Controversy over Ibuprofen started when Mr. Oliver Veran tweeted on March 14 that people with suspected Coronavirus infection should avoid Ibuprofen. “Taking anti-inflammatory drugs (ibuprofen, cortisone…) could be an aggravating factor for the infection. If you have a fever, take paracetamol (Tylenol).” Apparently, there were four cases in southwest France where young patients with COVID-19 infection without any underlying health conditions, developed serious complications after using non-steroidal anti-inflmmatory drugs (NSAIDS) like ibuprofen.
National Agency for the Safety of Medicines and Health Products, the French government agency with jurisdiction over pharmaceuticals, biological products, medical devices, and cosmetics, advised health workers in France not to use Ibuprofen to treat fever in patients with COVID-19 illness.
At the time of writing this article, there is no research studying effects of Ibuprofen in patients with COVID-19 illness, however, there are multiple studies on the effects of Ibuprofen in other respiratory illnesses. According to the research published in ‘Archives of Disease in Children’, safety of Ibuprofen is studied in children who have symptoms of lower respiratory tract infection like shortness of breath and cough. It reviewed seven published studies and concluded that “six out of seven studies found an association between prehospital administration of ibuprofen and an increased risk of pus formation in the lungs (empyema) or complication in children with pneumonia.” This is also backed by experts in the UK that prolonged illness or the complications of respiratory infections may be more common when NSAIDS are used.
There is already strong evidence not to use steroids routinely in patients with COVID-19 illness. Steroids are known to dampen our immune system and several inflammatory markers. Due to further weakening of immune system, people affected with COVID-19 have worse outcomes. It is recommended not to use steroids unless patients have septic shock and other lung complications. A recent study published in Lancet confirms these recommendations. It is stated by several health authorities that non-steroidal anti-inlammatory drugs (NSAIDS) may have similar undesirable effects due to their capability to reduce inflammatory markers. However, as mentioned earlier, there is no research looking at effects of NSAIDs in patients with COVID-19 illness.
As per European Medicines Agency, “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. When starting treatment for fever or pain in 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.”
World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) released similar statements that there is no strong evidence to prove that Ibuprofen worsens COVID-19 illness. WHO stated, "Based on currently available information, WHO does not recommend against the use of ibuprofen."
Based on the available research regarding the negative effects of ibuprofen in patients with respiratory infections, considering the statements of few experts from France and other European countries not to use Ibuprofen in COVID-19 affected people, caution should be taken while using Ibuprofen in patients with COVID-19 illness. While there is no strong evidence to prove that Ibuprofen should be completely avoided in affected people, implications of available research cannot be refuted either. Paracetamol or Tylenol should probably be the first line of drug to treat fever. If it is not effective, Ibuprofen may be used with caution. More research studies are required to have further clarification regarding this matter.