Coronavirus: Should you take paracetamol rather than ibuprofen to treat symptoms?

Sophie Gallagher
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While there have been calls for coronavirus tests to be made available to NHS staff and the wider public, currently individuals are only tested if they are being treated in hospital.

For the rest of the public, the UK government says if you show symptoms for the virus — the two main symptoms being a high temperature and a new, continuous cough — you should stay at home for seven days and not call 111 or attend a GP or hospital.

If you do not get better on your own within a week, or your symptoms get worse, then you can seek medical help, says the most recent NHS advice.

Currently there is no specific treatment for coronavirus and any potential treatment, in hospital or elsewhere, simply aims to relieve symptoms rather than cure them.

So what should you do if you’re at home with symptoms and waiting for them to pass?

The NHS says you should self-isolate and don’t take antibiotics as they do not work against viruses.

Instead it recommends drinking plenty of water, sleeping alone, washing your hands regularly and taking everyday painkillers to treat symptoms.

But the UK’s chief scientific adviser Sir Patrick Vallance said the “sensible thing” at the moment is to avoid ibuprofen if you have coronavirus.

This follows comments made by French authorities warning that people shouldn’t be taking anti-inflammatory drugs such as ibuprofen and instead should be relying solely on paracetamol, which is not anti-inflammatory.

So is ibuprofen safe to take if you have coronavirus?

Why are we talking about paracetamol and ibuprofen with regards to Covid-19?

The French health minister, Olivier Véran, tweeted: “The taking of anti-inflammatories could be a factor in aggravating the infection.

“In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

It is not clear whether Véran’s tweet is based on evidence from Covid-19 cases in France explicitly, or more generally on some studies which have previously suggested that non-steroidal anti-inflammatory drugs (known as NSAIDs) can weaken the immune system – something which could be dangerous when your body is trying to fight off the coronavirus.

So should people in the UK with suspected coronavirus be buying paracetamol rather than anti-inflammatory drugs? And if you do take anti-inflammatories, is this a problem or just less effective than paracetamol?

Is paracetamol safer than ibuprofen?

Public Health England (PHE) tells The Independent there is not currently enough information on ibuprofen use and Covid-19 to advise people to stop using ibuprofen.

A spokesperson said: “Currently there is no published scientific evidence that ibuprofen increases the risk of catching Covid-19 or makes the illness worse. There is also no conclusive evidence that taking ibuprofen is harmful for other respiratory infections.”

They add that patients who have been prescribed NSAIDs for other long-term health problems should continue to take them as prescribed.

Dr Rupert Beale, group leader in cell biology of infection at The Francis Crick Institute agrees that there isn’t any “widely accepted additional reason to avoid it [NSAID drugs] for Covid-19”. He adds: “Patients taking cortisone or other steroids should not stop them except on advice from their doctor.”

On the government’s website, it states: “Until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.”

Are there risks to taking ibuprofen for Covid-19?

PHE says there is currently no evidence that ibuprofen can make Covid-19 worse.

But Dr Tom Wingfield, senior clinical lecturer and honorary consultant physician at Liverpool School of Tropical Medicine, says that paracetamol may be preferable because it is less likely to cause side effects if taken over a long period.

Dr Wingfield says: “In the UK, paracetamol would generally be preferred over non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen to relieve symptoms caused by infection such as fever. This is because, when taken according to the manufacturer’s instructions in terms of timing and maximum dosage, it is less likely to cause side effects.”

The NHS says possible side effects of NSAIDs when taken for any length of time, include indigestion, stomach ulcers, headaches, drowsiness, dizziness, allergic reactions and in rare cases problem with your liver or kidneys.

Dr Charlotte Warren-Gash, associate professor of epidemiology at London School of Hygiene and Tropical Medicine agrees that if people have underlying health conditions they should take NSAIDs with caution.

“In England, NICE recommends prescribing the lowest dose for the shortest duration to prevent adverse effects such as gastrointestinal bleeding and cardiovascular or kidney problems,” she says.

Should I switch to paracetamol?

Both Dr Wingfield and Dr Warren-Gash agree it is not clear whether the advice given by French health minister Olivier Véran to switch to paracetamol is just following generic “good practice guidelines” or specifically related to data emerging from cases of Covid-19.

“For COVID-19, research is needed into the effects of specific NSAIDs among people with different underlying health conditions, which takes into account the severity of infection,” says Warren-Gash.

For now Public Health England says that people should not be worried about taking ibuprofen: “Most people with COVID-19 will have a mild illness and some people may need to take medicines, such as paracetamol or ibuprofen, to help with raised temperature, headache and other pains; always follow the instructions on the label if you do take these medicines and do not exceed the stated dose.”

The NHS says that until they have more information, people should take paracetamol to treat symptoms at home, unless they have been told not to by a doctor.

“If you are already taking ibuprofen or another non-steroidal anti-inflammatory (NSAID) on the advice of a doctor, do not stop taking it without checking first,” the health service adds.