WHO: No evidence to avoid Ibuprofen if suffering symptoms of COVID-19


The World Health Organization and other leading agencies say there is no evidence to support the suggestion that ibuprofen might worsen the symptoms of COVID-19.


Why the confusion?

The confusion started on the 18th March 2020 when the French Health Minister Olivier Veran highlighted a recent study in The Lancet medical journal that hypothesised that an enzyme boosted by anti-inflammatory drugs such as ibuprofen could facilitate and worsen COVID-19 infections. WHO said earlier this week that it did a quick review and found no published research or data on the issue. It also checked with doctors treating coronavirus patients.

This link has  also now been ruled out by the EMA (the European Medicines Agency), the UN health Agency and the Food and Drugs Administration (FDA) in the USA. The U.N. health agency said it was "not aware of reports of any negative effects of ibuprofen, beyond the usual known side effects." It added that it was not recommending against using ibuprofen for the treatment of fever in people with COVID-19.

According to Dr. Dominic Hegarty (Clinical Director of Pain Relief Ireland and Senior Lecturer at the Department of Pharmacology & Therapeutic UCC) these drugs are among the most widely used and generally have a safe track record, particularly when used temporarily during self-limited infections or injury. For many individuals with chronic pain conditions Non-Steroidal Anti-inflammatory drugs (NSAIDS), of which ibuprofen in one such product, are very important agents. Individuals have contacted us in relation to stopping the agents “in case they get COVID-19”. We have given the reassurance they need.


Is there a rationale for the concern?

NSAIDs work by inhibiting the production of biomolecules 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 Dr. Hegarty.

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 or in pain. 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.


Pharmaceutical opinion

A spokesperson for British pharmaceutical company Reckitt Benckiser, which makes Nurofen, has been reported as stating  that the company was aware of concerns raised about "the use of steroids and non-steroidal anti-inflammatory (NSAIDs) products, including ibuprofen, for the alleviation of COVID-19 symptoms."

"Consumer safety is our number one priority," the spokesperson said, stressing that "ibuprofen is a well-established medicine that has been used safely as a self-care fever and pain reducer, including in viral illnesses, for more than 30 years."

"We do not currently believe there is any proven scientific evidence linking over-the-counter use of ibuprofen to the aggravation of COVID-19," the statement said.

The spokesperson said Reckitt Benckiser was "engaging with the WHO, EMA (the European Medicines Agency) and other local health authorities" on the issue and would provide "any additional information or guidance necessary for the safe use of our products following any such evaluation."


Conclusion

“For now, there is not enough evidence to recommend that patients who take NSAIDs for medically-indicated reasons should change their behaviour in the face of this new pandemic,” Dr. Hegarty 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. Elderly individuals may be more at risk to the side effects so greater attention to the dosage would be wise.

It’s also important not to overuse over-the-counter pain- and fever-relievers. There are several ibuprofen based products available and individuals should be alert to the possible over dosing that might inadvertently occur.

Mild cases of COVID-19, the illness caused by SARS-CoV-2, seem to last about two weeks; longer for more severe symptoms. Keeping a supply of a fever- and pain-relieving medication such as paracetamol 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.

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