Gastrointestinal and hepatic manifestations of COVID-19 infection: Lessons for practitioners

Table 6 Commonly administered pharmacotherapy for coronavirus disease 2019 and their gastrointestinal adverse effects[162]

Drug	Proposed mechanism in COVID-19	GI side effects	Hepatic side effects	Pancreatic side effects
Remdesivir	Inhibitor of viral RNA-dependent RNA polymerase.	Nausea, Vomiting, gastroparesis, GI bleeding	Increased LFTs	NA
Chloroquine and Hydroxychloroquine	Disruption of endosome-mediated viral entry and transport.	Nausea, vomiting, abdominal cramping	NA	NA
Lopinavir/Ritonavir	Protease inhibitor. Disrupts viral replication.	Diarrhea, nausea, vomiting	LFT elevation, hepatitis, worsening of underlying CLD	Pancreatitis
Ribavirin	Nucleoside analog inhibitor of viral RNA synthesis.	Nausea	NA	NA
Nitazoxanide	Increase production of type I IFNs enhancing antiviral activity.	Abdominal pain, nausea, diarrhea, acid reflux	NA	NA
Nelfinavir	HIV-1 protease inhibitor. Action against SARS-CoV-2 unclear.	Diarrhea, nausea, increased flatulence	LFT elevation	NA
INF-α	Enhances cell mediated immune response against the virus.	NA	Auto-immune hepatitis	NA
Barcitinib	JAK inhibitor. Downregulation of hyper-inflammatory state seen in severe disease.	Nausea	LFT elevation	NA
Tocilizumab	IL-6 inhibitor. Downregulation of hyper-inflammatory state seen in severe disease.	Gastrointestinal perforation in patients on high dose steroids or history of diverticulitis	LFT elevation	NA

LFT: Liver function test; SARS-CoV-2: Severe acute respiratory syndrome coronavirus-2; IFN: Interferon; HIV: Human immunodeficiency viruses; CLD: Chronic liver disease; GI: Gastrointestinal; NA: Not applicable.