Should Ibuprofen Really Be Avoided During the Covid-19 Pandemic?

Ibuprofen illustration.

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• Monday evening, the number of new cases of coronavirus contamination stood at 52,518 in 24 hours in France.

  To fight against headaches and other inherent pain, health authorities recommend taking paracetamol as a priority.

• But several studies have denied the dangerousness of ibuprofen in the event of Covid-19.

• Some laboratories and doctors regret that the health authorities have not updated their speech.

We knew that the use of hydroxychloroquine in the treatment of Covid-19 had provoked in France a number of heated debates, contradictory articles and false information.

We know much less about another French specificity in the series "drugs vs Sars-Cov-2": ibuprofen, much more used, has been considered dangerous since March.

However, several studies have since shown that this nonsteroidal anti-inflammatory drug (NSAID) does not pose an additional risk for patients.

Studies deny the dangerousness of ibuprofen

Let's go back to the beginning of 2020, when we discovered the coronavirus.

"In March, there is a warning from the Directorate General of Health against the use of NSAIDs in general, and ibuprofen in particular, in Covid following cases", explains medical pharmacology specialist Nicholas Moore .

This pharmacovigilance and cardiology expert spoke on Tuesday during a conference organized by the Zambon laboratory, which markets in particular ibuprofen-based drugs (Spedifen, Spifen).

The information then makes its way.

On March 14, the Ministry of Health, Olivier Véran, alerted, especially on Twitter, on the dangerousness of ibuprofen.

⚠️ #COVID ー 19 |

Taking anti-inflammatory drugs (ibuprofen, cortisone, etc.) could be a factor in worsening the infection.

In case of fever, take paracetamol.

If you are already on anti-inflammatory drugs or if in doubt, ask your doctor for advice.

- Olivier Véran (@olivierveran) March 14, 2020

A position that emerged from the field, in particular of patients hospitalized in Bordeaux and Toulouse.

It conquers several European countries.

And is based on a bias, critic Nicholas Moore.

"It is not surprising that most of the severe cases have been exposed to ibuprofen [which relieves pain and headaches]".

This is not sufficient evidence to incriminate the product.

A point of view shared by a team of Spanish researchers who took an interest in the course of this “fake news” (in their words).

They conclude, in this article of

, that the impact of disinformation is all the more massive that it is credible sources that peddle it.

Here the Minister of Health and the media, who have not denied the information ...

This alert has since been denied by scientific studies.

“Since March, we have made good progress,” continues Nicholas Moore.

A good ten studies have been done.

Do NSAIDs increase the risk of catching Covid-19?

No.

When you are positive, are you more likely to have a severe form?

There are nine studies that show that there is no additional risk of death.

"Including a British, dating from August 14 and drawing on nearly 2 million people, who concludes:" [there is] no difference in the risk of death linked to COVID-19 associated with the current use of NSAIDs versus non-use '

In France, however, a pharmacovigilance review by the National Medicines Safety Agency dating from May 2020 remains on this precautionary principle.

"This recommendation to avoid taking NSAIDs for suspicious early symptoms of Covid-19 remains very topical," the report concludes.

Insufficient, criticizes the pharmacovigilance specialist.

“All in all, we see that the vast majority of studies show that there is no risk in taking NSAIDs, only one shows an increased risk and two shows protection, which is compatible with the anti-inflammatory effect in a disease, Covid-19, which causes inflammation of the lungs.

"

A French exception?

"To paraphrase the conclusions of the World Health Organization, in Covid-19, there is no reason not to use NSAIDs", synthesizes Nicholas Moore.

In its recommendations, the WHO added ibuprofen in May to treat pain and fevers in Covid-19.

"No other country except France has issued a vigilance on ibuprofen," he adds.

Specifying that the European Medicines Agency (EMA) has also returned to this alert.

Unsurprisingly, pharmaceutical laboratories and pharmacies hope that the French health authorities will correct their discourse on this drug particularly used in the country.

And shunned for months.

A study by the National Medicines Safety Agency (ANSM) on the consumption of drugs during confinement reveals that sales of ibuprofen fell sharply in March in France, "to reach - 80%.

This phenomenon can be linked, for the initial part, to the warning by the French health authorities concerning the use of anti-inflammatory drugs, and in particular ibuprofen, for a potential risk of aggravation of Covid-19.

"

But it's not just the labs that are hoping for this update.

Doctors too.

"All the initial theories which, out of prudence, had ibuprofen banned do not hold water," insists Nicholas Moore.

This needs to be reviewed.

But it is difficult, once it is installed, to modify this discourse ”, he regrets.

"The government has changed its mind about wearing masks, it can do it on NSAIDs ...", ironically Pascale Bazerolle Bouché, pharmacist in Savoie.

Be careful all the same

Does this mean that we can advise the general public to gorge on ibuprofen from the first symptoms of Covid-19?

"As a precaution, take paracetamol to treat the early symptoms of Sars-Cov-2," advises Nicholas Moore.

If that is not enough, it is up to the doctor to see if he increases the paracetamol, if he gives anti-inflammatory drugs or if he needs to be hospitalized.

"

For these doctors, everything obviously depends on the patient's profile.

“And therefore risk factors, Covid or not Covid for that matter!

», Adds Alain Serrie, head of pain medicine at Lariboisière (AP-HP).

It is not only for the Covid that this molecule can be useful.

Because it relieves all types of significant pain, from postoperative to migraines through painful periods.

NSAIDs are more effective than paracetamol and do not cause addiction, unlike opiates, responsible for a real epidemic in the United States.

But, like any molecule, it is not without danger.

Some patients should avoid them in case of pregnancy, hepatic, renal and cardiac insufficiency, digestive ulcer and perforation, allergy ...

And everyone must respect the doses and duration.

"No drug is harmless, everything is in the dose and the pharmacist remains the guardian of the poisons", insists Pascale Bazerolle Bouché.

Indeed, to limit accidents and given that NSAIDs are one of the most widely consumed drugs for self-medication, the ANSM has decided since January 2020 to no longer have these self-service pads in pharmacies.

And the ANSM reminds that "these drugs are safe and effective when used correctly, but present risks when used inappropriately".

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