Hepatic Disorders and COVID-19: From Pathophysiology to Treatment Strategy

Table 2

Clinical symptoms and functions of drug-induced liver injury.

Drug	Clinical symptoms	Functions
Remdesivir	Elevated liver enzymes [92]	Hepatic dysfunction due to an association with P-GP inhibitors [93]
Methylprednisolone	Not reported	Modulation of cytokine cascades [52]
Tocilizumab	Elevates the serum ALT [26]	Alleviate inflammatory cytokines
		Acute liver disease
		Acute hepatitis liver transplantation in some cases [93]
Hydroxychloroquine	Not reported	Relieve inflammation caused by the disease [94–96]
Azithromycin	Hepatocellular [97]	(1) Induce acute liver injury within a few days of beginning therapy
		(2) Clinical signs of cholestatic hepatitis within 1 to 3 weeks of starting treatment [97, 98]
Interferon-beta	Elevated the ALT/AST/ALP serum [98]	Leads to asymptomatic and minor liver disorders [98]
Lopinavir	Significantly high level of serum’s aminotransferase [98]	Protease inhibitor [98]
Ritonavir	Causes self-limiting and asymptomatic elevated in liver enzymes [98]	Improve lopinavir levels by inhibiting the liver enzyme CYP450; as a consequence, CPY3A4 produces a toxic mediator of ritonavir or other metabolized factors, which causes liver disorders [94–96]
Baricitinib	Temporary elevate in transaminase enzyme levels [98, 99]	Inhibitor of JAK-1/2 [98, 99]
Oseltamivir	There is no enough detail about its	Effect on liver function [12]
Ribavirin	Extreme hemolysis [12]	Broad spectrum [12]
ACE inhibitors and ARBs	Promotes the levels of liver enzymes [89]	Not reported
Pirfenidone	Promotes the levels of liver enzymes [100]	(1) Suppress liver fibrosis
		(2) Increase the potential of liver disease [100]

mTOR inhibitors: mammalian target of rapamycin, P-GP: P-glycoprotein, ALT: alanine aminotransferase, ALT: alanine aminotransferase, ALP: alkaline phosphatase, CYP450: cytochrome P450, CPY3A4: cytochrome P450 3A4, JAK-1/2: Janus kinase 1/2, ACE: angiotensin-converting enzyme, and ARBs: angiotensin II receptor blockers.