There’s mixed evidence on whether people with Covid-19 should avoid ibuprofen

“#COVID-19 The taking of anti-inflammatories [ibuprofen, cortisone…] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

Olivier Véran, 14 March 2020 [in French] 

 

French health minister Olivier Véran warned on Twitter that people suffering from Covid-19 should avoid taking anti-inflammatories like ibuprofen or cortisone. The comments made by Mr Véran, who is a qualified doctor and neurologist, have been widely reported in the British press.

Some health professionals have warned that paracetamol is preferable to ibuprofen, as it is less likely to cause side effects in people with underlying health issues, who are also more susceptible to Covid-19. (Cortisone is not commonly used in the UK to relieve symptoms like fever.) 

Until March 16, when this article was first published, NHS advice for people self-isolating because of the new coronavirus recommended drinking lots of water and taking “everyday painkillers, such as paracetamol and ibuprofen, to help with your symptoms”. 

However, the NHS has now changed this guidance. Although it says there is “currently no strong evidence that ibuprofen can make coronavirus (Covid-19) worse”, it recommends using paracetamol to treat the symptoms “until we have more information”. The exception to this is if a doctor has told you not to use paracetamol.

It adds that, if you are taking ibuprofen or other non-steroidal anti-inflammatories (NSAID) on the advice of a doctor, you should not stop doing so without checking first. 

Experts have warned paracetamol may be preferable to ibuprofen

Dr Charlotte Warren-Gash, associate professor of epidemiology at the London School of Hygiene and Tropical Medicine, said that NSAIDs like ibuprofen “should be prescribed with caution for people who have underlying health conditions”.

“For Covid-19, research is needed into the effects of specific NSAIDs among people with different underlying health conditions, which takes into account the severity of infection. In the meantime, for treating symptoms such as fever and sore throat, it seems sensible to stick to paracetamol as first choice.”

Dr Rupert Beale, group leader in cell biology of infection at The Francis Crick Institute, said: “There is good reason to avoid ibuprofen as it may exacerbate acute kidney injury brought on by any severe illness, including severe Covid-19 disease.

“There isn’t yet any widely accepted additional reason to avoid it for Covid-19.”

Professor Paul Little, professor of primary care research at the University of Southampton, said there was “sizeable literature” from case control studies in several countries that the complications of respiratory infections - whether respiratory, septic or cardiovascular complications - can be “more common when NSAIDs are used.”

He added that using paracetamol was “less likely to result in complications”.

The old advice from Public Health England

On 16 March, Public Health England confirmed there is not enough information on ibuprofen use and Covid-19 to advise people to stop using ibuprofen, and said there is no published scientific evidence that ibuprofen increases the risk of catching Covid-19 or makes the illness worse.

Full Fact contacted PHE for more information about the decision to change the NHS guidance the next day, but has not yet received a response.

Asked by the government’s health and science committee about the concerns over taking ibuprofen on 17 March, government chief scientific adviser Sir Patrick Vallance said the warnings “may or may not be right, I don’t know. But the sensible thing to do I think would be to say well don’t take it at the moment. Take something else, paracetamol or something.”

If taking any painkillers, you should always follow the instructions on the label and make sure you do not exceed the stated dose.

Patients prescribed NSAIDs for long-term health problems should take them as directed by a healthcare professional.