Does Ibuprofen Make Coronavirus Worse? Experts Discuss Link Between Anti-Inflammatory Drugs and COVID-19

There is a lot of conflicting advice and confusion about ibuprofen and its effects on COVID-19 circulating online after a statement from France's health minister this weekend.

Olivier Véran—whose CV prior to taking office includes being assistant head of clinic at an intensive care unit of vascular neurology—said taking anti-inflammatories such as ibuprofen or cortisone could "be a factor" in worsening the infection.

"In the case of fever, take acetaminophen. If you are already taking anti-inflammatories or if you have any doubts, ask your doctor for advice," he tweeted.

The comment has been picked up online, with many now advising people to swap ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) for paracetamol. But is there any scientific evidence behind these claims?

The Medical University of Vienna in Austria, which many claimed had found evidence that Ibuprofen could accelerate the rate at which the virus multiplies, snapped back at the rumor, calling it "fake news."

The university's Twitter account released a statement, saying: "Attention! Currently circulating WhatsApp text and voice messages about alleged research results of the "Wiener Uniklinik" about a connection between Ibuprofen and Covid19 are Fake News, which have nothing to do with MedUniWien."

Others have linked the claims to an article published in The Lancet earlier this month, based on observations of COVID-19 patients in China.

The observations suggest the disease is more severe in people with certain pre-existing conditions, including hypertension, diabetes, or cardiovascular disease. The article's authors hypothesize this may be due to medications used to treat these conditions, including ibuprofen. But the emphasis here is on "hypothesized." The article itself has not been peer-reviewed and it came to no hard and fast conclusions. Rather it suggested a possible avenue for future research.

A subsequent post clarifies there are indications ibuprofen may have a negative effect but no clear evidence and more research is needed to test the hypothesis.

"It is not a recommendation to use certain medications or not," Prof. Dr. Michael Roth, research group leader at the Department of Biomedicine at University Hospital Basel and co-author of the article, said in a statement.

"Patients should strictly follow the instructions of their doctor or health care professional."

Following the discussion highlighting the lack of evidence that ibuprofen can worsen COVID-19, medical experts have commented online and on social media about the supposed link between ibuprofen and COVID-19.

"More research is needed to evaluate reports that ibuprofen may affect the course of COVID-19. Currently, there is no evidence that ibuprofen increases the risk of serious complications or of acquiring the virus that causes COVID-19," a spokesperson from the National Institute of Allergy and Infectious Diseases (NIAID) told Newsweek. "There is also no conclusive evidence that taking ibuprofen is harmful for other respiratory infections."

Similar advice has been issued by the World Health Organization (WHO), acknowledging concerns about ibuprofen use:

"At present, based on currently available information, WHO does not advise against the use of ibuprofen. We are also consulting with physicians treating COVID-19 patients and are not aware of reports of any negative effects of ibuprofen, beyond the usual known side effects that limit use in certain populations."

WHO is aware of concerns on the use of #ibuprofen for the treatment of fever for people with #COVID19.
We are consulting with physicians treating the patients & are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations.

— World Health Organization (WHO) (@WHO) March 18, 2020

The general consensus seems to be that there is no strong evidence to suggest it does, although prolonged use of the anti-inflammatory can put stress on the kidney and stomach.

"It is not clear from the French minister's comments whether the advice given is generic 'good practice' guidance or specifically related to data emerging from cases of Covid-19 but this might become clear in due course," Dr. Tom Wingfield, Senior Clinical Lecturer and Honorary Consultant Physician at Liverpool School of Tropical Medicine, U.K. said in a statement.

Health professionals have stressed that people should not stop taking prescribed medications unless advised to do so by their doctor.

"The first advice I would give is nobody should just stop any medication without advice from their practitioners," said Professor David Dockrell, Chair of Infection Medicine at the University of Edinburgh, told Newsweek. "If people are on it, they should follow the advice from their doctors as to whether to take it or not."

Dockrell explained it does not make people more susceptible to infection, but nonsteroidals and ibuprofen can have an effect on organs like the kidney. For this reason, it tends not to be recommended for people who are seriously ill with infection or have sepsis.

"One of the things that can happen with coronavirus is people can get sepsis and can get organ dysfunction," he said. "So, in theory, it would seem reasonable that ibuprofen and nonsteroidals should be avoided if possible for someone who might have coronavirus."

If someone is already taking them and gets COVID-19 infection it may be wise to avoid taking nonsteroidals unless there is an essential medical reason why the individual needs to continue them. It may be that updated guidelines for these and other medications become available and patients should follow this guidance and that of their doctors, Dockrell added.

Dr. Rupert Beale, Group Leader in Cell Biology of Infection at The Francis Crick Institute in the U.K., agreed, explaining: "There is a 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 that unless otherwise advised by their doctor, patients taking cortisone or other steroids should continue to do so.

Dr. Charlotte Warren-Gash, Associate Professor of Epidemiology, London School of Hygiene and Tropical Medicine, pointed out that most deaths from COVID-19 have affected older people and people with underlying health conditions.

"We already know that non-steroidal anti-inflammatory drugs [NSAIDs] should be prescribed with caution for people who have underlying health conditions," she said.

Warren-Gash highlights research that found there was a higher risk of heart attack among patients being treated for respiratory infections among those taking NSAIDs, suggesting there may be some interaction between anti-inflammatory drugs and respiratory illness. But, she adds, no data was available for naproxen or low dose ibuprofen—the two considered safest for older people and patients with cardiovascular disease.

She concluded by saying more research is needed. Adding: "In the meantime, for treating symptoms such as fever and sore throat, it seems sensible to stick to paracetamol as first choice."

The National Health Service (NHS) in the U.K. has updated its advice regarding ibuprofen in response to discussions around anti-inflammatories, saying:

"There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse.

"But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.

"If you are already taking Ibuprofen or another non-steroidal anti-inflammatory (NSAID) on the advice of a doctor, do not stop taking without checking first."

While the advice given by Ireland's Health Services (HSE) on Monday is to continue taking any medication you are on—including ibuprofen and other anti-inflammatories—unless told otherwise by a healthcare professional.

The article has been updated to include comment from National Institute of Allergy and Infectious Diseases (NIAID), the World Health Organization (WHO) and Professor David Dockrell.

Pill bottle
Stock image of pills. Advice circulating online suggests taking ibuprofen could make COVID-19 symptoms worse. The scientific evidence is less certain. iStock/epantha