Recommendations from the World Health Organization (WHO) and the National Health Service (NHS) in the UK now discourage the use of ibuprofen in the treatment of symptoms related to COVID-19 viral infection.
There have been widespread concerns over the use of ibuprofen for treating COVID-19 symptoms, namely fever and body aches, with worries that it may do more harm than good. There has been a lot of mixed, and at best, confusing information on the subject, with some claiming that it may worsen the effects of a contracted COVID-19 infection.
While there is no patient data to support this, ibuprofen is known to increase levels of an enzyme that functions as a receptor for COVID-19. The virus binds to this enzyme on host cells to gain entry into them and replicate.
Moreover, while there have been no direct studies on the use of ibuprofen for treating symptoms of COVID-19, research on ibuprofen use in related respiratory infections indicates that it may negatively impact immune responses in fighting infection. Based on these concerns, official health organizations have moved to dissuade the use of ibuprofen for treating COVID-19 symptoms, and instead, recommend using acetaminophen for symptom relief.
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Despite the lack of clinical data on ibuprofen and COVID-19, given the unchartered territory we face with this new coronavirus, understanding the biological mechanisms of the virus as well as how commonly-used medications might affect patients may help guide informed approaches and studies on the topic.
The family of human pathogenic coronaviruses, which includes the severe acute respiratory syndrome coronavirus (SARS) and COVID-19, bind and gain entry into cells through an enzyme called the angiotensin-converting enzyme 2 (ACE2). This enzyme is expressed in epithelial tissues that line the lung, kidney, intestine and blood vasculature. These sites are therefore seemingly more prone to damage caused by coronaviruses.
ACE2 levels can be increased by drugs like ibuprofen and this could theoretically enhance the ability of coronaviruses to bind and enter cells. It is this hypothesis that a recent correspondence in the journal The Lancet reported on, postulating that ibuprofen may worsen COVID-19 infection by increasing levels of ACE2.
The report also warned against the increased risk of acquiring COVID-19 in patients with diabetes or hypertension who are treated with drugs that increase ACE2 (i.e. ACE inhibitors), as ACE2 beneficially lowers inflammation in these conditions.
In reference to the report, WHO spokesman Christian Lindmeier stated that experts at the UN health agency were “looking into this to give further guidance.” He also said it was important that people infected with COVID-19 “not use ibuprofen as a self-medication.”
While it is plausible that ibuprofen may negatively impact the symptoms and course of a COVID-19 infection, it is premature to draw any conclusions as its use has not been clinically studied in patients with this novel coronavirus. For now, however, based on its mechanism of action and evidence in related viral respiratory infections, ibuprofen is best avoided for treating symptoms associated with COVID-19.