Liver flare up due to Ivermectin?

By Editorial Team
Ivermectin, an antiparasitic medication metabolized primarily by the liver, has been associated with rare cases of liver injury or "liver flare-ups," especially when used off-label or inappropriately. Although liver damage from ivermectin is uncommon, there are documented instances where it has caused clinically apparent liver injury, including severe drug-induced liver injury (DILI).


Evidence of Liver Injury Due to Ivermectin

  • Reported Cases: There are a few reported cases of ivermectin-induced liver injury. One documented patient developed jaundice and liver injury about 3 weeks after starting ivermectin for COVID-19 prevention. Liver biopsy showed significant inflammation, including portal triaditis, interface hepatitis, and cholestasis, consistent with DILI. This patient's liver enzymes improved after treatment with corticosteroids over several months, and liver function normalized long-term (2).
  • Histological Findings: Liver biopsies in such cases reveal moderate to severe inflammation involving lymphocytes, plasma cells, histiocytes, and eosinophils, along with bile duct injury and cholestasis, indicating a mixed hepatocellular and cholestatic pattern of liver injury (2).
  • Severity and Outcomes: While some patients recover uneventfully, others may experience severe liver failure. A case report described acute liver failure in a patient who self-administered ivermectin at doses meant for animals, highlighting the risk of overdose or misuse (9).
  • Incidence and Risk Factors: Before the COVID-19 pandemic, ivermectin-induced liver injury was considered very rare and mostly mild, typically manifesting as transient elevations in liver enzymes. However, increased use during the pandemic, particularly for unapproved indications like COVID-19, has revealed more instances of serious hepatic adverse effects. Patients with pre-existing liver conditions, such as cirrhosis or hepatitis C, may be at higher risk (3,9).
  • Mechanism: The exact mechanism of ivermectin-induced liver injury is not fully understood but appears to involve immune-mediated inflammation and hepatocellular damage. The drug’s metabolism in the liver may trigger idiosyncratic reactions in susceptible individuals (2,3).

Symptoms of Liver Flare-Up or Damage from Ivermectin

Symptoms that may indicate liver involvement include:

  • Yellowing of the skin or eyes (jaundice)

  • Right upper abdominal pain

  • Fatigue and weakness

  • Nausea and vomiting

  • Dark urine

  • Elevated liver enzymes on blood tests (ALT, AST, bilirubin)45

Management

  • Discontinuation of ivermectin is essential if liver injury is suspected.

  • Monitoring liver enzymes and function tests is recommended, especially in patients with underlying liver disease or those taking ivermectin for off-label uses.

  • In severe cases, corticosteroids have been used to reduce liver inflammation successfully2.

  • Supportive care and, rarely, liver transplantation may be required in fulminant liver failure9.

Summary

  • Liver flare-ups or drug-induced liver injury from ivermectin are rare but documented adverse effects.

  • Most cases involve hepatocellular injury with inflammation and cholestasis.

  • Risk may increase with misuse, overdose, or pre-existing liver disease.

  • Symptoms include jaundice, abdominal pain, and elevated liver enzymes.

  • Prompt recognition, discontinuation of ivermectin, and medical management are critical for recovery.

If you or someone else experiences symptoms suggestive of liver problems after taking ivermectin, it is crucial to seek medical attention immediately for appropriate evaluation and treatment.

This information is based on clinical case reports, liver biopsy findings, and pharmacovigilance data from recent studies and reviews123459.

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