Ivermectin-Induced Liver Injury Due to Self-Medication in SARS-CoV-2 Infection

Abstract

Background:

With the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posing a global health emergency, self-medication with ivermectin has been observed in certain Latin American countries. This study aimed to characterize the clinical features of liver injury associated with ivermectin when used as self-medication for treating  coronavirus disease 2019 (COVID-19).

Materials and Methods:

 We reviewed the clinical records of patients diagnosed with severe COVID-19 at the Emergency Room of Rebagliati Hospital in Lima, Peru, in March 2021. The criteria of the Drug-Induced Liver Injury (DILI) Expert Working Group and the Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method (CIOMS/RUCAM) were utilized to establish the diagnosis of drug-induced liver injury and assess causality, respectively.

Results:

We report five cases of ivermectin-induced liver injury (IILI), comprising four men and one woman, with a mean age of 49.3±12.3 years. The mean daily dose, duration, and total dose of ivermectin were 32.9±21.8 mg/day, 2.6 ± 0.6 days, and 89.6±71.4 mg, respectively. On average, IILI occurred 11±3.8 days after the initiation of treatment, and none of the cases developed jaundice. The mean levels of alanine aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase were elevated 8±4.4, 1.7±0.9, and 10.9±5.0 times above the upper limit of normal, respectively. Two patients exhibited a hepatocellular pattern, two had a mixed pattern, and one displayed a cholestatic pattern. All cases were classified as mild and achieved recovery. Causality assessment categorized four cases as "possible" and one case as "highly probable."

Conclusions:

The findings emphasize the need for further pharmacovigilance studies on IILI when used for COVID-19 treatment.