WHO clarifies guidance on ibuprofen, says there's no evidence it can worsen COVID-19

The World Health Organization (WHO) has said there's no evidence to suggest that using ibuprofen to manage symptoms of COVID-19 will worsen the condition, a statement that was echoed Friday by Health Canada.

Earlier reports said a spokesperson had cautioned against using ibuprofen to manage symptoms of the illness caused by the coronavus until WHO experts could investigate.

Ibuprofen is a non-steroidal anti-inflammatory medicine, or NSAID. It's sold under a number of brand names, including Advil and Nurofen. In addition to treating pain, it's often used to manage fever associated with various viral or bacterial infections.

WHO clarified its position Wednesday evening in a tweet saying "at present, based on currently available information, WHO does not recommend 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 its use in certain populations."  

There have been conflicting reports about the use of Ibuprofen and other NSAIDs since French Health Minister Olivier Véran, also a neurologist, tweeted Saturday that it may worsen a COVID-19 infection.

The European Union's medicines agency said Wednesday there is currently no evidence that taking ibuprofen makes the disease caused by the coronavirus worse.

The British Pharmacological Society agrees but recommends against their use for now, following advice from the U.K.'s National Health Service to use other fever relievers first.

"There is no consistent evidence to suggest that ibuprofen worsens the disease, but we support the cautious approach as more evidence is collected," said the society's president, Munir Pirmohamed.

"Until we have more information, people should take paracetamol to treat the symptoms of coronavirus, unless they have been told by their doctor that paracetamol is not suitable for them."

Paracetamol is known commonly as acetaminophen in Canada and sold under brands such as Tylenol.

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While telling everyone to be prepared, the World Health Organization praised South Korea's handling of the coronavirus and said Canada is part of a large international treatment study.

David Juurlink, head of the division of clinical pharmacology at the University of Toronto, said the concern about ibuprofen "doesn't seem to be based on a great deal of good evidence."

He said he worries that people who take ibuprofen to manage conditions such as rheumatoid arthritis or other chronic pain will stop doing so out of concern about COVID-19. That's not advisable, especially without first speaking to your primary care physician.

Health Canada echoed that concern in its written statement Friday, saying that people who use ibuprofen to treat chronic conditions should not stop their treatment and should speak to their health-care professional if they have any questions about changing medications.

Not all fevers need to be treated

If you do have the virus, it may be helpful to consider that fever is part of the body's natural defences against infection.

"The first decision people should make is whether or not they need to treat a fever at all. It's very common for people to want to intervene when they see that their temperature is up," he said.

"The main reason to do so is when it's making the person very, very uncomfortable."

Regardless of whether future research will reveal negative effects of ibuprofen on COVID-19, acetaminophen is the preferred choice for most patients anyway, said Juurlink. "It's generally safer than ibuprofen anyway."

Those who can't take acetaminophen and need relief from severe discomfort related to fever may be advised by their doctor to try ibuprofen. Health Canada said health-care professionals should consider all available treatment options for patients experiencing pain or fever related to COVID-19.

While COVID-19 is a new disease, some of what's known about ibuprofen's potential downsides could apply, experts say.

Charlotte Warren-Gash, an associate professor of epidemiology at the London School of Hygiene and Tropical Medicine, said the class of drugs is already used only selectively for people with underlying health conditions.

"Most deaths from COVID-19 have been among older people and those with underlying health conditions such as cardiovascular disease," she said in a written statement. "We already know that non-steroidal anti-inflammatory drugs should be prescribed with caution for people who have underlying health conditions."

Switzerland's government has launched the rationing of some common painkiller and anti-fever drugs to prevent panic buying caused by the coronavirus outbreak.

The government said the restriction, which starts immediately and will run for the next six months, was not introduced due to a shortage of drugs.

"It is a message to people not to buy too much and is designed to regulate the situation," a government spokesperson said. "There is no reason to panic buy."