Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists
, Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists
, , M., BMJ, doi:10.1136/bmj.m1086 (Review)
Discussion of potential harms of ibuprofen use for COVID-19.
Day et al., 17 Mar 2020, peer-reviewed, 1 author.
Abstract: BMJ 2020;368:m1086 doi: 10.1136/bmj.m1086 (Published 17 March 2020)
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Covid-19: ibuprofen should not be used for managing
symptoms, say doctors and scientists
Scientists and senior doctors have backed claims by France’s
health minister that people showing symptoms of covid-19
should use paracetamol (acetaminophen) rather than ibuprofen,
a drug they said might exacerbate the condition.
The minister, Oliver Veran, tweeted on Saturday 14 March that
people with suspected covid-19 should avoid anti-inflammatory
drugs. “Taking anti-inflammatory drugs (ibuprofen, cortisone
. . .) could be an aggravating factor for the infection. If you have
a fever, take paracetamol,” he said.
His comments seem to have stemmed in part from remarks
attributed to an infectious diseases doctor in south west France.
She was reported to have cited four cases of young patients with
covid-19 and no underlying health problems who went on to
develop serious symptoms after using non-steroidal
anti-inflammatory drugs (NSAIDs) in the early stage of their
symptoms. The hospital posted a comment saying that public
discussion of individual cases was inappropriate.
But Jean-Louis Montastruc, a professor of medical and clinical
pharmacology at the Central University Hospital in Toulouse,
said that such deleterious effects from NSAIDS would not be
a surprise given that since 2019, on the advice of the National
Agency for the Safety of Medicines and Health Products, French
health workers have been told not to treat fever or infections
Experts in the UK backed this sentiment. Paul Little, a professor
of primary care research at the University of Southampton, said
that there was good evidence “that prolonged illness or the
complications of respiratory infections may be more common
when NSAIDs are used—both respiratory or septic
complications and cardiovascular complications.”
He added, “The finding in two randomised trials that advice to
use ibuprofen results in more severe illness or complications
helps confirm that the association seen in observational studies
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is indeed likely to be causal. Advice to use paracetamol is also
less likely to result in complications.”
Ian Jones, a professor of virology at the University of Reading,
said that ibuprofen’s anti-inflammatory properties could
“dampen down” the immune system, which could slow the
recovery process. He added that it was likely, based on
similarities between the new virus (SARS-CoV-2) and SARS
I, that covid-19 reduces a key enzyme that part regulates the
water and salt concentration in the blood and could contribute
to the pneumonia seen in extreme cases. “Ibuprofen aggravates
this, while paracetamol does not,” he said.
Charlotte Warren-Gash, associate professor of epidemiology at
the London School of Hygiene and Tropical Medicine, said:
“For covid-19, research is needed into the effects of specific
NSAIDs among people with different underlying health
conditions. In the meantime, for treating symptoms such as
fever and sore throat, it seems sensible to stick to paracetamol
as first choice.”
Rupert Beale, an infectious diseases researcher at the Francis
Crick Institute, had a warning on cortisone, however. “Patients
taking cortisone or other steroids should not stop them except
on advice from their doctor,” he said.
The complex role that the immune system might play in
covid-19 disease has been..
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