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

With the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic posing a global health emergency, selfmedication 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).

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.

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.".

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