"WHO reminds people to avoid using ibuprofen when dealing with COVID-19?" Don't be misled by outdated information!

Recently, a piece of news released in 2020 has once again attracted the attention of many people. The news said that the World Health Organization reminded people to avoid using ibuprofen when they have COVID-19 symptoms to avoid exacerbating the infection. What is going on? Is it of reference value to ordinary people?

Have you seen such a message in the group?

Let me first state the conclusion: this is outdated news and is completely unsuitable as a reference for today's medication .

01

Where did the saying "COVID-19 patients cannot take ibuprofen" come from?

The news that COVID-19 patients cannot take ibuprofen first came from a study published in The Lancet in March 2020. The study pointed out that the new coronavirus invades cells by "hijacking" the human body's ACE2 receptors, and some drugs such as ibuprofen may increase the expression level of ACE2 and promote the invasion of the new coronavirus. For this reason, researchers have made a hypothesis that these drugs may increase the risk of severe COVID-19.

This study quickly brought a huge impact under the attention and forwarding of French Health Minister Olivier Veran. He wrote on social media: "Taking anti-inflammatory drugs such as ibuprofen and cortisone may become an exacerbating factor for infection," and recommended taking other drugs if fever symptoms occur.

In the early days of the COVID-19 outbreak , humans had limited knowledge of the virus and were struggling to find treatments or ways to relieve symptoms, which is understandable. In order to better provide diagnosis and treatment guidelines, the World Health Organization also pointed out in March 2020 that it would conduct research on this and give follow-up recommendations; while the research is still unclear, it is recommended that ordinary people do not take ibuprofen on their own.

02

What is wrong with this statement?

The above information constitutes the main body of the message at the beginning of this article. However, when people forwarded the message, they did not realize that it had a major omission of information, that is, the assumption that "drugs such as ibuprofen may increase the risk of severe COVID-19" appeared two and a half years ago, and even at that time, the World Health Organization quickly clarified that this recommendation was not against the use of ibuprofen .

Note the yellow words. The World Health Organization clarified that month (March 2020) that it did not recommend against the use of ibuprofen. Image source: World Health Organization official website

In fact, in the past two years, people have already had a deeper understanding of the new coronavirus and ibuprofen. Many studies have not found any scientific evidence to show a link between ibuprofen and overexpression of ACE2 receptors. On the contrary, some studies have confirmed that patients who are positive for the new coronavirus can safely take drugs such as ibuprofen . In addition, some studies have pointed out that ibuprofen can inhibit the production of inflammatory cytokines, which may reduce the risk of severe illness .

The official website of the U.S. Centers for Disease Control and Prevention currently states that some self-purchased medications can be used to relieve COVID-19 symptoms, including ibuprofen and acetaminophen .

In summary, "The World Health Organization reminds people to avoid using ibuprofen when they have COVID-19 symptoms" is an inaccurate statement. As time goes by, more and more evidence shows that even if you are infected with COVID-19, you can safely use ibuprofen. As ordinary people, we know that ibuprofen is a drug that can be used, and we don't need to be afraid of it . That's enough.

03

Precautions for correct use of antipyretics

1. Dosage

It is important to remind everyone that although ibuprofen and acetaminophen can be used to relieve COVID-19 symptoms, they must be taken according to the recommended doses .

Patients want to relieve symptoms as quickly as possible, so some people will unconsciously increase the frequency of medication or take multiple cold medicines at the same time, which can easily lead to overdose. However, if you take too much ibuprofen, it will increase the risk of internal bleeding and heart attack ; and if you take too much acetaminophen, it may cause acute liver failure . So don't add more medicine on your own.

2. Medication interval

Ibuprofen and acetaminophen are often used to relieve high fever symptoms . Most patients can see their fever go down after 45 to 90 minutes of taking an antipyretic drug. However, if the patient's temperature does not go down within 1 to 2 hours after taking the medicine, or if the patient has a high fever again before the next dose, in these two cases, the doctor may recommend that the patient take another different drug .

Note that the additional medication must be different and must be taken after the first medication takes effect, i.e., if certain conditions are met, acetaminophen can be taken about 2 hours after taking ibuprofen, and vice versa. This can also minimize the risk of overdose.

Even if you take another drug, the recommended interval for the same drug should still be followed, i.e., ibuprofen should be taken every 6 to 8 hours, and acetaminophen should be taken every 6 hours. It is best for patients or caregivers to record the time of each medication to avoid confusion or forgetfulness.

3. Pay attention to your diet

Ibuprofen will increase the burden on the stomach and kidneys . Although its damage to the body can be ignored if the medicine is taken correctly and not in excess, in order to relieve gastrointestinal discomfort, it is recommended to take the medicine with or after meals, and drink at least 118 ml of water while taking the medicine .

Acetaminophen is metabolized in the liver . If you drink alcohol while taking the drug, it may lead to incomplete drug metabolism and increase the risk of liver toxicity. Therefore, not only should you avoid drinking alcohol while taking the drug, but people with liver disease or alcoholism are also not suitable for taking acetaminophen .

4. Special Populations

To reduce the risk, infants under six months old or pregnant women should avoid taking ibuprofen, and only choose acetaminophen as an antipyretic. The elderly or patients with gastrointestinal, kidney problems, ulcers, and inflammatory bowel disease should also choose acetaminophen. Patients who need to take aspirin daily should also avoid taking ibuprofen, because ibuprofen will interfere with the effectiveness of aspirin. Acetaminophen can be chosen as an antipyretic .

Please be sure to follow your doctor's advice on specific medication.

References:

[1]Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?[J]. The lancet respiratory medicine, 2020, 8(4): e21.

[2] Rob Picheta. France says ibuprofen may aggravate coronavirus. Experts say more evidence is needed .[EB]. 2020-03-18. https://www.cnn.com/2020/03/16/health/coronavirus-ibuprofen-french-health-minister-scn-intl-scli/index.html

[3] Avoid ibuprofen for coronavirus symptoms, WHO says. [EB]. 2020-03-18. https://www.france24.com/en/20200318-avoid-ibuprofen-for-coronavirus-symptoms-who-says

[4] Poutoglidou F, Saitis A, Kouvelas D. Ibuprofen and COVID-19 disease: separating the myths from facts[J]. Expert Review of Respiratory Medicine, 2021, 15(8): 979-983.

[5] Moore N, Carleton B, Blin P, et al. Does ibuprofen worsen COVID-19?[J]. Drug safety, 2020, 43(7): 611-614.

[6] Zhou Q, Zhao S, Gan L, et al. Use of non-steroidal anti-inflammatory drugs and adverse outcomes during the COVID-19 pandemic: A systematic review and meta-analysis[J]. EClinicalMedicine, 2022, 46: 101373.

[7] DW Kaufman et al., Exceeding the daily dosing limit of nonsteroidal anti-inflammatory drugs among ibuprofen users. Pharmacoepidemiol Drug Saf, (2018).

[8] Shi Jun. How to use antipyretic and analgesic drugs Tylenol and Ibuprofen correctly? [EB]. Fanpu. 2022-12-05. https://mp.weixin.qq.com/s/VqYfPecwzfRWR4XPc4KsuA

Author: Ye Shi

Review | Li Dongzeng, Chief Physician, Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University

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