The position of ibuprofen in Covid-19

GP in Cavan Dr. Sinead Beirne helps clear the confusion around treating some Covid-19 symptoms

Dr. Sinead Beirne

IIt was noted on social media in the early stages of the Covid-19 pandemic1 Taking ibuprofen could make Covid-19 symptoms worse in people with the virus and advise people to take paracetamol for Covid-19 fever.

These messages and posts on social media, some of which are allegedly from doctors,2 led to Health Service Executive (HSE)2 To examine the available evidence and submit your own position on ibuprofen regarding Covid-19: Noting that there is essentially no scientific evidence linking the use of non-steroidal anti-inflammatory drugs (NSAIDs) to worsening symptoms of Covid-19 .

Despite official bodies that regularly correct such misinformation, a new survey was carried out3 Out of 1,044 adults in Ireland, a third of respondents said they found it difficult to determine fact or fiction during the pandemic – and worryingly, one in five have treatment for symptoms of pain (most commonly back pain, toothache and joint pain) due to confusion to take over pain medication (OTC).

This nationally representative survey also found that:

• 23 percent of people who ignored the pain symptoms had to see a doctor.
• A quarter weren't sure what to take to treat coronavirus-like symptoms.
• Exactly 41 percent were unsure whether ibuprofen could be used to relieve some of the recognized symptoms of the virus, such as fever, headache or sore throat, after reading or hearing conflicting advice on using ibuprofen.
• About 30 percent of parents weren't sure they could take ibuprofen because of possible coronavirus-like symptoms like fever and headache.

Ibuprofen and Covid-19: New guidelines
The confusion about ibuprofen for Covid-19 symptoms started in The Lancet4th on March 11, when an article suggested that ibuprofen use could make them worse.

The authors hypothesized that ibuprofen is used because the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to angiotensin converting enzyme 2 (ACE2) on the surface of a cell to gain access, and because ibuprofen has been shown to increase ACE2 could worsen symptoms in patients with Covid-19 by making it easier for the virus to enter cells.

The World Health Organization (WHO) 5 then warned against the use of ibuprofen in patients with Covid-19 on the basis of this Lancet article.

A day later, however, the WHO considered again:5 and stated, "Currently, based on the information currently available, WHO does not advise against the use of ibuprofen in patients with Covid-19."

The use of this double negative may have further increased patient confusion.

Since then, the HSE6th and National Health Service7th In the UK, both have published their own guidelines for patients.

The Commission's Medicinal Products for Human Use (CHM) working group on Covid-19 in the UK also came to the conclusion8th There isn't enough evidence to link the use of ibuprofen and other NSAIDs to being susceptible to contracting Covid-19 or making its symptoms worse.

The CHM expert working group also stated that patients who have been prescribed NSAIDs to treat a long-term illness should continue to take these drugs as needed.

More recently, the UK has published the Medicines and Health Products Regulatory Authority (MRHA) and the National Institute for Health and Care Excellence (NICE)9 A joint statement says that patients can take acetaminophen or ibuprofen if they are treating themselves with symptoms of Covid-19 such as fever and headache.

Of course, all authorities will continue to monitor the situation to inform doctors and patients of new evidence that becomes available.

Clarifying information to patients
There is currently no evidence that could prevent the use of paracetamol or NSAIDs in patients with Covid-19. Until there is enough scientific evidence to support the use or avoidance of NSAIDs in patients with Covid-19, we should (as always) make our best judgment on the use of NSAIDs. Consider the risks and benefits for each patient; B. The following patient-specific factors and advise accordingly:

• Is the patient on chronic NSAID therapy ?;
• Does the patient have any comorbidities or risk factors that would prevent you from using NSAIDs?
• What are the patient's individual risk factors, including a history of cardiovascular or gastrointestinal disorders or known kidney problems?
• Patients should use the lowest available dose of an NSAID for the shortest amount of time necessary to control symptoms.
• Adult patients who are regularly receiving low-dose aspirin for cardiovascular prevention purposes should continue to take it.
• All suspected side effects should be reported.
• Patients should always remember to read the product information and labeling that comes with every medicine they take to treat symptoms, and if they have any questions, ask their doctor or pharmacist. • •

In collaboration with Reckitt Benckiser.

References

1. https://www.hse.ie/eng/services/news/media/pressrel/advice-about-anti-inflammatory-medication-and-covid-19.html.
2. https://www.breakingnews.ie/ireland/hse-warns-of-fake-message-on-coronavirus-988137.html.
3. Study conducted by Toluna Insights of 1,044 adults in the Republic of Ireland, including 454 adults with children under 18, in May 2020.
4. https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf.
5. https://www.sciencealert.com/who-recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms.
6. https://www.hse.ie/eng/services/news/media/pressrel/advice-about-anti-inflammatory-medication-and-covid-19.html.
7. https://www.nhs.uk/medicines/ibuprofen-for-adults/.
8. https://www.gov.uk/government/news/commission-on-human-medicines-advice-on-ibuprofen-and-coronavirus-covid-19.
9. https://medicines.necsu.nhs.uk/covid-19-ibuprofen-nsaids-advice-from-nice-mhra-nhsei/.