Inflammatory effect on the gastrointestinal system associated with COVID-19

Table 1 Side effects of most common drugs during coronavirus disease-2019 treatment

Pharmacological intervention	Mechanism of action	Adverse effects	Ref.
Hydroxychloroquine	Elevated endosomal pH; Disruption of lysosome-endosome fusion. Inhibition of cell-virus fusion when interacting with N-terminal domain of the SARS-CoV-2 peak	Q-T segment prolongation; Gastrointestinal Adverse Effects	[62-64]
Chloroquine	Inhibits RNA-dependent polymerases, decreases endosomal iron release required for DNA replication, and inhibits glycosylation of viral envelope glycoproteins	Gastrointestinal adverse effects; visual and extrapyramidal disturbances; Arrhythmogenic cardiotoxicity	[65-67]
Remdesivir	Transcription Inhibitor	Caution in patients with severe renal impairment [estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73] or severe liver disease	[68]
Lopinavir/Ritonavir	Lopinavir binds to the viral protease and prevents the cleavage of the Gag-Pol polyprotein, resulting in the production of non-infectious immature viral particles. Ritonavir increases the plasma concentration of lopinavir by inhibiting the metabolism of cytochrome P450 3A (CYP3A)	Gastrointestinal adverse effects	[64,65,68-72]
Ribavirin	Interferes with RNA polymerase and viral protein synthesis	Hemolytic anemia; Leukopenia; Teratogenic	[68]
Interferon	Degradation of viral RNA; Alteration of RNA transcription; Inhibition of protein synthesis and apoptosis	Worsening psychiatric conditions, cytopenia, and uncontrolled seizures	[68]
Cortocosteroids, dexametasone	Inhibitor of the inflammatory process	Impair the immune response; Bacterial pneumonia risk; Hyperglycemia; Osteoporosis; Hypertension	[68-70]
Azithromycin	Bacteriostatic antibiotics; Anti-inflammatory effects Immunomodulatory effects	QTc with the risk of arrhythmias	[71,73]
Heparin	Antiplatelet	Risk GI symptoms; Bleeding; Heparin-induced thrombocytopenia	[74]
Favipiravir	Competitive inhibitor of RNA-dependent RNA polymerase	GI adverse effects; liver injury	[75,76]

SARS-CoV-2: Severe acute respiratory syndrome-coronavirus-2; GI: Gastrointestinal.