Rumours have been flying around that taking painkillers could make the symptoms of coronavirus worse. So, could the use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen make the illness worse?
The probability is that it’s safe to take NSAIDs at this time, though for as short a time as possible.
It could be that occasional use could help patients with Covid-19. They could, for example, help to relieve night-time symptoms and aid sleep if paracetamol is inadequate, given the fact that sleep is crucial to maintain the integrity of the immune system.
But long-term use of NSAIDs such as ibuprofen, naproxen and diclofenac has been linked to higher rates of heart attack, heart failure and stroke.
Acute respiratory tract infections themselves are already associated with an increased risk of stroke and heart attack, so use of NSAIDs during the illness brings further increases in risk.
NSAIDs also cause kidney damage, which is a risk in Covid-19 made more likely by fever and dehydration.
There’s also evidence that long-term NSAIDs are associated with higher rates of complications after chest infections, including pneumonia, pleurisy, tonsil abscess, prolonged illness and sepsis.
As Professor Paul Little of Southampton University points out in the British Medical Journal, the big question is whether any of this evidence applies in the Covid-19 pandemic.
It’s thought the evidence to date isn’t strong enough to ban the use of NSAIDs altogether with Covid-19 patients.
The trials mentioned tested more regular dosing with NSAIDs during respiratory infections, so there’s little evidence about intermittent use.
Aspirin is an NSAID and probably shouldn’t be given to Covid-19 patients but people taking low dose aspirin to help prevent cardiovascular disease should continue to take it.
Aspirin has anti-inflammatory effects only at much higher doses (1g to 4g per day).
So what should we do?
We can’t do better than take the advice of the Commission on Human Medicines. It reviewed the safety of ibuprofen in patients with Covid-19 and said there was insufficient evidence to establish a link between using ibuprofen, or other NSAIDs, and contracting or worsening of the disease.
The commission states patients can take paracetamol or ibuprofen when self-medicating for symptoms of Covid-19 such as fever and headache, and should follow NHS advice if they have any questions or if their symptoms get worse.
The lowest effective ibuprofen dose should be for the shortest duration necessary to control symptoms.