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Indomethacin: Can It Counteract Bradykinin Effects in COVID-19 Patients?

Alkotaji et al., Current Pharmacology Reports, doi:10.1007/s40495-021-00257-6
Apr 2021  
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Hypothesis that indomethacin will be beneficial for COVID-19 induced dry cough, via inhibition of the cyclooxygenase enzyme and reducing the level of inflammatory mediator bradykinin.
Alkotaji et al., 22 Apr 2021, peer-reviewed, 2 authors.
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Indomethacin: Can It Counteract Bradykinin Effects in COVID-19 Patients?
Myasar Alkotaji, Radhwan N Al-Zidan
Current Pharmacology Reports, doi:10.1007/s40495-021-00257-6
COVID-19 represents the biggest health challenge. Although the mortality rate of COVID-19 is low, the high numbers of infected people and those with post-COVID-19 symptoms represent a real problem for the health system. A high number of patients with COVID-19 or people recovered from COVID-19 suffer from a dry cough and/or myalgia. Interestingly, an imbalance in bradykinin was observed in COVID-19 patients, which might be due to the accumulation of bradykinin as a result of a reduction in the degradation of bradykinin. This finding inspired the idea of possible similitude between the dry cough that is induced by angiotensin-converting enzyme inhibitors and the COVID-19-induced dry cough. Both of these types of cough are mediated, at least partially, by bradykinin. They both manifested as a persistent dry cough that is not responded to traditional dry cough remedies. However, several drugs were previously investigated for the treatment of angiotensin-converting enzyme inhibitor-induced dry cough. Here, we hypothesized that such treatment might be useful in COVID-19-induced dry cough and other bradykinin-related symptoms such as generalized pain and myalgia. In this article, evidence was presented to support the use of indomethacin as a potential treatment of COVID-19-induced dry cough. The choice of indomethacin was based on its ability to suppress the cyclooxygenase enzyme while also lowering the level of the inflammatory mediator bradykinin. Furthermore, indomethacin has been shown to be effective in treating angiotensin-converting enzyme inhibitor-induced dry cough. Moreover, indomethacin is a long-established, low-cost, effective, and readily available medication.
Declarations Ethics Approval and Consent to Participate Not applicable. Consent for Publication Not applicable. Conflict of Interest The authors declare that there is no conflict of interest.
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