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The latest from WHO: No evidence that ibuprofen worsens COVID-19


There’s no evidence that ibuprofen and similar anti-inflammatory drugs have serious effects in people who tested positive of COVID-19.

The World Health Organization reached this conclusion after reviewing 73 studies—28 in adults, 46 in children and one in adults and children—on the effects of nonsteroidal anti-inflammatory drugs or NSAIDs in patients infected with respiratory viruses. None of the studies addressed COVID-19, SARS or MERS, however.

In a scientific brief dated April 19, WHO said:

At present there is no evidence of severe adverse events, acute health care utilization, long-term survival, or quality of life in patients with COVID-19, as a result of the use of NSAIDs.

NSAIDs include nonselective cyclooxygenase (COX) inhibitors such as ibuprofen, aspirin, diclofenac and naproxen, and selective COX2 inhibitors such as celecoxib, rofecoxib, etoricoxib, lumiracoxib and valecoxib.

Concerns over the use of ibuprofen for managing symptoms of the coronavirus disease have been raised, including by French Health Minister Olivier Veran who tweeted March 14, three days after the pandemic was declared, that ibuprofen could worsen the coronavirus infection. Veran suggested taking paracetamol for fever.


(A reader had earlier asked FactRakers to help her monitor developments on the use of ibuprofen for COVID-19 patients).

The common symptoms of COVID-19 are fever, tiredness and dry cough. Other symptoms are shortness of breath, aches and pains, sore throat and diarrhea, nausea or a runny nose in a few cases.

Filipino doctor Romeo F. Quijano has cautioned against the irrational use of not only ibuprofen but also paracetamol and other anti-fever drugs in treating viral infections, adding that fever in most cases should not be interfered with unless it exceeds 40 degrees Celsius.

He cited several published reports and studies, including clinical and population-based studies, that show the negative effects of these drugs if used in several types of viral infections.

For example, he said ibuprofen and other NSAIDs have been shown to inhibit the antibody production in human cells. Aspirin, acetaminophen and ibuprofen have also been shown to interfere with antiviral immune functions, he said.

Quijano said:

COVID-19 patients should not be presumed to be exempted from these potential negative effects.

Quijano weighed in on the issue after WHO said in a March 18 advisory that it “does not recommend against the use of ibuprofen” and is “not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations.”

The Department of Health said in a fact check that day it was still getting more information on the effects of ibuprofen and “is awaiting for a formal advice from the WHO.”

The U.S. Centers for Disease Control and Prevention said in a video statement in April it has not come across “compelling evidence" that ibuprofen and similar drugs “can make you sicker if you have COVID-19.”

In its April 19 brief, WHO said of the review it conducted:

No direct evidence from COVID-19 patients was available. Therefore, all evidence included should be considered indirect evidence with respect to the use of NSAIDs prior to or during the management of COVID-19.

It also acknowledged that NSAIDs are “a diverse set of drugs with different risk profiles for different populations and conditions.”

References

Centers of Disease Control and Prevention [CDCgov]. (2020, April 11). Ask CDC: Will taking anti-inflammatory drugs like ibuprofen worsen symptoms of COVID-19? Dr. John Brooks, CDC’s Chief Medical Officer for the COVID-19 emergency response, explains what is known about anti-inflammatory drugs and coronavirus [Tweet]. Retrieved from https://twitter.com/CDCgov/status/1248682911655591936

Department of Health. (2020, March 18). Q: Could ibuprofen worsen disease for people with COVID-19? A: Based on currently available information, WHO does not recommend against the use of of ibuprofen. WHO is aware of concerns on the use of ibuprofen for the treatment of fever for people with COVID-19. We are consulting with physicians treating the patients and are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations [Facebook status update]. Retrieved from https://www.facebook.com/OfficialDOHgov/posts/fact-check-stories-have-been-circulating-on-line-that-ibuprofen-should-not-be-us/3155109304500300/

Olivier Véran [olivierveran]. (2020, March 14). #COVIDー19 | La prise d'anti-inflammatoires (ibuprofène, cortisone, ...) pourrait être un facteur d'aggravation de l’infection. En cas de fièvre, prenez du paracétamol. Si vous êtes déjà sous anti-inflammatoires ou en cas de doute, demandez conseil à votre médecin [Tweet]. Retrieved from https://twitter.com/olivierveran/status/1238776545398923264

Quijano, R. (2020, March 26). COVID-19: Paracetamol, ibuprofen and other anti-fever drugs should be avoided. Retrieved from https://www.bulatlat.com/2020/03/26/covid-19-paracetamol-ibuprofen-and-other-anti-fever-drugs-should-be-avoided/

World Health Organization. (2020, March 19). WHO is aware of concerns on the use of #ibuprofen for the treatment of fever for people with #COVID19. We are consulting with physicians treating the patients & are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations [Tweet]. Retrieved from https://twitter.com/who/status/1240409217997189128

World Health Organization. (2020, April 19). The use of non-steroidal anti-inflammatory drugs (NSAIDs) in patients with COVID-19. Retrieved from https://www.who.int/publications-detail/the-use-of-non-steroidal-anti-inflammatory-drugs-(nsaids)-in-patients-with-covid-19

World Health Organization. (n.d.). Coronavirus. Retrieved from https://www.who.int/health-topics/coronavirus#tab=tab_3

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