APhA coronavirus watch: NSAIDs okay for COVID-19 patients

After a research article published in Lancet on March 11 indicated that the use of ibuprofen may worsen the symptoms of COVID-19, and the subsequent media attention, patients are wary of taking NSAIDs in case they may be infected with coronavirus. It’s important to note, however, that there is no scientific evidence connecting the use of NSAIDs such as ibuprofen with worsening COVID-19 symptoms.

In their Lancet letter, Fang and colleagues hypothesized that because SARS-CoV-2, the virus that causes COVID-19, binds to ACE2 on the cell surface to gain entry into cells, and because ibuprofen has been shown to increase ACE2, the use of ibuprofen could worsen symptoms in COVID-19 patients by making it easier for the virus to get into cells.

A few days later, on March 14, French Health Minister Olivier Véran tweeted that taking anti-inflammatory drugs such as ibuprofen and cortisone “could be an aggravating factor for the infection” and recommended that French citizens take paracetamol (acetaminophen) if they have a fever. On March 17, the World Health Organization (WHO) issued a warning against the use of ibuprofen in COVID-19 patients, again based on the letter in Lancet. But on March 18, one day later, WHO tweeted that “At present, based on currently available information, WHO does not recommend against the use of ibuprofen,” in COVID-19 patients. They continued that “WHO is not aware of published clinical or population-based data on this topic.” Use of the double negative in the second WHO recommendation caused significant concern among Twitter users and confusion among patients.

On March 19, FDA issued a statement clarifying their stance on the use of NSAIDs for COVID-19 patients, saying that “FDA is not aware of scientific evidence connecting the use of NSAIDs, like Ibuprofen, with worsening COVID-19 symptoms.” The statement indicated that the agency is investigating further and will communicate publicly when more information is available.

For the full article, please visit www.pharmacytoday.org for the May 2020 issue of Pharmacy Today.