Ibuprofen and Covid-19: to use or not to use

Dr Lefteris Teperikidis - freelance medical writer at Kolabtree explores the research for using Ibuprofen to treat the effects of Covid-19 .

Since the original Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV) 2 outbreak in Wuhan, China last December, a large body of evidence on Covid-19 has been published. However, the urgent need for scientific information relating to the virus has led to a lot of the usual safeguards of literature reporting, such as the peer-review process, being bypassed on several occasions.

As a result, an unprecedented number of publications have emerged, leading to a vast amount of available information. In fact, a simple Pubmed search using the term “Covid”, including only results from 1 December 2019 up to 16 April 2020, yielded an astonishing 4,090 reports. While some of these articles are reports on actual clinical data related to Covid-19, there are also a large number of editorials and expert opinions on various different topics.

One issue that came to mobilise a worldwide debate was the use of non-steroidal anti-inflammatory drugs (NSAIDs) and their potential to cause more severe illness in Covid-19 patients. This theory originated when the Angiotensin-converting enzyme (ACE)2 receptor was described as the SARS-CoV-2 receptor, binding to which the virus gains entry to the host cell via phagocytosis.

Furthermore, an unpublished report of an infectious disease specialist from France, describing four cases of children with Covid-19 whose condition worsened after ibuprofen administration, created reasonable concern regarding the use of NSAIDs in Covid-19 patients. Additionally, a letter to the editor describing potential mechanisms that put patients with diabetes and hypertension at higher risk of Covid-19 complications came to add to the ongoing speculation. This resulted in a recommendation to avoid ibuprofen by the World Health Organisation (WHO).

It should be stated that the evidence to support such a claim is virtually non-existent. In pre-Covid-19 times this type of evidence would be considered anecdotal, if considered at all. There is a complete lack of scientific data and everything is based on a theory and an unpublished report of four patients. The journey from theory to practice can be a very long one, regardless of how viable the theory actually sounds. In fact, this was taken into consideration by WHO when they retracted their original statement about the use of ibuprofen. Similarly, other authorities, such as the European Medicines Agency, have also made official statements that the data is insufficient to make specific recommendations.

So, what do we do? Do we use ibuprofen or not? The answer is simple as stated by all authorities who have issued statements on the subject. While their evidence is nowhere near sufficient to recommend against the use of NSAIDs in Covid-19 patients, the theory behind this debate is potentially viable. Consequently, medications such as ibuprofen should be avoided and acetaminophen (aka paracetamol) should be used instead as an anti-pyretic. If acetaminophen is ineffective, then ibuprofen may be considered. Hopefully more reliable data will emerge soon.

*Editor's Note

As stated by the NHS, the Commission on Human Medicines has confirmed "there is no clear evidence that using ibuprofen to treat symptoms such as a high temperature makes coronavirus worse." 

The NHS recommends taking paracetamol first as it has fewer side effects than ibuprofen and will therefore be a safer choice for most people.

Always follow the instructions that come with your medicine.