Can NSAIDs be used to treat a COVID-19 fever?

• NSAIDs are best not used to treat a COVID-19 fever. A fever is a sign your body is fighting an infection, and most experts recommend it not be suppressed. If you need to take something to make you feel more comfortable, use acetaminophen occasionally instead.
• There is some concern that ibuprofen and other NSAIDs may increase the risk of severe COVID-19 developing or increase the risk of complications from the disease, although this has not been proven. Several health authorities are investigating the possibility further.
• Until more information is known, NSAIDs should be avoided to treat symptoms of COVID-19, unless you are already taking them or cannot take acetaminophen. In this case, ask your doctor for advice.

What is wrong with taking NSAIDs to treat a COVID-19 fever?

NSAIDs (Nonsteroidal anti-inflammatory agents) are a group of medicines that relieve pain and fever and reduce inflammation. There are nearly two dozen different NSAIDs available; common agents include aspirin, celecoxib, diclofenac, ibuprofen, indomethacin, mefenamic acid, naproxen, and piroxicam.

On March 14th concern was expressed by France’s Health Minister, Olivier Veran, in a tweet that suggested anti-inflammatory drugs, such as ibuprofen and cortisone could be an aggravating factor in people with COVID-19.

On the same day, the French government reported that NSAIDs, the family of drugs that include ibuprofen, were linked with "grave adverse effects" in patients affected by Covid-19.

This prompted the WHO to issue a statement on the 18th of March 2020 which recommended that people suffering COVID-19 symptoms should avoid taking ibuprofen after French officials warned that anti-inflammatory drugs could worsen the effects of the virus.

Less than 24 hours later, the WHO had retracted that statement on its official twitter account, stating “The WHO does not recommend against the use of ibuprofen.”

The United States FDA is currently investigating whether NSAIDs do, or do not, make COVID-19 worse.

Related questions

• Can you take Ibuprofen if you have COVID-19 (coronavirus)?
• Naproxen vs ibuprofen: What's the difference?
• Can you take ibuprofen on an empty stomach?

What do we already know about NSAIDs use during an infection?

The product insert for all NSAIDs already states that there is the potential for this type of medicine to mask the symptoms of infections in general (not just COVID-19) which may mean that people are only diagnosed once their condition is severe.

NSAID use, in general, has occasionally been associated with acute kidney injury, and the risk of this is increased in people who are prone to dehydration, such as older and critically ill patients.

There is a hypothetical risk that NSAIDs might also affect the way SARS-COV-2 binds to human cells, as research in animals has shown that NSAIDs increase levels of a protein called ACE2 on the surface of cells, the same protein that SARS-COV-2 binds to.

Why do most experts recommend against lowering a fever?

Research has shown that a fever can enhance our body’s immune system response and create an unbearable environment for most infecting organisms.

Medications that lower a fever (these are called antipyretics) reduce this response. Most experts agree these medicines should only be used occasionally, if at all, to relieve discomfort, rather than specifically to lower body temperature. Using medicines to lower a fever will not shorten the duration of an illness.

People already prescribed NSAIDs for other conditions, such as arthritis or pain-relief, should not stop them without their doctor’s advice and be assured that currently there appears to be no evidence that NSAIDs increase the risk of acquiring COVID-19.