Hepatotoxicity of Hydroxychloroquine

Hepatotoxicity Profile

Hydroxychloroquine is classified by the NIH LiverTox resource with a likelihood score of "D" (possible rare cause of clinically apparent liver injury), according to the American Gastroenterological Association 1

Patients with pre-existing liver disease, such as hepatitis or other hepatic diseases, should exercise caution when taking hydroxychloroquine, as it concentrates in the liver, as noted by the National Institutes of Health 1
Hydroxychloroquine can trigger hypersensitivity attacks with fever and marked serum aminotransferase elevations in patients with acute intermittent porphyria or porphyria cutanea tarda, as reported by the American Gastroenterological Association 1

The American Gastroenterological Association recommends checking baseline liver function tests on admission and monitoring throughout hospitalization, particularly in COVID-19 patients receiving potentially hepatotoxic drug therapy, including hydroxychloroquine 1

In COVID-19 treatment studies, 23% of patients experienced elevated hepatic enzymes, with 8% discontinuing treatment prematurely, half due to elevated aminotransferases, as reported by the American Gastroenterological Association 1

Hydroxychloroquine is associated with ALT elevation in less than 5% of patients 2, 3
It is rarely linked to aminotransferase elevations or clinically apparent liver injury 4, 5

Pre-existing liver disease increases the risk of hydroxychloroquine-induced hepatotoxicity 2, 3
Concomitant use with other hepatotoxic medications can increase the risk of liver enzyme elevations 2, 3
Alcohol misuse is a risk factor for hydroxychloroquine-induced liver injury 2

Abnormal liver function tests are not an absolute contraindication to hydroxychloroquine use, but regular monitoring is necessary 6, 7
In patients with COVID-19, liver function abnormalities may be due to multiple factors including the virus itself, its complications, or side effects of therapeutic drugs 6, 7