Maharashtra has over a lakh actively-infected Covid-19 cases. (Representational)

At least 16,720 vials of Remdesivir have been used on Covid-19 patients until July 12 in Maharashtra since the pandemic began. Another 11,835 injections of Tocilizumab have been used to treat critical patients, data gathered from Food and Drug Administration shows.

The state has over a lakh actively-infected Covid-19 cases. The demand for the anti-viral drug Remdesivir, used in the early phase of admission to bring down the coronavirus load in a patient, and immunosuppressant Tocilizumab, used when patient is about to turn critical, has shot up in the last two weeks with an increasing number of doctors in smaller private hospitals and nursing homes prescribing it. A shortage has seen black marketeering of both drugs.

The supply is expected to smooth in a week, officials said. Maharashtra expects to receive 21,500 vials of Remdesivir in the next one week by manufacturer Hetero Healthcare and pharmaceutical company Cipla for both public and private sector hospitals. A stock of 9,000 injections of Tocilizumab will be supplied to the state by Cipla in the next one week, FDA officials said. Data shows there is a stock of 22,510 strips of Favipiravir in Mumbai, Pune, and Nagpur. Favipiravir is an anti-viral that is used for mildly ill Covid-19 patients to reduce the viral load. BMC alone has a stock of 5,000 strips. Each strip has 34 tablets.

Remdesivir, Favipiravir, Itolizumab, and Tocilizumab remain investigational drugs for Covid-19 treatment. The state government has come out with a protocol to do away with unnecessary prescriptions to curb rampant use of these drugs in patients. According to the protocol, released on July 9, “Remdesivir use must be reserved for severe patients needing high flow nasal oxygen, non invasive ventilator or invasive ventilator”. The protocol for Tocilizumab states it is advisable for people aged up to 60 years, in intensive care unit, with evidence of cytokine storm, persistent fever above 101 degrees Fahrenheit and requiring oxygen at 6 litres per minute to maintain oxygen saturation levels in patients.

The task force formed by the state government in its meeting on Saturday also discussed the need to formulate a treatment protocol for investigational drugs and therapies like Remdesivir, Tocilizumab, Favipiravir and plasma. A doctor, part of the committee, said they have noticed a sudden spike in doctors prescribing this medicine in even cases where it is not required.

“Drugs like Remdesivir and Tocilizumab must be prescribed for severe cases. Doctors are prescribing it more often, agreed, but even patients’ families insist on these drugs. A five-year-old boy’s family wanted to try Tocilizumab, I had to counsel them that it is not necessary,” said Dr Shahid Barmare, general physician in SRV Hospital.

With black marketing rampant, FDA commissioner Arun Unhale said they have started monitoring the supply chain right from manufacturer to carrying and forwarding agents to distributors to tap into available stock of these drugs. On July 10, a Mira Road chemist shop owner and his aide were arrested for selling Remdesivir at double cost at Rs 10,000 per vial. J B Mantri, holding charge of joint commissioner, said while Tocilizumab and Itolizumab can be sold directly to patients based on doctor’s prescriptions, Remdesivir can only be supplied directly to hospitals, not patients.

Sunil Bharadwaj, joint commissioner (vigilance), FDA, said, “Patients should avoid buying these drugs from unknown agents as the drug quality may be compromised.”