May 2020 COVID-19 News

TL;DR: It’s ok to take Advil (R) for appropriate symptoms.

The Take Home:

NIH recommends the same fever-reducing strategies in COVID-19 patients as non-COVID-19 patients.

If you are already prescribed NSAIDS for other reasons, continue to take them as prescribed. FDA recommends reading the full Drug Facts Label on all over the counter (OTC) medications prior to use.

The Background:

There was a letter published in The Lancet in March 2020 referencing increased ACE2 enzyme activity stimulated by NSAIDs (and other medications and certain disease processes) and an untested, unproven hypothesis that increased enzyme activity could facilitate severe Sars-CoV-2 infection. This sparked immediate concerns regarding widely used easily-accessible and effective medications used to manage symptoms of respiratory system inflammation like those caused by COVID-19 illness.

Which medications are these?

Ibuprofen (commerically available in branded formulations such as Advil (R), Motrin (R))

Naproxen (commerically branded formulations such as Aleve (R))

The Support:

There is no evidence that ibuprofen worsens COVID-19 illness symptoms. It can help reduce fever and other symptoms of inflammation including body aches.

The Caveats:

If you have been told not to take Advil in the past, don’t take it now. There are many conditions for which people are generally recommended to avoid NSAIDs, including cardiovascular disease, gastrointestinal concerns, including stomach ulcers, gastro-esophageal reflux (GERD or heartburn), and potential interactions with other medications like blood thinners.

There is some evidence that NSAIDs may reduce the immune response and prolong viral shedding,

The References:

The Lancet Published Online March 18, 2020 https://doi.org/10.1016/ S2213-2600(20)30116-8

The FDA advises patients on the use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19

NIH COVID-19 Treatment Guidelines

Author: Jennifer Mills, M.D., F.A.C.P