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)