Justin Rother, PharmD candidate, BSc.
What are NSAIDS?
The Nonsteroidal anti-inflammatory drugs (NSAIDS) are a class of drugs that are used to decrease pain, reduce fever, and decrease inflammation. Some of the most common drugs prescribed and used over the counter from this class include ibuprofen (Advil or Motrin) and naproxen (Aleve). Note that another common pain medication acetaminophen (Tylenol) is not an NSAID and is a common alternative used for pain relief.
How do they work?
NSAIDS work by inhibiting the production of prostaglandins which are involved in the immune system and inflammation. Some of the concerns that have been discussed are that using NSAIDS in patients with COVID-19 could reduce the body’s immune response to the virus or even mask symptoms of the virus, making it harder for doctors to diagnose!
What is the concern all about?
In mid-March, the French government released a statement regarding the use of these anti-inflammatory drugs and the virus causing this ongoing pandemic. “The taking of anti-inflammatories [ibuprofen, cortisone …] could be a factor in aggravating the infection. In case of fever, take paracetamol (acetaminophen). If you are already taking anti-inflammatory drugs, ask your doctor’s advice.” It is important to note that the World Health Organization (WHO) and Health Canada have indicated that there is insufficient scientific evidence in regard to this claim. Health Canada continues to recommend both acetaminophen and ibuprofen in treating fever in those with COVID-19 as they are effective at reducing fever.
Are there any studies comparing NSAIDS vs Acetaminophen in those with the virus?
Yes, a large systemic review was carried out in mid-March by the WHO on the relationship between NSAIDS and viral respiratory diseases, specifically studies on COVID-19, the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) were included. Overall, seventy-three studies were included in the review. There was moderate to high certainty evidence showing little or no difference between ibuprofen and acetaminophen among patients with fever regarding hospitalizations and all cause mortality. Furthermore, a NIH panel of U.S. physicians, statisticians and other experts developed treatment guidelines for coronavirus disease. Included in these guidelines is that there be no difference in the use of pain medications such as NSAIDS or acetaminophen between patients with or without COVID-19. The panel goes on to recommend that patients with COVID-19 who are already taking NSAIDS for a condition continue treatment as directed by their doctor.
Are there any potential benefits to NSAIDS with regards to the virus?
Yes, the NSAIDs naproxen and indomethacin have shown to have anti-viral activity to certain viruses. Indomethacin was shown in lab studies and animal models to have direct antiviral activity against the SARS coronavirus identified in 2003. Other animal models have shown naproxen having antiviral activity against influenza A and B.
Are NSAIDS appropriate for everyone?
No. NSAIDs are associated with a greater risk of adverse effects including stomach ulcers and kidney failure. In general, NSAIDS should also avoided in individuals with high blood pressure, heart, and kidney disease. Always ask your pharmacist or doctor to make sure this class of medications is appropriate for you.
What is the final verdict?
There is no current evidence that NSAIDs negatively affect outcomes in patients diagnosed with COVID-19 and both ibuprofen and acetaminophen are suitable options to treat fever in those with the virus. Further research is required to determine the impact of NSAIDS on those diagnosed with COVID-19.