Table 4.

GI side effects of medications used for COVID-19

Type	Drug	Dosage	Administration	GI side effects	References
Antivirals	Remdesivir (in phase 3 clinical trials)	Not needing invasive mechanical ventilation/ECMO: 5 d	Intravenous	1–10%: nausea, liver enzyme derangement, hyperbilirubinaemia	108–111
		Needs mechanical ventilation or ECMO: 10 d		Frequency not known: vomiting, gastroparesis, rectal bleeding
		Loading dose 200 mg over 30–120 min on day 1 followed by 100 mg once daily for remaining 4–9 d
	Lopinavir/ritonavir (Kaletra)	400/100 mg twice daily or 800/200 mg once daily for 14 d	Oral (administer with or without food)	1–10%: abnormal appetite, diarrhoea, nausea, vomiting, dry mouth, GI discomfort, GI disorders, hepatic disorders, pancreatitis	112,113
				0.1–1%: cholangitis, constipation, hyperbilirubinaemia
	Ribavirin (in phase 2 clinical trials)	400 mg twice daily for 14 d (in clinical trials), dosing not defined	Oral (administer with food)	1–10%: decreased appetite, constipation, diarrhoea, nausea, vomiting, dry mouth, GI discomfort, GI disorders, throat pain	114
				0.1–1%: hepatic disorders
				<0.1%: cholangitis, hepatic failure, pancreatitis; frequency not known: tongue discolouration, ulcerative colitis
	Favipiravir	1800 mg twice daily on day 1 followed by 800 mg twice daily on day 2 to maximum of 14 d	Oral	1–10%: hyperuricaemia (5%), diarrhoea (5%), liver enzyme derangement (2%)	115,116
	Oseltamivir	75 mg twice daily for 5 d	Oral	1–>10%: nausea, vomiting, GI discomfort	117
				<0.1%: GI haemorrhage (children), hepatic disorders
	Arbidol	For prevention, 200 mg once a day	Oral	Diarrhoea, nausea, vomiting, deranged liver enzymes	118
		Therapeutic dose 600 mg/d (200 mg three times/d) for 5 d
Immunomodulatory	Interferon-α/β	Interferon-1β 0.25 mg alternated for 3 d (in clinical trials), dosing not established	Subcutaneous injection	1–>10%: low appetite, diarrhoea, nausea, vomiting	108
				0.1–1%: hepatic disorders, autoimmune hepatitis
				<0.1%: haemolytic uraemic syndrome, pancreatitis
				Frequency not known: abdominal pain, constipation
	Tocilizumab	4–8 mg/kg (maximum 800 mg) over 1 h or 400 mg once	Intravenous infusion	1–>10%: abdominal pain, GI disorders, oral disorders	108
		Consider additional dose 8–12 h later if continued clinical decompensation (maximum of 2 doses)		Frequency not known: hepatic disorders
	Sarilumab (Kevzara) IL-6 inhibitor	400 mg	Intravenous	1–10%: liver enzyme derangement	119
	Baricitinib (completed clinical trial)	4 mg once daily baricitinib+antiviral therapy administration for 2 weeks	Oral	1–>10%: nausea	120,121
				Frequency not known: abnormal liver enzymes
Antiparasitic	Nitazoxanide	500 mg twice daily (duration not specified)	Oral (administer with or without food)	1–10%: abdominal pain (8%), diarrhoea (2%), nausea (3%), vomiting (1%)	108
				<1%: increased ALT, anorexia, increased appetite, flatulence, salivary gland enlargement
	Chloroquine	500 g twice daily for 10 d	Oral (administer with food)	<0.1%: hepatitis	109
				Frequency not known: abdominal pain, GI disorders, nausea, diarrhoea, vomiting, metallic taste
	Hydroxychloroquine	Loading dose of 400 mg twice daily for 1 d, followed by 200 mg twice daily for 4 d	Oral (administer with food)	1–>10%: low appetite, diarrhoea, nausea, vomiting, abdominal pain	108
				Frequency not known: acute hepatic failure
Steroids	Dexamethasone	6 mg daily for 7–10 d	Intravenous	1–>10%: GI discomfort, peptic ulcer, nausea	122–124
				0.1–1%: increased appetite, pancreatitis
	Methylprednisolone	0.5–1 mg/kg/day in two divided doses	Intravenous	1–>10%: GI discomfort, peptic ulcer, nausea	125–127
				0.1–1%: increased appetite, pancreatitis
				Frequency not known: diarrhoea, vomiting
	Budesonide	Levamisole 50–100 mg every 8 h	Oral and inhaled	1–>10%: GI discomfort, peptic ulcer, nausea	128
		Budesonide+formoterol inhaled 1–2 puffs every 12 h		0.1–1%: increased appetite, pancreatitis
Immunoglobulins	IVIG with moxifloxacin	20–25 g/d (0.1–0.5 g/kg/day) for 5–15 d with moxifloxacin	Intravenous	1–>10%: low appetite, constipation (in adults), diarrhoea, GI discomfort (in adults), nausea, vomiting	129,130
				0.1–1%: antibiotic-associated colitis (in adults), low appetite (in children), GI discomfort (in children), hepatic disorder, gastritis
				<0.1%: antibiotic-associated colitis (in children), pancreatitis, abdominal pain

ALT: alanine transaminase; ECMO: extracorporeal membrane oxygenation.