Is ibuprofen dangerous for COVID-19 patients? That's been a major topic of discussion this week but with no clear answer.
It started last Saturday, when France's health minister Olivier Véran "could be an aggravating factor" in coronavirus infection and that "paracetamol" (acetaminophen in the U.S.) should be used to treat fever.
It was followed later in the day by an official health ministry that included the following (in Google translation):
"Serious adverse events related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported in patients with COVID19, possible or confirmed cases. We remind you that the treatment of a poorly tolerated fever or pain in the context of COVID19 or any other respiratory virosis is based on paracetamol, without exceeding the dose of 60 mg/kg/day and 3 g/day. NSAIDs should be banned."
"Conversely, patients on corticosteroids or other immunosuppressants for a chronic pathology should not interrupt their treatment, unless otherwise advised by the doctor who follows them for this pathology."
Neither Véran nor the ministry followed up with details on the adverse event reports. The state-owned news service Agence France-Presse muddied the waters further on Tuesday with an pointing to a as the rationale -- but that paper made no mention of NSAIDs or reports of adverse events. Rather, it speculated that patients with type 2 diabetes and hypertension might be at extra risk for COVID-19 and posed a theoretical possibility that certain antihypertensive medications might increase patients' susceptibility to infection.
The World Health Organization also weighed in Tuesday, with a spokesman telling reporters that COVID-19 patients who self-treat should use acetaminophen instead of ibuprofen. But he, too, had no details on the actual basis for the recommendation. Agency professionals are "looking into this to give further guidance," he said.
Independent experts expressed puzzlement about the warnings. quoted two who said they were unaware of any evidence linking ibuprofen specifically to worse outcomes. Another, though, cited the Lancet paper as indirectly suggesting a "hypothetical risk" that NSAIDs could promote viral entry into host cells -- as "shown in animal models, but not in patients." And that's a far cry from the "serious adverse events" the French health ministry said were reported.
In fact, the European Medicines Agency entered the fray on Wednesday, seeking to dampen concerns about NSAIDs.
"There is currently no scientific evidence establishing a link between ibuprofen and worsening of COVID-19," . "EMA is monitoring the situation closely and will review any new information that becomes available on this issue in the context of the pandemic."
The statement went on to acknowledge some evidence that ibuprofen and ketoprofen may worsen varicella (chickenpox) and certain bacterial infections. But for treating symptoms of COVID-19, "patients and healthcare professionals should consider all available treatment options including paracetamol and NSAIDs. Each medicine has its own benefits and risks which are reflected in its product information and which should be considered along with EU national treatment guidelines, most of which recommend paracetamol as a first treatment option for fever or pain."
"In line with EU national treatment guidelines, patients and healthcare professionals can continue using NSAIDs (like ibuprofen) as per the approved product information. Current advice includes that these medicines are used at the lowest effective dose for the shortest possible period."
Meanwhile, other physicians argued that mild to moderate fevers don't need any treatment. "Fever is not a disease," said Jane Orient, MD, executive director of the Association of American Physicians and Surgeons, . "Very high fevers (say 105 degrees) can cause brain damage, and children can have seizures. But don't pop Tylenol or ibuprofen at the first sign of fever."