Ibuprofen and COVID-19

Is it true that it is dangerous to take ibuprofen if you have COVID-19?

Anika H. Ahmed, MD

The decision of taking a fever reducing medicine is an important part of the decision tree of COVID-19 patients and many people may need to make this decision at home, when sick with mild symptoms. Some physicians are reluctant to use Ibuprofen and prefer using Acetaminophen as the first line of treatment for a fever caused by COVID-19. The main reason is that as the pandemic of COVID-19 has evolved through different clinical pictures, since the beginning of 2020, some have linked the use of NSAID (non-steroidal anti-inflammatory drug, commonly-used fever-reducing medicines) to adverse effects (headache, dizziness, upset stomach, vomiting, ringing in the ears etc.). However, this has not been proven to be correct scientifically. So far, many observational studies, clinical trials, and data collection are underway and do not necessarily prove the stated effects to be causally linked to the medication.

Social Media continues to heavily influence people globally, and many posts on such media contain unsubstantiated stories about Ibuprofen. It started when the French Health Ministry put out a note of caution in mid- March 2020 against the use of Ibuprofen, labelling it as a drug with serious consequences to its use, and recommending that French citizens avoid its use. They were soon followed by the British Medical and Healthcare Regulatory Agency (equivalent to the Food & Drug Authority – FDA – in the United States), which also issued an advisory against its use. In the same timeframe, the World Health Organization (WHO) also issued a statement that it was looking into the adverse effects of Ibuprofen in COVID-19 positive patients and to hold off on its use. WHO encouraged the use of Acetaminophen instead of Ibuprofen.

So what is Ibuprofen and why did it get a bad reputation during the COVID-19 pandemic? Ibuprofen is a non-steroidal anti-inflammatory drug that affects hormones in the body and is used for treating pain and fever. It works by blocking the production of Prostaglandins, a chemical released during pain and inflammation. Some scientists claim that Ibuprofen may boost the Angiotensin Converting Enzyme 2 (ACE2- an enzyme released by the kidney which is a vasoconstrictor that affects blood pressure). Coronavirus uses ACE2 to bind to cells to infect them and with a boost from Ibuprofen, it could make the virus spread faster, resulting in severe acute respiratory disorder. But so far, this is just a theory and has not been proven clinically and scientifically. 

At the end of April 2020, the National Institute of Health (NIH) and the British health officials issued guidelines for treatment of COVID-19 patients. These guidelines eased concerns about the use of nonsteroidal anti-inflammatory drugs, specifically Ibuprofen, putting an end to the notion that Ibuprofen may make people more vulnerable to Sars-Cov-2 in COVID-19, an infection that could lead to serious consequences. In addition to this, the National Institutes of Health also advised people that are taking NSAIDs for other medical conditions to continue usage as prescribed by their doctor. The NIH was followed by the British and the French Health organizations with confirmation that there is no link connecting NSAIDs, particularly Ibuprofen, to adverse effects in COVID-19 patients. More research is definitely needed, but presently there is no conclusive evidence that Ibuprofen increases the risk of serious complications or that it is harmful to patients with COVID-19 and other respiratory infections.