Can hydroxychloroquine (HCQ) cause liver cirrhosis?

From the Guidelines

Hydroxychloroquine is unlikely to cause cirrhosis, as it is rarely associated with severe liver injury or cirrhosis, according to the most recent and highest quality study available 1. While hydroxychloroquine may cause elevated liver enzymes in some patients, cases of severe liver injury or cirrhosis are uncommon. The medication is more frequently associated with other side effects such as retinal toxicity, cardiac issues, and skin reactions. Some key points to consider:

• Patients taking hydroxychloroquine typically undergo regular monitoring of liver function tests, especially during the initial months of treatment.
• If liver enzyme elevations occur, they are often mild and transient, resolving with dose adjustment or discontinuation of the medication.
• The mechanism by which hydroxychloroquine might affect the liver involves its accumulation in lysosomes and potential disruption of cellular processes.
• Patients with pre-existing liver disease should use hydroxychloroquine with caution and under close medical supervision, as stated in the study 1.
• The National Institute of Health LiverTox resource rates hydroxychloroquine with a likelihood score of D, indicating it is a possible rare cause of clinically apparent liver injury 1. It is essential for patients taking hydroxychloroquine to undergo regular monitoring with their healthcare provider, but developing cirrhosis solely from this medication is not a common outcome, as supported by the study 1.

From the Research

Hydroxychloroquine and Liver Damage

• Hydroxychloroquine has been associated with hepatotoxicity, as evidenced by a case report of a patient with COVID-19 who exhibited a 10-fold increase in serum levels of transaminases after being administered hydroxychloroquine 2.
• Another study reported a case of hydroxychloroquine-induced toxic hepatitis in a patient with systemic lupus erythematosus, which rapidly returned to normal after cessation of the medication 3.
• However, there is no direct evidence to suggest that hydroxychloroquine can cause cirrhosis.

Liver Damage and Rheumatoid Arthritis

• Liver damage is a common complication in patients with rheumatoid arthritis, and can progress to cirrhosis in some cases 4.
• Medications used to treat rheumatoid arthritis, including hydroxychloroquine, can be hepatotoxic and may contribute to liver damage 4.

Hydroxychloroquine and Liver Protection

• One study found that hydroxychloroquine may have a protective effect on the liver by reducing lymphocyte infiltration and promoting antioxidant enzyme expression 5.
• However, this study was conducted in mice and more research is needed to confirm these findings in humans.

Toxicity of Hydroxychloroquine

• Hydroxychloroquine can be toxic in high doses, and has been associated with significant morbidity and mortality due to cardiovascular effects and electrolyte derangements 6.
• Emergency clinicians should be aware of the potential toxicity of hydroxychloroquine and take steps to manage and prevent it 6.