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Ibuprofen for COVID-19
14 studies with >50,000 patients
Serious outcome risk
Ibuprofen
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COVID-19 Ibuprofen studies · October 2026
Concerns have been raised over potential harm with the use of ibuprofen for COVID-191 due to the suppression of beneficial immune and inflammatory responses during early infection, ACE2 upregulation, and delaying further care. There is limited clinical data currently, especially with regard to acute usage at the onset of infection. Ibuprofen was adopted in 16 countries. Recent:
Vasilkova.
Covid Analysis Ibuprofen for COVID-19: real-time meta-analysis of 14 studies (Version 12)
Meta-analysis using the most serious outcome reported shows 1% [-9‑9%] lower risk, without reaching statistical significance. 4 studies from 4 independent teams in 4 countries show significant benefit. Concerns have been raised..
Jun 2
 Vasilkova et al., Pharmacology & Pharmacotherapy, doi:10.46393/27132129_2026_2_86-92 Course of COVID-19 in children under one year of age depending on the type of antipyretic therapy at the pre-hospital stage
38% lower ICU admission (p=0.53) and 16% lower progression (p=0.22). Retrospective 86 infants under 1 year old comparing pre-hospital antipyretic therapy with Viburcol, paracetamol, and ibuprofen. No statistically significant differences were found between groups for hospitalization duration, disease sever..
Dec 8
2024
 Miele et al., medRxiv, doi:10.1101/2024.12.07.24318645 Effect of background therapy with Non-steroidal anti-inflammatory drugs (NSAIDs) and other anti-inflammatory agents on COVID-19 outcomes
Retrospective 485,779 osteoarthritis patients in the US showing lower mortality with non-aspirin NSAIDs and celecoxib, and higher mortality with aspirin. Aspirin was associated with higher hospitalization in COVID-positive and COVID-negat..
Feb 2
2024
 Moshawih et al., Heliyon, doi:10.1016/j.heliyon.2024.e25734 Evaluating NSAIDs in SARS-CoV-2: Immunomodulatory mechanisms and future therapeutic strategies
Review of NSAIDs and their complex immunomodulatory roles in SARS-CoV-2 infection. Authors discuss the mechanisms by which NSAIDs impact viral replication, immune responses, and inflammation. They note NSAIDs can reduce neutrophil recruit..
Jan 3
2024
 Stuart et al., BMJ Open, doi:10.1136/bmjopen-2023-077365 NSAID prescribing and adverse outcomes in common infections: a population-based cohort study
219% higher combined mortality/hospitalization (p<0.0001). Retrospective 142,925 outpatients in the UK showing significantly higher risk of hospitalization or death with prescription of NSAIDs for respiratory tract infections (RTI) or urinary tract infections (UTI). Practice-level analysis also f..
Oct 18
2023
 Marjaneh et al., Journal of Infection, doi:10.1016/j.jinf.2023.10.009 Analysis of blood and nasal epithelial transcriptomes to identify mechanisms associated with control of SARS-CoV-2 viral load in the upper respiratory tract
Blood and nasal epithelial transcriptomic analysis suggesting potential benefits of several treatments including: Vitamin E: transcriptomic analysis revealed that the AIPL1 module, which contains genes connected to vitamin E (α-tocopherol..
May 16
2023
 Zurita-Lizza et al., Clinical and Translational Discovery, doi:10.1002/ctd2.204 Repurposing Inhaled Ibuprofenate, a Non Steroidal Anti‐Inflammatory Drug, as a Potential Adjuvant Treatment for Pneumonia, CARDS and its Aetiological Agent SARS‐CoV‐2
Review of the potential mechanisms of action and therapeutic effects of inhaled sodium ibuprofenate for the treatment of COVID-19 pneumonia. Authors describe potential anti-inflammatory, immunomodulatory, antiangiogenic, and virucidal eff..
Apr 19
2023
 Sobhy et al., The Open Anesthesia Journal, doi:10.2174/25896458-v17-e230403-2022-26 Early Use of Ibuprofen in Moderate Cases of COVID-19 Might be a Promising Agent to Attenuate the Severity of Disease: A Randomized Controlled Trial
52% lower ICU admission (p=0.05), 52% lower need for oxygen therapy (p=0.05), and 26% shorter hospitalization (p=0.01). RCT 180 moderate hospitalized COVID-19 patients in Egypt, showing lower ICU admission and shorter hospitalization with ibuprofen compared with acetaminophen.
Dec 31
2022
 Kalayan et al., European Journal of Respiratory Medicine, doi:10.31488/EJRM.132 Safety and Efficacy of Nebulised Anti-Inflammatory Solution of Alkaline Hypertonic Ibuprofen (AHI) for Treatment of SARS-Cov-2 Infection: A Compassionate Study with a Comparator Arms
79% lower mortality (p=0.0009). Retrospective 99 COVID-19 patients in Argentina showing significantly lower mortality with inhaled alkaline hypertonic ibuprofen (AHI) treatment. The treatment has a pH of 8.5. 3 times daily for 7-10 days.
