Does ibuprofen worsen coronavirus? Canadian pharmacists say evidence is lacking

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UPDATE as of March 18, 8:00 a.m.: The World Health Organization has clarified its recommendation on ibuprofen use in coronavirus patients. The agency says people who suspect they have COVID-19 should take paracetamol, not ibuprofen, but added that health experts are still looking into the matter to provide “further guidance.”

A suggestion out of France that taking popular anti-inflammatory painkillers like ibuprofen could worsen the effects of the novel coronavirus has raised concerns over what to take to treat mild symptoms.

Olivier Véran, France’s health minister, who is also a qualified physician, tweeted Saturday that “the taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection.”
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“In case of fever, take paracetamol,” he said. “If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

At this point, there isn’t enough evidence to say whether it’s harmful or beneficial, said Barry Power, spokesperson for the Canadian Pharmacists Association.

“There is some evidence to support the claim, but there’s just as much evidence to not support it,” he told Global News.

“It’s definitely a point of controversy.”

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Non-steroidal anti-inflammatory drugs, or NSAIDS, which include aspirin and ibuprofen, are common over-the-counter medications primarily used to treat inflammation, pain and fever.

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The World Health Organization has advised those experiencing mild symptoms of the virus to treat it like you would the common cold: get plenty of rest, drink fluids and a take an antipyretic — which includes NSAIDS like Advil or ibuprofen — for aches and fevers.

However, the agency has cautioned that while ibuprofen may help to alleviate some symptoms, it can also mask them should they get worse.

Power said there are “small cases” that suggest some that ibuprofen can complicate certain types of pneumonia — also a respiratory infection.

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But in the case of SARS, an anti-inflammatory drug that was common at the time called indomethacin was “found to have some antiviral properties” and could “actually be a benefit” during laboratory tests in animals, he said.

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“It didn’t create a problem with it. At least in the lab, it showed some improvement,” he said.

The French health minister’s tweet garnered criticism from other health experts, including from one in Canada.

Dr. David Juurlink, a pharmacologist at Sunnybrook Health Sciences in Toronto, tweeted that it’s possible the drugs could “influence coronavirus replication, infectivity or the host response,” but “whether any such effect would be harmful or beneficial, I don’t know.”

Juurlink tweeted a series of observations about the claim after questions began swirling online over whether taking ibuprofen is the right move for those feeling COVID-19-like symptoms.

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“As far as I can tell, it’s not based on very much,” he said.

Muge Cevik, a virology researcher at the University of St. Andrews’ infection and global health division in Scotland, also tweeted that the “bold statement” by Véran is “causing public concern.”

“There’s no scientific evidence I am aware of that ibuprofen [can] cause worse outcomes in COVID-19,” she said.

The makers of Nurofen, a popular ibuprofen-based drug, discounted the claim on Monday, saying it was not aware of any evidence that the active ingredient could adversely impact COVID-19 patients.

“RB has neither received new safety information nor been involved in the evaluation of any adverse events regarding the use of ibuprofen in COVID-19,” the company wrote in a statement on its website.

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“Appropriate use of ibuprofen and paracetamol is still currently being recommended by most European health authorities as part of the symptomatic treatment of COVID-19.”

If the claim was based on cases of worsening COVID-19 patients in France who took ibuprofen, this would be a different story, said Power.

“It sounded like he was making a statement based on experience in France, but this is nothing published to support that at this point,” he said.

“It’s something we’re watching. If we need to change our statement, we will.”

For now, Power said: “Proceed with your usual routine.”

“The bottom line is there’s no strong evidence to say that it’s a problem to use it in COVID-19,,” he said.

“Just apply the regular cautions you would around any anti-inflammatories.”

— With files from Reuters

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