Officials Discourage Ibuprofen for Symptoms of COVID-19

The painkiller's effect on the body and brain may weaken immune response.

Posted Mar 17, 2020

On Saturday, France's Minister of Health Olivier Véran warned coronavirus sufferers against taking anti-inflammatory drugs like ibuprofen, advising them to treat their symptoms with acetaminophen instead. 

Olivier Véran/Twitter
Source: Olivier Véran/Twitter

In a tweet, Véran wrote: "Taking anti-inflammatories (ibuprofen, cortisone, ...) could aggravate the infection. In case of fever, take paracetamol [also called acetaminophen].

"If you are already on anti-inflammatories or if in doubt," he added, "consult your doctor."

Véran's message comes at a time when recommendations for mitigating the coronavirus are flying fast and furious, and it's difficult to separate facts from pseudoscience and wishful thinking. 

This post will explain the difference between acetaminophen and anti-inflammatory medications like ibuprofen and assess whether there's any evidence that anti-inflammatories affect the course of COVID-19.

Ibuprofen vs. Acetaminophen

If you're like most people, medications like ibuprofen, aspirin, and acetaminophen probably seem pretty much the same. All are over-the-counter drugs used to treat pain and fever, and you'll find them shelved side-by-side at your local pharmacy.

Brett Jordan/Unsplash
Source: Brett Jordan/Unsplash

These drugs, though, actually fall into two different groups. 

First are the NSAIDs. NSAID stands for Non-Steroidal Anti-Inflammatory Drug. Ibuprofen (the active ingredient in Advil and Motrin), naproxen (the active ingredient in Aleve), and aspirin are all part of the NSAID family of medications.

NSAIDs stop the body's production of prostaglandin, a chemical released by injured cells that triggers swelling, fever, and pain as part of the healing process. Because NSAIDs work by muzzling damaged cells, they’re best for silencing pain from tissue damage, like osteoarthritis, muscle aches, and back injuries. They’re also effective at treating menstrual cramps, which are caused by the release of prostaglandin just before or during menstruation. Pain receptors fire in response to this chemical discharge even though the body hasn’t actually been injured.

Acetaminophen, sold under the brand names Tylenol and Panadol, is the only member of the second category of over-the-counter painkillers. Even though it's one of the most widely used over-the-counter medications, we still don't have a complete understanding of why it works.

Unlike NSAIDs, acetaminophen doesn't block the production of prostaglandin throughout the body. Instead, it may decrease the production of prostaglandin specifically in the brain, which could play a role in lowering fever.

Acetaminophen also seems to affect the brain's cannabinoid system — the same neurological system that's influenced by cannabis. The drug's pain-relieving properties could be a result of this process. 

The crucial takeaway is that NSAIDs like ibuprofen, naproxen, and aspirin act differently on the body and the brain than acetaminophen does. One major result is that NSAIDs reduce inflammation, while acetaminophen doesn't.

What does this have to do with COVID-19?

Although NSAIDs can be used safely and effectively to ease the symptoms of a variety of conditions, they depress our immune systems. Inflammation and inflammatory chemicals are important weapons in the body's arsenal for fighting off infections. If all you're dealing with is the common cold or a bacterial infection that's well controlled by antibiotics, you can generally take NSAIDs safely because you don't need a full-bore immune response to recover from those conditions. 

Pixabay
Source: Pixabay

In the case of more serious viruses like COVID-19, on the other hand, we need our immune systems to be in peak working order. If our inflammatory system is hobbled, our bodies are less able to fight the infection, which could result in a longer illness and a greater chance of complications.

Still, it's important to note that there's no concrete evidence that NSAIDs hinder recovery from coronavirus specifically. 

An article published in British medical journal The Lancet on March 11 observed that COVID-19 is more severe in patients with pre-existing conditions like diabetes and hypertension. The article's authors suggested that the medications commonly used to treat these conditions, like thiazolidinediones and ibuprofen, could be partly responsible.

The authors, however, proposed this possibility only as a theory, and the paper hasn't been peer-reviewed.

So should you take NSAIDs like ibuprofen and aspirin if you come down with coronavirus?

In France, medical professionals and public health officials are answering a resounding no, based on their anecdotal observations. According to doctor and researcher Sébastien Gallien, Ph.D., head of infectious medicine at the Henri-Mondor de Créteil hospital in Val-de-Marne, "in intensive care, among young people who have developed severe cases of coronavirus, it's been noted that one of the possible explanatory factors was that these patients had been taking anti-inflammatories. 

"It's one possibility, among others. We're functioning by analogy and we're saying to ourselves that, perhaps, this could explain why some young people without any apparent comorbidities are having complications."

As we struggle to learn more about COVID-19 and cases continue to rise around the world, French physicians are opting to take a cautious approach. Dr. Gallien's advice is: "As a precaution and in the absence of clear evidence, the message to relay to the public is: Caution! Warning! No anti-inflammatories against the symptoms of coronavirus."

Although medical opinion on NSAIDs and COVID-19 in other parts of the world is divided, Dr. Tom Wingfield, Senior Clinical Lecturer and Honorary Consultant Physician at the Liverpool School of Tropical Medicine, notes that: “In the UK, paracetamol [a.k.a. acetaminophen] would generally be preferred over non-steroidal anti-inflammatory drugs such as ibuprofen to relieve symptoms caused by infection such as fever. This is because, when taken according to the manufacturer’s and/or a health professional’s instructions in terms of timing and maximum dosage, it is less likely to cause side effects. Side effects associated with NSAIDs such as ibuprofen, especially if taken regularly for a prolonged period, are stomach irritation and stress on the kidneys, which can be more severe in people who already have stomach or kidney issues."

Polina Tankilevitch/Pexels
Source: Polina Tankilevitch/Pexels

If you find yourself infected with COVID-19 and decide to take acetaminophen to ease your symptoms, be sure to check all the medications you're on for hidden acetaminophen to avoid exceeding the daily maximum dose. An overdose of acetaminophen can cause liver failure, and the drug is included in so many "Cold and Flu" combinations that it's possible to accidentally overdose by inadvertently consuming acetaminophen in several different medications at once.

Finally, if you're already taking an NSAID to treat a pre-existing condition, don't stop taking it except on the advice of your doctor. NSAIDs aren't fundamentally bad for you; they play an important role in treating inflammation and pain from a variety of causes.

As always, the key is to use the right medication for the job and to consult your doctor to make sure you're taking the correct measures based on your complete medical history.

World Health Organization
Source: World Health Organization

UPDATE, March 18:  Despite a statement by World Health Organization spokesman Christian Lindmeier on Tuesday, March 17, recommending that COVID sufferers use only acetaminophen to treat their pain and fever until we know more about how NSAIDs affect the progress of the illness, a WHO tweet posted Wednesday, March 18, clarified that, based on the information that's presently available, the organization doesn't recommend against the use of ibuprofen.