation so that the immune system does not attack the lung tissue. Dexamethasone is well proven and has been used as a treatment for other diseases for 60 years. Quite a few side effects are documented, but which ones occur is largely determined by the length of treatment. When the treatment time is relatively short, which is usually for patients with covidity, it is, among other things, high blood sugar.
– You should look for the effect on the sugar levels in the body. If a patient has diabetes, you need to monitor it closely, more insulin is often needed, says Karl-Mikael Kälkner.
Dexamethasone can also be tough on the gastrointestinal tract, with gastric ulcers and holes in the intestine as a result.
– It is probably not impossible that you can have these problems after a week of high dose treatment. You should watch out for that.
Another thing that doctors should be aware of is mental symptoms.
– You may feel a little dizzy from the cortisone, anxious, staring, and confused, even if you don’t have an underlying mental illness. Most people look a little at a high dose of dexamethasone.
The EMA has so far received 84 reports of suspected side effects in covid patients. These are mainly blood sugar disorders.
Dexamethasone is a proven old drug that has been around for 60 years.
Photo: Nati Harnik / AP
Infektionsläkaren Piotr Nowak Karolinska University Hospital believes that it can be difficult to distinguish side effects from symptoms of the disease itself. At the same time, he notes that the benefits outweigh the risks, as the side effects are transient and treatable.
Common side effects that doctors have observed with remdesivir are nausea and headaches. In some cases, they have also noticed liver effects.
– But it is difficult to generalize about the side effects of remdesivir because experience is limited. We treated about 40 patients with the drug during the fall, he says.
However, hundreds of covid patients have been treated with dexamethasone or other cortisone preparations.
– The side effects that appear mainly are the effect on sugar levels. At the same time, people with diabetes are at risk and already have high blood sugar when they enter. Your diabetes may get worse during treatment, but we have a chance to correct your blood sugar levels.
Doctors are aware that dexamethasone can cause stomach ulcers and generally use protective medications such as omeprazole during treatment.
In some cases, they have also experienced a psychological impact.
– Especially confusion in the elderly, but it can also appear in younger patients. Then you can adjust the dose or stop the medicine.
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