Sep 24
2022
 Mattiuzzi et al., Hospital Pharmacy, doi:10.1177/00185787221125721 How Much has COVID-19 Contributed to Increase the Worldwide Consumption of Paracetamol and Ibuprofen? Evidence From an Infodemiological Analysis
Infodemiological analysis showing a significant worldwide increase in Google searches for paracetamol (54%) and ibuprofen (24%) during the COVID-19 pandemic compared to pre-pandemic levels, suggesting dramatically increased consumption.
Aug 16
2022
 Loucera et al., Virology Journal, doi:10.1186/s12985-023-02195-9 (date from preprint) Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments
48% lower mortality (p=0.002). Retrospective 15,968 COVID-19 hospitalized patients in Spain, showing lower mortality with existing use of several medications including metformin, HCQ, azithromycin, aspirin, vitamin D, vitamin C, and budesonide. Since only hospitalized ..
Jul 13
2022
 Xie et al., Drugs, doi:10.1007/s40265-022-01822-z (date from preprint) Risk of COVID-19 Diagnosis and Hospitalization in Patients with Osteoarthritis or Back Pain Treated with Ibuprofen Compared to Other NSAIDs or Paracetamol: A Network Cohort Study
12% higher hospitalization (p=0.26) and 8% more cases (p=0.25). PSM retrospective 1,697,522 osteoarthritis or back pain patients in the US, showing no significant differences in COVID-19 cases and hospitalization for ibuprofen vs. other NSAIDs.
Jun 17
2022
 Los et al., Nucleic Acids Research, doi:10.1093/nar/gkac513 Body temperature variation controls pre-mRNA processing and transcription of antiviral genes and SARS-CoV-2 replication
In vitro and hamster study showing that higher temperature reduces SARS-CoV-2 replication. Authors show a 1.5°C increase in temperature (from 36.5 to 38°C) enhanced the expression of antiviral genes. Elevated temperatures were found to re..
May 31
2022
 Calonico et al., National Bureau of Economic Research, doi:10.3386/w30084 Causal Inference During a Pandemic: Evidence on the Effectiveness of Nebulized Ibuprofen as an Unproven Treatment for COVID-19 in Argentina
49% lower mortality (p=0.01). Retrospective 5,146 hospitalized COVID-19 patients in Argentina, showing lower mortality associated with nebulized ibuprofen (NaIHS) treatment. Doubly robust inverse probability weighting estimators were used to control for confounding. A..
May 5
2022
 Campbell et al., PLOS ONE, doi:10.1371/journal.pone.0267462 Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen and relationship with mortality among United States Veterans after testing positive for COVID-19
no change in mortality (p=0.54). Retrospective 28,856 COVID-19 patients in the USA, showing no significant difference in mortality for chronic ibuprofen use vs. sporadic NSAID use. Since ibuprofen is available OTC and authors only tracked prescriptions, many patients cla..
Dec 31
2021
 Zhou et al., Computational and Structural Biotechnology Journal, doi:10.1016/j.csbj.2020.12.005 Temperature dependence of the SARS-CoV-2 affinity to human ACE2 determines COVID-19 progression and clinical outcome
In silico and in vitro study showing decreased SARS-CoV-2 binding affinity to the human ACE2 receptor at higher temperature (40°C vs. 37°C). Molecular dynamics simulations, surface plasmon resonance experiments, and pseudovirus cell entry..
Aug 30
2021
 Salva et al., Infectious Diseases and Therapy, doi:10.1007/s40121-021-00527-2 Reversal of SARS-CoV2-Induced Hypoxia by Nebulized Sodium Ibuprofenate in a Compassionate Use Program
45% lower mortality (p=0.009) and 14% shorter hospitalization (p<0.0001). Retrospective 383 hospitalized COVID-19 patients in Argentina showing signifcantly lower mortality and shorter hospital stay with nebulized sodium ibuprofenate compared to 195 contemporaneous controls. The treatment appears to be the same..
Aug 16
2021
 Leal et al., COVID, doi:10.3390/covid1010018 Paracetamol Is Associated with a Lower Risk of COVID-19 Infection and Decreased ACE2 Protein Expression: A Retrospective Analysis
3% fewer cases (p=0.29). UK Biobank retrospective showing no significant difference in cases with ibuprofen use.
Jul 31
2021
 Drake et al., The Lancet Rheumatology, doi:10.1016/S2665-9913(21)00104-1 Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC Clinical Characterisation Protocol UK cohort: a matched, prospective cohort study
10% lower mortality (p=0.36). Prospective study of 78,674 COVID-19 patients, showing no significant difference in mortality with ibuprofen use.
