Table 2 .

Potential liver side effects of currently and previously used medications in COVID-19

Class	Drug	Dosage	Administration	Liver side effects	References
Antivirals	Remdesivir (In phase 3 clinical trials)	Loading dose 200 mg over 30–120 minutes on day 1 followed by 100 mg once daily for remaining 4/9 days Not needing invasive mechanical ventilation/ECMO: for 5 days Needs mechanical ventilation or ECMO for 10 days	Intravenous	1–10%—liver enzyme derangement, hyperbilirubinemia	31, 32, 33, 34
	Paxlovid ((PF-07321332 150 mg and ritonavir 100 mg)	300 mg PF-07321332 (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) all taken together orally every 12 hours for 5 days	Oral	May cause liver damage because of ritonavir. No dosage adjustment is needed for patients with either mild (Child-Pugh Class A) or moderate (Child-Pugh Class B) hepatic impairment.	47
	Molnupiravir	800 mg (administered as four 200 mg capsules) taken orally every 12 hours with or without food for 5 days	Oral	N/A	48
	Lopinavir/ ritonavir (LPV/r) (Kaletra)	400/100 mg twice daily or 800/200 mg once daily for 14 days.	Oral (administer with or without food)	1–10%—hepatic disorders, cholangitis, hyperbilirubinemia	35
	Ribavirin (In phase 2 clinical trials)	400 mg twice daily for 14 days (in clinical trials)—dosing not defined	Oral (administer with food)	0.1–1%—Hepatic disorders Less than 0.1%—Cholangitis, hepatic failure	36
	Darunavir	1 pill of DRV/c (a single-tablet regimen containing 800 mg of darunavir and 150 mg of cobicistat) per day for 5 days	Oral	Moderate to severe elevations in serum aminotransferase levels (> 5 × ULN) in 3–10% of patients overall	37
	Favipiravir	1,800 mg twice daily on day 1 followed by 800 mg twice daily on days 2 to a maximum of 14 days	Oral	Liver enzyme derangement (2%)	38
Immunomodulatory drugs	Tocilizumab	4–8 mg/kg (maximum 800 mg) over 1 hour; or 400 mg once Consider an additional dose 8–12 hours later if continued clinical deterioration (maximum of 2 doses)	Intravenous	Frequency not known—Hepatic disorders	31
	Interferon α/β	INF-β-1b 0.25 mg alternated for 3 days (in clinical trial)—dosing not established	Subcutaneous injection	0.1–1%—Hepatic disorders, autoimmune hepatitis	31
	Baricitinib (completed clinical trial)	4 mg once daily	Oral	Frequency not known—Abnormal liver enzymes	39, 40
		Baricitinib + antiviral therapy administration for 2 weeks
	Imatinib	400 mg daily for 14 days	Oral	Common elevations in serum aminotransferase levels mild elevations in serum bilirubin can occur. These abnormalities are usually mild, asymptomatic, and resolve despite continuing therapy. Linked to rare instances of clinically apparent acute liver injury with jaundice.	41, 42
Antiparasitic	Chloroquine	500 mg twice/day for 10 days.	Oral (administer with food)	Less than 0.1%—Hepatitis	( 33
	Hydroxychloroquine	Loading dose of 400 mg twice daily for 1 day, followed by 200 mg twice daily for 4 days.	Oral (administer with food)	Frequency not known—Acute hepatic failure	31, 43
Steroids	Dexamethasone	6mg daily for 7–10 days	Oral	Frequency not known—Acute hepatic failure	44, 45
Antibiotic	Azithromycin	NA	NA	Low rate of acute, transient, and asymptomatic elevation in serum aminotransferases which occurs in 1–2% of patients treated for short periods, and a somewhat higher proportion of patients given azithromycin long term. Rarely cause clinically apparent liver injury.	46

ALT = alanine transaminase; ECMO = extracorporeal membrane oxygenation; INF-β = interferon-beta; LPV/r = lopinavir/ritonavir; NA = not applicable.