Liver dysfunction and SARS-CoV-2 infection

Table 2 Therapeutic management of patients with coronavirus disease 2019 and hepatotoxicity

Medication	Hepatotoxicity	Action mechanism	Currently recommended use for COVID-19
Hydroxychloroquine	Likelihood score: D (possible). Rare cause of clinically-apparent liver injury	Altered metabolism of other medications	Not recommended
Azithromycin	Likelihood score: A (well-known). Transient and asymptomatic elevation in serum aminotransferases; Typical cholestatic hepatitis	Unknown	Not recommended
Ivermectin	Likelihood score: D (possible). Mild elevation of serum aminotransferases; Reports of acute liver failure	Unknown	Not recommended
Dexamethasone	Likelihood score: A (well-known). Long-term use effects; Symptoms usually represent the worsening or triggering of an underlying liver disease	Drug-associated fatty liver disease	Recommended as emergency use
Remdesivir	Likelihood score: D (possible). Mild to moderate transient elevation of serum aminotransferases	Inhibition of mitochondrial RNA polymerase or idiosyncratic injury	Recommended as emergency use
Lopinavir/ritonavir	Likelihood score: D (possible). Moderate to severe elevation of serum aminotransferases (pattern hepatocellular to cholestatic or mixed); Duration 1-2 mo; Reports of acute liver failure; Caution in patients with co-infection by hepatitis B virus-hepatitis C virus-human immunodeficiency virus	Inhibits both of the isoforms of CYP3A del P450, which may result in production of a toxic intermediate	Not recommended
Baricitinib	Likelihood score: E (unlikely). Moderate transient elevation of serum aminotransferases (17% of patients); Hepatitis B reactivation	Unknown	Recommended as emergency use
Tocilizumab	Likelihood score: C (probably). Mild to moderate transient elevation of serum aminotransferases; Duration 8 wk	Unknown	Recommended as emergency use

COVID-19: Coronavirus disease 2019.