Covid-19: Should you take NSAIDS?

People have asked me about the risk of using NSAIDS like ibuprofen (Advil), for inflammation and fever, in situations such as Covid19.

There is really two sides to the answer.

NSAIDs like ibuprofen could increase levels of ACE2 (shown in animal models, but not in patients.) Most medical professional societies have not gone so far as to recommend that people taking NSAIDS who are at risk for Covid19 discontinue them, but then again, ACE2 is the ‘docking’ molecule for novel coronavirus attachment, so having more ACE2 in your lungs would in theory probably not be such a good thing.

If we go with the precautionary principle, it would be best to find other ways of modulating inflammation and fever, such as paracetamol (also known as acetaminophen or in the states Tylenol) although as has been previously discussed, this class of drugs is not without its own consequences.

Most medical professional societies have not gone so far as to recommend that people taking NSAIDS who are at risk for Covid19 discontinue them, although health authorities in France are recommending against it.

Other options might include the anti-inflammatory enzyme bromelain, the herbs Feverfew, St. John’s Wort (not great for blood type O), Willow Bark and Valerian, Turmeric and Boswellia.

Or if you want to go old-school, there’s always aspirin, although aspirin comes with its own baggage, and should not be be used to treat fevers in children. Reye’s syndrome usually occurs in children who have had a recent viral infection, such as chickenpox or the flu. Taking aspirin to treat such an infection greatly increases the risk of Reye’s.

If you find that you absolutely must use NSAIDs, you might want to consider adding the herb Magnolia (well regarded in Traditional Chinese Medicine, and perhaps the most popular herb commercially in Japan) to your plans. One of its ingredients, magnolol, seems to decrease ACE2 expression in lung tissue. (PubMed Link)

1 comment on “Covid-19: Should you take NSAIDS?”

  1. Rafal Olszanecki Reply

    Thank you for your well balanced opinion in last discussion about ACEI, ARB and NSAIDs use in COVID patients. We all need calm and answerable discussion not hype.
    It is still not clear whether these drugs may increase ACE2 in humans. Moreover 2 or 3 papers suggest that ACE2 in lungs may be protective and/or ARB, by binding with ACE2 may decrease ability of SARS to enter into the cells… Nowadays it far too easy to publish hypotheses esp. with potential of hysterical aggravation in media and consequences for patients chronically treated with drugs. ..
    For example it would be easy to say that red wine resveratrol, by induction of ACE2 (there are 2, or 3 papers in Pubmed on animal models) or even broader – mediterranean diet – may be partially responsible for such high fatality of COVID in Italy, Spain or France…I hope, that all such hypotheses – about drugs, life style – will be correctly verified when the pandemic will cease and numbers will be more firm ans “finished”…Now it probably make more harm than profit.
    Thanks again.
    (PS. your datapunk toolsite is great 🙂

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