Apr 20
2021
 Reese et al., medRxiv, doi:10.1101/2021.04.13.21255438 Cyclooxygenase inhibitor use is associated with increased COVID-19 severity
9% lower mortality (p=0.65) and 303% higher severe cases (p<0.0001). N3C retrospective 250,533 patients showing higher COVID-19 severity with ibuprofen use. Note that results for individual treatments are not included in the journal version or v2 of this preprint.
Jan 21
2021
 Wong et al., Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-219517 Use of non-steroidal anti-inflammatory drugs and risk of death from COVID-19: an OpenSAFELY cohort analysis based on two cohorts
23% higher mortality (p=0.19). Retrospective 2,463,707 people in the UK, showing no significant difference in COVID-19 mortality with NSAID use. Current NSAID users were defined as those ever prescribed an NSAID in the 4 months prior to study start, and non-users were ..
Nov 23
2020
 Wrotek et al., Evolution, Medicine, and Public Health, doi:10.1093/emph/eoaa044 Let fever do its job
Review of fever focusing on COVID-19. Authors note that fever is a key component of the acute phase response to infection. Fever enhances immune cell performance, induces cellular stress on pathogens, and acts synergistically with other s..
Nov 2
2020
 Abu Esba et al., Infectious Diseases and Therapy, doi:10.1007/s40121-020-00363-w Ibuprofen and NSAID Use in COVID-19 Infected Patients Is Not Associated with Worse Outcomes: A Prospective Cohort Study
170% higher mortality (p=0.35), 45% higher need for oxygen therapy (p=0.64), 18% higher hospitalization (p=0.64), and 85% higher severe cases (p=0.42). Prospective study of 503 COVID-19 cases in Saudi Arabia, 40 using ibuprofen during infection, and 357 not using NSAIDs, showing no significant differences in outcomes. Results are subject to confounding by indication.
Oct 21
2020
 Kragholm et al., Clinical and Translational Science, doi:10.1111/cts.12904 Association Between Prescribed Ibuprofen and Severe COVID-19 Infection: A Nationwide Register-Based Cohort Study
4% lower progression (p=0.78). Retrospective 4,002 COVID-19 patients in Denmark, 264 with ibuprofen prescriptions, showing no significant difference for COVID-19 severity.
Sep 30
2020
 Rinott et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2020.06.003 Ibuprofen use and clinical outcomes in COVID-19 patients
21% higher mortality (p=0.73), 12% higher ventilation (p=0.77), and 40% higher ICU admission (p=0.56). Retrospective 403 COVID-19 cases in Israel, showing no significant difference in outcomes with ibuprofen use. Patients were asked about ibuprofen use starting a week before diagnosis of COVID-19 - treatment time may have been early, late,..
Jul 13
2020
 Samimagham et al., Archives of Clinical Infectious Diseases, doi:10.5812/archcid.106847 The Association of Non-Steroidal Anti-Inflammatory Drugs with COVID-19 Severity and Mortality
100% higher mortality (p=0.001), 428% higher severe cases (p=0.0007), and 13% higher progression (p=0.04). Retrospective 158 COVID-19 patients in Iran, showing higher risk of mortality with ibuprofen use.
Jun 23
2020
 Choi et al., Journal of Clinical Medicine, doi:10.3390/jcm9061959 Clinical Characteristics and Disease Progression in Early-Stage COVID-19 Patients in South Korea
240% higher progression (p=0.26). Retrospective 293 patients in South Korea, showing higher risk of progression with ibuprofen use, without statistical significance.
Mar 17
2020
 Day, M., BMJ, doi:10.1136/bmj.m1086 Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists
Discussion of potential harms of ibuprofen use for COVID-19.
Dec 1
1990
 Graham et al., Journal of Infectious Diseases, doi:10.1093/infdis/162.6.1277 Adverse Effects of Aspirin, Acetaminophen, and Ibuprofen on Immune Function, Viral Shedding, and Clinical Status in Rhinovirus-Infected Volunteers
RCT examining the effects of aspirin, acetaminophen, and ibuprofen on immune function, virus shedding, and clinical symptoms in 60 healthy volunteers experimentally infected with rhinovirus type 2. The study found that aspirin and acetami..
Apr 30
1988
 Downing et al., Journal of Interferon Research, doi:10.1089/jir.1988.8.143 Hyperthermia in Humans Enhances Interferon-γ Synthesis and Alters the Peripheral Lymphocyte Population
Analysis of induced hyperthermia (high body temperature) showing 10 times greater interferon gamma (IFN-γ) production and increased natural killer cells. This response was observed at a core body temperature of ~39°C, highlighting its pot..
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