Opinion Review
Copyright ©The Author(s) 2021.
World J Hepatol. May 27, 2021; 13(5): 522-532
Published online May 27, 2021. doi: 10.4254/wjh.v13.i5.522
Table 1 Impact of drugs currently used for the management of coronavirus disease 2019 on the liver
Mechanism of action
Impact on CLD management
RemdesivirViral RNA-dependent RNA polymerase inhibitorLiver toxicity possible; No liver relevant drug-drug interactions
Lopinavir/ritonavirProtease inhibitors mTOR inhibitors (sirolimus, everolimus) should not be co-administered; Close monitoring of drug level is required for calcineurin inhibitors (cyclosporine, tacrolimus); The risk of lopinavir-associated hepatotoxicity in patients with very advanced liver disease is low; Patients with decompensated cirrhosis should not be treated
TocilizumabHumanized monoclonal antibody targeting interleukin-6 receptorPatients with decompensated cirrhosis should not be treatedConsider risk of HBV reactivation
Methylprednisolone (steroids)Bind nuclear receptors todampen proinflammatory cytokinesThe risk of other infections (e.g., spontaneous bacterial peritonitis) and viral shedding may increase in patents with decompensated liver cirrhosis; Consider antimicrobial prophylaxis; Consider risk of HBV reactivation
FavipiravirGuanine analogue, RNA-dependent RNA polymeraseElevation of ALT and AST possible; No data in cirrhosis available