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If you have a fever, it’s better to take paracetamol than ibuprofen, suggests Olivier Véran on Twitter. Could anti-inflammatory drugs make COVID-19 more severe? The World Health Organization took the floor. The European Medicines Agency also presented its position.
WHO denies the information about the harmfulness of ibuprofen
After several days of heated debate over whether ibuprofen worsens the course of the COVID-19 disease caused by the SARS CoV-2 coronavirus, the World Health Organization made an official statement. WHO on Wednesday said it was based on the available data is not against the use of ibuprofen, although is aware of the concerns associated with its use to treat fever in people with COVID-19. The organization said it consulted doctors and was not informed of any negative effects beyond the usual side effects that limit the use of ibuprofen in some cases.
The day before, Christian Lindmeier, a WHO spokesman, said in an interview with journalists in Geneva:
– There are no studies which show that the use of ibuprofen is associated with higher mortality. Scientists are trying to clarify the situation. If in doubt, we advise you to use paracetamol instead of ibuprofen (according to Deutsche Welle). Lindmeier also noted that his words relate only to taking this drug without a doctor’s recommendation.
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The whole discussion started with a tweet by French health minister Olivier Véran, who wrote on March 14 that some anti-inflammatory drugs (such as ibuprofen) could exacerbate the course of infection from the new coronavirus. He recommended that in case of fever, paracetamol-containing agents should be used. He referred those already taking anti-inflammatory drugs to consult a doctor. Conclusions regarding this group of drugs were drawn on the basis of preliminary observations of patients admitted to intensive care in French hospitals.
Jérôme Salomon, health director of the Ministry of Health of France, also stated that patients with COVID-19 should not be treated with non-steroidal anti-inflammatory drugs, which include ibuprofen, i.a. acetylsalicylic acid (ASA), aspirin and diclofenac.
- Also read: Could I have contracted the coronavirus?
Last week, a publication in which the question of the influence of ibuprofen on the course of coronavirus infection was indirectly raised, was published by the journal “The Lancet”. Here is a quote from an article by an international team of scientists:
Human pathogenic coronaviruses (SARS-CoV and SARS-CoV-2 acute respiratory syndrome coronavirus) bind to target cells by angiotensin-converting enzyme 2 (ACE2), which is produced by the epithelial cells of the lungs, intestines, kidneys and blood vessels. ACE2 expression is significantly increased in patients with type 1 or type 2 diabetes who are treated with ACE inhibitors and type II angiotensin receptor blockers (ARBs).
Hypertension is also treated with ACE and ARB inhibitors, which increases ACE2 secretion. ACE2 can also be increased by thiazolidinediones and ibuprofen. (…) Increased ACE2 expression facilitates COVID-19 infection. We therefore hypothesize that treating diabetes and hypertension with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.
Following the information provided by representatives of the French ministry of service of some countries, incl. Switzerland, recommended caution when using drugs with ibuprofen, although they noted that there is no hard evidence yet that this agent exacerbates the course of COVID-19 disease. Doctors tried to explain that inflammation is the body’s natural response to infection, and that anti-inflammatory drugs can reduce the immune system’s response and mask the symptoms of the disease.
Many experts immediately criticized the French minister for such a “bold” claim. “I don’t know of the scientific evidence that ibuprofen exacerbates COVID-19 symptoms,” said Dr. Muge Cevik, a virologist at the University of St Andrews in Scotland, on Twitter. Dr Colm Henry, head of the Health Services Executive (HSE) of Ireland, commented on the reports that Véran presented, stressed that they should not be interpreted as an indication to abandon ibuprofen. For people diagnosed with COVID-19, acetaminophen is indeed recommended as the first line of treatment for fever and pain symptoms associated with the virus, but ibuprofen is the second line.
The European Medicines Agency also pointed out the lack of evidence confirming the harmfulness of ibuprofen in its position, which ensures that it monitors the situation and reviews any new information on this matter.
European Medicines Agency
The European Medicines Agency reports that there is currently no scientific evidence to support a link between ibuprofen and the worsening of COVID-19 disease. EMA monitors the situation on an ongoing basis, and any new information available will be carefully analyzed in terms of the ongoing pandemic.
When treating fever or pain in patients with COVID-19, patients and healthcare professionals should consider all available treatment options, including paracetamol and non-steroidal anti-inflammatory drugs. The use of each medicinal product has benefits and risks, which are reflected in the approved product information, and which should be taken into account together with national treatment guidelines, most recommending paracetamol as the drug of first choice for the treatment of fever and pain.
Patients and healthcare professionals should continue to use non-steroidal anti-inflammatory drugs (such as ibuprofen) in accordance with approved product information and national treatment guidelines. In the current situation, it is recommended that these drugs be used at the lowest effective dose for the shortest possible time.
Patients should ask their doctor or pharmacist if they have questions. At present, based on the information available, there is no reason for patients taking ibuprofen to stop treatment. This is especially important in patients taking ibuprofen or other NSAIDs for chronic diseases.
Antipyretic and anti-inflammatory drugs: the choice of the appropriate drug, as well as its dosage, should always be consulted with a doctor.
It’s easy to overdose paracetamol
Doctors warn chronically ill people against self-withdrawal of anti-inflammatory drugs, which are the only available treatment option for some. They also indicate the risk of overdosing with paracetamol. Taking too much of this medicine may damage your liver (the maximum daily dose given by manufacturers is 4 g). Poisoning in healthy people occurs when the dose exceeds 10 g. People with chronic liver diseases and other systemic diseases are particularly sensitive to the toxic effects of paracetamol. It can be very dangerous for them to take 6 g of this active substance.
Therefore, before taking certain medications, including those without a prescription, it is worth consulting a doctor. It will help you choose the right drugs to avoid the unpleasant consequences of overdosing. Currently, it is worth arranging a convenient and safe teleportation with a family doctor or internist.
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- The SARS-CoV coronavirus may be most contagious before symptoms appear
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