Ask Dr. John, Esq – Review of Recommendations Regarding Ibuprofen in the Context of COVID-19

COVID-19 and ibuprofen reports from  Dr. John Naranja, MD, JDIn the context of decreased health care access and the recommendation of social distancing due to the COVID-19 pandemic, many personal injury victims have been self-treating for their injuries. Among the ways individuals are seeking relief for their pain, ibuprofen is a common option.

Ibuprofen is a drug classified as a non-steroidal anti-inflammatory. Of its many effects, Ibuprofen acts primarily by reducing inflammation in the body. Reduction of inflammation can improve pain.

Recently, a debate has ensued regarding the use of ibuprofen in the background of COVID-19. The purpose of this review is to review the current state of recommendations.

First, how did ibuprofen start receiving such scrutiny? A recent article published in the medical journal, The Lancet, evaluated risk factors for developing a more severe expression of COVID-19 disease. Specifically, the authors found that certain conditions, such as hypertension and diabetes, were associated with being sicker from COVID-19.

The authors further found that the COVID-19 virus attacks human cells by attaching to a target in human cells called ACE2. Coincidentally, ACE2 is present to a greater degree in patients who have diabetes and hypertension treated by a specific hypertensive medication. ACE2 receptors have also been found to increase with ibuprofen.

As a result of that article, a frenzy in the media ensued debating the actual effects of ibuprofen on COVID-19.

The communication that received significant attention came from the French Health Minister who tweeted “The taking of anti-inflammatories be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

Response from the United Kingdom was, “There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse. But until we have more information, take paracetamol [in the U.S. this is acetaminophen or Tylenol] to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you. If you are already taking ibuprofen or another non-steroidal anti-inflammatory (NSAID) on the advice of a doctor, do not stop taking it without checking first.

Meanwhile, the Spanish Ministry of Health stated there is no evidence that ibuprofen makes COVID-19 infection worse. It did state, however, that ibuprofen package inserts mention the use of the drug might mask the symptoms of infections, which could delay diagnosis and cause patients to be diagnosed in more severe stages. They emphasize, however, that this refers to infections in general, not specifically to COVID-19.

In the United States, the National Institute of Allergy and Infectious Diseases, stated, “More research is needed to evaluate reports that ibuprofen and other over-the-counter anti-inflammatory drugs may affect the course of COVID-19. Currently, there is no conclusive evidence that ibuprofen and other over-the-counter anti-inflammatory drugs increase the risk of serious complications or of acquiring the virus that causes COVID-19. There is also no conclusive evidence that taking over-the-counter anti-inflammatory drugs is harmful to other respiratory infections.”

Finally, both the European Medicines Agency (the European Union’s equivalent of the FDA) and the World Health Organization have stated their position. They both report that there is no reason to stop using ibuprofen to home-treat fever from COVID-19.

As far as acetaminophen, or Tylenol, remember that acetaminophen can sometimes be toxic. The drug is the most commonly consumed pain-killer in the US, but according to a 2016 review by researchers from Rutgers New Jersey Medical School, it causes tens of thousands of cases of sudden liver failure in the United States each year and about 300 deaths.

Please follow your health care provider’s advice during this uncertain time. Your health care provider may also be available through telehealth.

Dr. John, Esq. is both an attorney and a physician. Before obtaining his law degree, Dr. John Naranja practiced for approximately 12 years as an orthopedic surgeon.
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