France's government stated that people with coronavirus symptoms should steer clear of ibuprofen and other NSAIDs. But, not everyone agrees.

By Renee Cherry
March 18, 2020

It's clear now that a large percentage of the population will likely become infected with COVID-19. But that doesn't mean the same number of people will experience life-threatening symptoms of the novel coronavirus. So, as you learn more about how to prepare for a potential coronavirus infection, you may have caught wind of France's warning against using a common type of painkiller for coronavirus COVID-19 symptoms—and now you have some questions about it.

If you missed it, France's health minister, Olivier Véran warned about NSAIDs' potential effects on coronavirus infections in a tweet on Saturday. "#COVID—19 | Taking anti-inflammatory drugs (ibuprofen, cortisone...) could be a factor in aggravating the infection," he wrote. "If you have a fever, take paracetamol. If you are already on anti-inflammatory drugs or are in doubt, ask your doctor for advice."

Earlier that day, France's Ministry of Health issued a similar statement about anti-inflammatory drugs and COVID-19: "Serious adverse events related to the use of non-steroidal anti-inflammatory drugs (NSAIDs) have been reported in patients with potential and confirmed cases of COVID-19," reads the statement. "We remind you that the recommended treatment of a poorly-tolerated fever or pain in the context of COVID-19 or any other respiratory virus is paracetamol, without exceeding the dose of 60 mg/kg/day and 3 g/day. NSAIDs should be banned." (Related: Everything You Need to Know About Prescription Delivery Amid the Coronavirus Pandemic)

A quick refresher: Non-steroidal anti-inflammatory drugs (NSAIDs) can help prevent inflammation, reduce pain, and lower fevers. Common examples of NSAIDs include aspirin (found in Bayer and Excedrin), naproxen sodium (found in Aleve), and ibuprofen (found in Advil and Motrin). Acetaminophen (referred to as paracetamol in France) also relieves pain and fevers, but without lowering inflammation. You probably know it as Tylenol. Both NSAIDs and acetaminophen can be OTC or prescription-only, depending on their strength.

The reasoning behind this stance, which is held not just by health experts in France, but also some researchers from the UK, is that NSAIDs might interfere with the body's immune response to the virus, according to BMJ. At this point, many scientists seem to believe that the coronavirus gains entry into cells through a receptor called ACE2. Research on animals suggests NSAIDs might increase ACE2 levels, and some scientists believe increased ACE2 levels translates to more severe COVID-19 symptoms once infected.

Some experts don't believe that there's enough scientific evidence to warrant France's directive, though. "I do not think people necessarily need to steer clear of NSAIDs," says Edo Paz, M.D., a cardiologist and vice president, medical at K Health. "The rationale for this new warning is that inflammation is part of the immune response, and therefore drugs that stop the inflammatory response, like NSAIDs and corticosteroids, may reduce the immune response that is needed to fight COVID-19. However, NSAIDs have been extensively studied and there is no clear link to infectious complications." (Related: The Most Common Coronavirus Symptoms to Look Out for, According to Experts)

Angela Rasmussen, Ph.D., a virologist at Columbia University, gave her perspective on the link between NSAIDs and COVID-19 in a Twitter thread. She suggested that France's recommendation is based on a hypothesis that "relies on several major assumptions that may not be true." She also argued that there's currently no research suggesting that an increase in ACE2 levels necessarily leads to more infected cells; that more infected cells mean more of the virus will be produced; or that cells producing more of the virus mean more severe symptoms. (If you're interested in learning more, Rasmussen breaks down each of these three points in more detail in her Twitter thread.)

"In my opinion, it is irresponsible to base clinical recommendations from governmental health officials on an unproven hypothesis advanced in a letter that did not undergo peer review," she wrote. "So don't throw out your Advil or stop taking your blood pressure medicine just yet." (Related: Everything You Need to Know About Coronavirus Transmission)

That said, if you'd prefer not to take NSAIDs right now for one reason or another, acetaminophen can also relieve pain and fevers, and experts say there are other reasons why it might be a better choice for you.

"Unrelated to COVID-19, NSAIDs have been linked to kidney failure, gastrointestinal bleeding, and cardiovascular events," explains Dr. Paz. "So if someone wants to avoid these drugs, a natural substitute would be acetaminophen, the active ingredient in Tylenol. This can help with aches, pains, and fever associated with COVID-19 and other infections."

But keep in mind: Acetaminophen isn't without fault, either. Taking excessive amounts can potentially cause liver damage.

Bottom line: When in doubt, discuss your options with your healthcare provider. And as a general rule for painkillers like NSAIDs and acetaminophen, always stick to the recommended dosage, whether you're taking an OTC or prescription-strength version.

The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it’s possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.

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