#15,095
The above (translated) tweet - which is causing some consternation on the Internet - was issued a few hours ago by France's Health Minister and now has more than 22.5K retweets. Since a lot elderly people take NSAIDs and other anti-inflammatory drugs for a variety of ailments, it seems worth digging a little deeper.
Note: I'm not offering medical advice. I am not a doctor, and if you have questions or concerns you should ask your doctor for advice. The following is provided for educational purposes only.Since most of us who contract COVID-19 are going to be treated at home, we need to make informed decisions over how we treat the symptoms (fever, body aches, cough, etc.), particularly since no drug - even those you can buy over the counter - is 100% safe.
NSAIDs, and other anti-inflammatory drugs (including synthetic corticosteroids), are linked to a wide range of side effects. For NSAIDs, a heightened risk of cardiovascular events and bleeding (see FDA Strengthens Warnings Of Cardiovascular Risks With NSAIDs), and in the case of corticosteroids, lowered immunity to infections.
We've looked at this debate a number of times over the years, and the answers have not always been consistent.
- A 2009 study by researchers at the University of Rochester, appearing in the journal Cell Immunology (see Ibuprofen and other widely used non-steroidal anti-inflammatory drugs inhibit antibody production in human cells) warned the use of NSAIDs after infection or vaccination may lower host defense
- In 2011 - the American Academy of Pediatrics (AAP) released a report on the use of antipyretics in children, suggesting that we ought not over-treat fevers (Clinical Report—Fever and Antipyretic Use in Children)
- And in 2014's Start Spreading the Flus, we looked at a study that appeared in the Proceedings of the Royal Society B, that calculated the use of fever suppression meds increased the number of annual cases by approximately 5%, resulting in more than 1,000 additional flu deaths each year in North America.
In 2016, French researchers released a study in the Journal of Pediatrics (Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study), which found an increased risk of Empyema (bacterial lung infection) in children receiving NSAIDS for viral infections.
This from the NEJM Journal Watch:
July 18, 2016
Empyema: Do Nonsteroidal Anti-Inflammatory Drugs Increase the Risk?
Deborah Lehman, MD reviewing Le Bourgeois M et al. J Pediatr 2016 Jun 20
Children who received NSAIDs during treatment for acute viral illnesses were at increased risk for empyema.
Empyema, an uncommon complication of pneumonia, is typically preceded by an acute respiratory viral illness. The incidence of empyema has increased, and findings of small studies suggest increased risk with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during treatment of community-acquired pneumonia and respiratory viral infection.
(SNIP)
Risk for developing empyema was significantly elevated in children who received ≥1 day of NSAIDs within 72 hours of viral symptom onset compared with those receiving no NSAIDs (adjusted odds ratio, 2.8). Antibiotic use for ≥ 6 days (vs. < 6 days) was significantly associated with reduced risk for empyema (aOR, 0.3). Although not statistically significant, antibiotic use attenuated the excess risk associated with NSAID use. Acetaminophen administration was not associated with risk for empyema.
Just last year, the French Medicines Agency (ANSM) issued a new warning about NSAIDs, and in France, if you want to buy them, you have to ask a pharmacist. This summary from RAPS.org.
EU Regulatory Roundup: France’s ANSM Warns About NSAIDs Following Safety Review
Posted 25 April 2019 | By Nick Paul Taylor
France’s National Agency for the Safety of Medicines and Health Products (ANSM) has published a warning about the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients suffering from infectious diseases. ANSM issued the warning after analyzing almost 20 years of real-world safety data on the use of the NSAIDs ibuprofen and ketoprofen.
(SNIP)
ANSM selected 337 cases of infectious complications linked to ibuprofen and a further 49 cases tied to ketoprofen for analysis based on their severity and the lack of risk factors and comorbidities. The selected cases included reports of infections of the skin and soft tissue, blood, pleuropulmonary and neurological systems and other parts of the body. Some of the infections led to patient deaths.
The infectious complications were mainly associated with Streptococcus and occured after two to three days of treatment with NSAIDs, including when they were given with antibiotics. The NSAIDs were given by healthcare professionals or self-administered by patients to treat conditions including fever, insect bites and other benign inflammatory skin lesions and respiratory conditions. ANSM also found people with chickenpox continue to take NSAIDs, despite them being contraindicated.
ANSM emerged from the analysis with concerns that existing infections are exacerbated by the use of NSAIDs. In response, the French regulator has issued a reminder about the safe use of NSAIDs to patients and healthcare professionals and passed the findings on to its counterparts across Europe. ANSM hopes to spark a European Union-wide analysis of the safety of NSAIDs.
Despite today's alert from France's MOH, and the other known potential side effects from NSAIDs, I haven't found any other expressions of concern over taking NSAIDs for COVID-19.
Obviously, you never want to use aspirin for a viral infection in anyone under the age of 18, due to the risk of developing Reye's Syndrome. The CDC's advice (below) mentions having OTC meds for fever, but make no specific recommendations as to what type.
Personally, I'll avoid taking any antipyretic (fever reducing) drugs if I become infected, since that would dampen down my body's natural defenses. If I felt I had to take something, I'd elect to take acetaminophen, being careful not to exceed the safe daily dose (see A Reminder To Know Your Dose).
Get Ready for COVID-19 Now
Have supplies on hand
- Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time.
- If you cannot get extra medications, consider using mail-order for medications.
- Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
- Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.
Personally, I'll avoid taking any antipyretic (fever reducing) drugs if I become infected, since that would dampen down my body's natural defenses. If I felt I had to take something, I'd elect to take acetaminophen, being careful not to exceed the safe daily dose (see A Reminder To Know Your Dose).
