This has been another tough pill to swallow: France’s health ministry has suggested that certain painkillers could aggravate the effects of the coronavirus.
Olivier Veran tweeted last week that some nonsteroidal anti-inflammatories (aka NSAIDs) worsen the effects of COVID-19, the disease caused by the novel coronavirus. And now people are questioning whether it’s still safe to take common over-the-counter drugs such as aspirin and ibuprofen to soothe their aches and fevers.
His tweet, translated into English, reads: “Taking anti-inflammatory drugs (ibuprofen, cortisone...) could be an aggravating factor of the infection. If you have a fever, take paracetamol [aka acetaminophen]. If you are already on anti-inflammatory drugs or in doubt, ask your doctor for advice.”
And his warning echoed a paper that The Lancet published earlier this month, which suggested certain drugs increase the number of ACE2 receptors on the surfaces of cells. Because the coronavirus infects cells using these receptors, the paper theorized that patients taking painkillers like ibuprofen might be more at risk of catching the virus. “The increased expression of ACE2 would facilitate infection with COVID-19,” researchers wrote.
But don’t panic. There is no reason to throw your bottles of ibuprofen like Advil /zigman2/quotes/202877789/composite PFE +1.43% or Motrin /zigman2/quotes/201724570/composite JNJ +1.83% , or aspirin like Bayer /zigman2/quotes/203424967/composite BAYRY +1.43% or Excedrin /zigman2/quotes/209463850/composite GSK +2.11% , into the trash just yet, health experts say.
The FDA announced Thursday that it “is not aware of scientific evidence connecting the use of NSAIDs, like ibuprofen, with worsening COVID-19 symptoms. The agency is investigating this issue further and will communicate publicly when more information is available.”
On Wednesday, European Union’s health care regulator also announced that there is currently “no scientific evidence establishing a link between ibuprofen and worsening of COVID‑19.” The European Medicines Agency will continue to monitor the situation, as well, and recommends that patients and medical professionals consider all treatment options, including acetaminophen (such as Tylenol, Dayquil and Nyquil) and anti-inflammatories like ibuprofen.
“In line with EU national treatment guidelines, patients and health care professionals can continue using NSAIDs (like ibuprofen) as per the approved product information,” the EMA said .
Other medical professionals note that there is still far too much that we don’t know about COVID-19, which is a new pathogen, to make such claims.
“Deeply concerned about this bold statement by the French MoH with no reference to the claim, which is causing public concern,” tweeted Muge Cevik , a researcher at the University of St Andrews Infection and Global Health Division. “There’s no scientific evidence I am aware of that ibuprofen cause worst outcomes in #COVID19.”
And a rep from the National Institute for Allergy and Infectious Diseases told the Los Angeles Times : “More research is needed to evaluate reports that ibuprofen may affect the course of COVID-19. Currently, there is no evidence that ibuprofen increases the risk of serious complications or of acquiring the virus that causes COVID-19. There is also no conclusive evidence that taking ibuprofen is harmful for other respiratory infections.”
NBC News medical correspondent Dr. John Torres also said that the ibuprofen warning is “very theoretical. Nothing’s been proven about that.” But he added that if people are concerned, it doesn’t hurt to “take acetaminophen instead of ibuprofen to reduce your fevers.”
Dr. Tania Elliott, clinical instructor of infectious diseases and allergy at NYU Langone in New York City, told MarketWatch by email that while people with underlying conditions such as kidney disease, stomach ulcers or a respiratory condition called “aspirin-exacerbated respiratory disease” should avoid NSAIDs and aspirin, she also said that “more data is needed” before we can determine whether this particular group of painkillers exacerbates COVID-19.
Still, it’s recommended that any painkiller or fever reducer be used at the lowest dose for the shortest period — whether it’s Advil or Tylenol. Dr. Stephen Sigworth, the senior medical director at Mount Sinai Queens in New York City, explained why: since drugs like aspirin, ibuprofen and acetaminophen treat aches and reduce fevers, they may hide some of the earlier signs of COVID-19, which include coughing, body aches, fever and shortness of breath.
The FDA also reminds people to read the full Drug Facts Label on any over-the-counter medications before taking them, and/or to take them as directed by your health care professional.
“By potentially masking one of these signs of infection, those infected individuals may not recognize symptoms of infection and can potentially shed virus and infect others for a longer period of time,” he said. “At this time, we are recommending Tylenol for symptoms of fever IF a fever is present, as it helps to reduce the fever and body aches associated with viral illness.”
“Tylenol is more effective for fevers than NSAIDs in general,” added NYU’s Dr. Elliott. “So while the jury is still out, opt for Tylenol.”
And if you are already on a prescribed anti-inflammatory regimen, speak with your doctor before you change your medication regimen.
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This article was originally published on March 18, and has been updated with the FDA’s statement.