Consider Paracetamol When Treating COVID-19 Patients

Paracetamol is less likely to result in COVID-19 disease treatment complications

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Various healthcare leaders have backed claims by France’s Minister of Social Affairs and Health that people showing symptoms of COVID-19 disease should use paracetamol (acetaminophen) rather than ibuprofen.

France’s minister, Oliver Veran, tweeted on March 14, 2020, that people with suspected COVID-19 should avoid anti-inflammatory drugs.

“Taking anti-inflammatory drugs (ibuprofen, cortisone . . . could be an aggravating factor for the infection. If you have a fever, take paracetamol,” reported BMJ on March 17, 2020.

Paracetamol and acetaminophen are generic names for a chemical substance known as para-acetylaminophenol. All three of these are better known by its trade name (at least in the U.S.) Tylenol.

His comments seem to have stemmed in part from remarks attributed to an infectious disease doctor in France. She was reported to have cited 4 cases of young patients with COVID-19 and no underlying health problems who went on to develop serious symptoms after using non-steroidal anti-inflammatory drugs (NSAIDs) in the early stage of their symptoms.

France’s National Institute for Health and Care Excellence (NHS) recommends prescribing the lowest dose of ibuprofen for the shortest duration to patients with underlying conditions to prevent adverse events, including cardiovascular or kidney problems. 

And, the NHS additionally advises using ibuprofen over paracetamol for inflammatory problems such as arthritis but warns against taking it for long periods.

The local hospital posted a comment saying that public discussion of individual cases was inappropriate.

But, Jean-Louis Montastruc, a professor of medical and clinical pharmacology at the Central University Hospital in Toulouse, said that such deleterious effects from NSAIDs would not be a surprise given that since 2019, on the advice of the National Agency for the Safety of Medicines and Health Products, French health workers have been told not to treat fever or infections with ibuprofen.

Experts in the UK backed this sentiment. 

Paul Little, a professor of primary care research at the University of Southampton, said that there was good evidence “that prolonged illness or the complications of respiratory infections may be more common when NSAIDs are used—both respiratory or septic complications and cardiovascular complications.”

He added, “The finding in two randomized trials that advice to use ibuprofen results in more severe illness or complications helps confirm that the association seen in observational studies is indeed likely to be causal.” 

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“Advice to use paracetamol is also less likely to result in complications.”

Ian Jones, a professor of virology at the University of Reading, said that ibuprofen’s anti-inflammatory properties could “dampen down” the immune system, which could slow the recovery process. 

He added that it was likely, based on similarities between the new virus (SARS-CoV-2) and SARS, that COVID-19 reduces a key enzyme that part regulates the water and salt concentration in the blood, and could contribute to pneumonia seen in extreme cases.

Charlotte Warren-Gash, associate professor of epidemiology at the London School of Hygiene and Tropical Medicine, said: “For COVID-19, research is needed into the effects of specific NSAIDs among people with different underlying health conditions.” 

“In the meantime, for treating symptoms such as fever and sore throat, it seems sensible to stick to paracetamol as the first choice.”

Rupert Beale, an infectious disease researcher at the Francis Crick Institute, offered a warning on cortisone. “Patients taking cortisone or other steroids should not stop them except on advice from their doctor.”

Reckitt Benckiser, the manufacturer of the Nurofen brand of ibuprofen, published a related website statement: "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.”

“Reckitt Benckiser is not aware of any evidence that ibuprofen adversely impacts the outcome in patients suffering from COVID-19 infection."

"As with any medicine, we would remind consumers and their caregivers to carefully read and follow the instructions provided on the packaging and in the patient information leaflet."

The complex role that the immune system might play in COVID-19 disease has been underscored by reports that Swiss drug company Roche has secured approval from China for its anti-inflammation drug Actemra (tocilizumab) to treat patients developing severe complications from COVID-19.

SARS-CoV-2 outbreak news is published by Coronavirus Today.

Coronavirus medication and vaccine development news published by Precision Vaccinations.