French public health officials have reported serious adverse effects with the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, in patients with COVID-19, a disease caused by the novel coronavirus. Instead, they said patients could be treated with acetaminophen.
However, many doctors, particularly outside of France, said there is currently no enough evidence for such a recommendation.
For instance, the Spanish Ministry of Health agreed that there is no strong evidence that ibuprofen, or any other NSAID, aggravates COVID-19 infection. British doctors also agreed to it but they said acetaminophen could also be a better choice for the infection.
On Saturday, the French government reported “serious adverse events” linked to NSAIDs in people with COVID-19 infection. Shortly after, Olivier Véran, the Health Minister of France, tweeted, “Taking anti-inflammatory drugs (ibuprofen, cortisone…) could be an aggravating factor of the [COVID-19] infection.”
“If you have a fever, take paracetamol,” he added. “If you are already on anti-inflammatory drugs or in doubt, ask your doctor for advice.”
Paracetamol, which is a generic term for acetaminophen, is commonly used outside the United States.
Reckitt Benckiser, the manufacturer of the Nurofen (ibuprofen), said, “Appropriate use of ibuprofen and paracetamol is still currently being recommended by most European health authorities as part of the symptomatic treatment of COVID-19. Reckitt Benckiser is not aware of any evidence that ibuprofen adversely impacts the outcome in patients suffering from COVID-19 infection.”
“The company has neither received new safety information nor been involved in the evaluation of any adverse events regarding the use of ibuprofen in COVID-19.”
“As with any medicine, we would remind consumers and their caregivers to carefully read and follow the instructions provided on the packaging and in the patient information leaflet,” the company added.
Dr. Gregory Poland of Mayo Clinic said that without clarification of any new data detailing side effects, additional risks of NSAIDs associated with COVID-19 infection are questionable.
He told Medscape Medical News, “I think there is far inadequate information to make a blanket statement like that [which the French Health Minister has made].”
“I think what [the French] are recommending is an overextension of the known concerns,” continued Dr. Poland. “I know of no published data on the use of NSAIDs with COVID-19 that represents any sort of unique risk.”
Dr. Poland noted, “There was an inappropriate inference of cause and effect. This is a mistake we commonly see — people will assume causality and more often than not, it’s not the case.”
Meanwhile, UK doctors agree that acetaminophen is a better choice over NSAIDs in people who are at risk of developing COVID-19.
Rupert Beale from Francis Crick Institute, London, said, “There is a good reason to avoid ibuprofen as it may exacerbate acute kidney injury brought on by any severe illness, including severe COVID-19 disease. There isn’t yet any widely accepted additional reason to avoid it for COVID-19.”
Dr. Poland noted that the French officials are also recommending against the use of corticosteroids (cortisone) in COVID-19.
He said, “Corticosteroids, though having a different mechanism of action than NSAIDs, are still non-inflammatory and therefore seem [ideal] to use in an inflammatory disease.”
“But the reasons for the recommendation against them is the observation that with SARS I, they not only did not improve the clinical course, but in fact appeared to have short-term and mid-term adverse effects in delaying viral clearance,” Dr. Poland added. However, doctors recommend that patients who take cortisone or other steroids for chronic medical conditions should not stop them.
