Patients with COVID-19 should take paracetamol rather than ibuprofen, says NHS England

Concerns had been raised about people with coronavirus taking ibuprofen, after a warning from the French health minister.

The NHS has updated its advice to recommend paracetamol rather than ibuprofen to treat some of the symptoms of COVID-19. | GETTY IMAGES
The NHS has updated its advice to recommend paracetamol rather than ibuprofen to treat some of the symptoms of COVID-19. | GETTY IMAGES

Updated 15th April 2020

CHM now doesn't recommend avoiding ibuprofen

Since this article was first published, the Commission on Human Medicines (an advisory body of the MHRA) has concluded that there is insufficient evidence to establish a link between use of ibuprofen, or other NSAIDs, and contracting or worsening of COVID-19. The CHM says patients can take paracetamol or ibuprofen when self-medicating for symptoms of COVID-19.

NHS England Medical Director, Professor Stephen Powis, said the statement by Olivier Véran, a clinician, was based on provisional information reported from French care settings which UK authorities have not seen and is, to date, unpublished.

Prof Powis noted that there is no current literature on the impact of NSAID use in COVID-19 although there appears to be 'some evidence for SARS 1 that there may be an adverse impact on pneumonia', and 'some literature suggesting NSAIDs may increase complications from simple acute respiratory infections or slow recovery'. However, the evidence is 'not conclusive overall,' he said.

'There appears to be no evidence that NSAIDs increase the chance of acquiring COVID-19,' he added.

Whilst the MHRA and NICE are reviewing the evidence, NHS England suggests that patients with confirmed or suspected COVID-19 use paracetamol in preference to NSAIDs.

However, patients taking NSAIDs for other conditions, such as arthritis, should not stop doing so.

Underlying conditions

Other health professionals have advised that paracetamol may be generally preferable to ibuprofen in people with underlying health problems.

Dr Charlotte Warren-Gash, associate professor of epidemiology at the London School of Hygiene and Tropical Medicine, said that NSAIDs like ibuprofen 'should be prescribed with caution for people who have underlying health conditions'.

'For COVID-19, research is needed into the effects of specific NSAIDs among people with different underlying health conditions, which takes into account the severity of infection. In the meantime, for treating symptoms such as fever and sore throat, it seems sensible to stick to paracetamol as first choice.'

Dr Rupert Beale, group leader in cell biology of infection at The Francis Crick Institute, said: 'There is good reason to avoid ibuprofen as it may exacerbate acute kidney injury brought on by any severe illness, including severe COVID-19 disease.

'There isn’t yet any widely accepted additional reason to avoid it for COVID-19,' he added.

Professor Paul Little, professor of primary care research at the University of Southampton, said there was 'sizeable literature' from case control studies in several countries that the complications of respiratory infections - whether respiratory, septic or cardiovascular complications - can be 'more common when NSAIDs are used.'

He added that using paracetamol was 'less likely to result in complications'.

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