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Ibuprofen and COVID-19: a doctor’s guidance

Mar. 18, 2020, 2:06 PM

 

by Bill Snyder

Last week, France’s health ministry urged people who have been infected by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) to avoid taking over-the- counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen and aspirin because they might increase the severity of the infection. SARS-CoV-2 causes the illness COVID-19.

Infected people were advised to take acetaminophen (such as Tylenol) for relief of pain and fever instead.

However, there is no published or peer-reviewed data suggesting a potential interaction between NSAID use and SARS-CoV-2.

According to David Aronoff, MD, director of the Department of Medicine’s Division of Infectious Diseases at Vanderbilt University Medical Center and an expert on NSAID action, these drugs are among the most widely used and generally have a safe track record, particularly when used temporarily during self-limited infections.

David Aronoff, MD

NSAIDs work by blocking the production of small molecules called prostaglandins, which have many roles in regulating the human immune system and in the body’s response to infection.

“Some prostaglandins enhance our inflammatory response to infection, helping us fight invading microbes,” said Aronoff, Addison B. Scoville Jr. Professor of Medicine.

The proinflammatory actions of prostaglandins contribute to the generation of pain and fever that occur during infection. They are the primary reason NSAIDs are used so commonly when people are sick.

On the other hand, other prostaglandin molecules work to limit the strength and duration of the inflammatory response to infection, thereby preventing self-inflicted damage from our own immune response.

In fact, some prostaglandin compounds help with the resolution of inflammation and healing following infection.

When it comes to determining whether NSAIDs help or hinder the body’s response to infection, the data are mixed.

A 2016 retrospective study of patients in the United States who were hospitalized during the pandemic 2009 H1N1 influenza did not find any evidence of increased mortality in adults infected with influenza who were taking NSAIDs prior to hospitalization.

Following a previous outbreak caused by the SARS-CoV, which erupted in 2002, investigators made the surprising discovery that one NSAID, called indomethacin, could impair viral replication in the lab and resulted in enhanced clearance of the virus from infected animals that received the NSAID compared to those that did not.

However, in that study NSAIDs other than indometh-acin, such as aspirin, did not show the same results, suggesting a unique feature of indomethacin. No human studies have been done to confirm any beneficial effect of indomethacin on SARS-CoV-2 infection.

Health professionals thus cannot say whether NSAID use before or during SARS-CoV-2 infection has either a positive or a negative impact on patient outcome, Aronoff said.

“For now, there is not enough evidence to recommend that patients who take NSAIDs for medically-indicated reasons should change their behavior in the face of this new pandemic,” he added.

However, because NSAIDs can cause kidney damage and stomach ulceration in some patients, it is a good idea to avoid their use in critically ill patients or sick persons who have pre-existing kidney dysfunction or stomach ulcer disease.

It’s also important not to overuse over-the-counter pain- and fever-relievers, Aronoff said.

Mild cases of COVID-19, the illness caused by SARS-CoV-2, seem to last about two weeks; longer for more severe symptoms. Keeping one bottle of a fever- and pain-relieving medication such as acetaminophen or ibuprofen on hand should be plenty.

While these medications are generally safe, patients should consult with their health professional or pharmacist, particularly if they are already taking other medications, since medications can interact.

In addition, some medications that appear to be different contain the same drug. Acetaminophen, for example, is found in combination products like Theraflu, Excedrin and Nyquil. If used in excess, acetaminophen can harm the liver.

“As the COVID-19/SARS-CoV-2 story unfolds and we learn more about factors that affect patient outcomes, we will be better positioned to guide the use of medicines such as NSAIDs in this setting,” Aronoff said.

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