Avoid NSAIDs in COVID-19? Where’s the Evidence?

I’m seeing this article all over the place recommending to avoid NSAIDs in patients who have an infection with the new COVID-19 coronavirus. My question is, where’s the evidence? The only thing I can find is that it was based upon is a scientific theory as well as data that NSAIDs may not be good for other respiratory infections.

I cannot find any data from COVID-19 infections to support this. I do not want to totally discount this, but this report to my knowledge is anecdotal. It could very well turn out to be true, but it might not be either. I want to make a few clinical points about this, however.

  1. The elderly are at the highest risk of complications from NSAID use. If elderly patients who have heart failure, hypertension, or renal failure are using NSAIDs to manage their fever, pain, or other symptoms associated with COVID-19, it definitely makes sense that this may lead to worse outcomes. Whether that’s due to altering the activity of the infection or causing problems with compelling indications would be difficult to say.
  2. In addition to the elderly being at risk for adverse effects from NSAIDs, they are also at the highest risk for death from COVID-19 infection.
  3. In most geriatric patients, I would not recommend ibuprofen or other NSAIDs over acetaminophen for generalized aches, pain, or fever. For the majority of patients who do not have liver failure, acetaminophen will be a safer alternative than NSAIDs even in non-COVID-19 patients.
  4. I’m 100% guessing here, but I would speculate this anecdotal report from physicians and providers on the front line is associated more with patients who are older or who have risk factors that could be exacerbated by NSAIDs like heart failure, hypertension, or renal disease.

Should we avoid NSAIDs in COVID-19? For elderly patients, if we can we should be anyway under most circumstances even without COVID-19 infection. For younger patients, most could likely get by with acetaminophen and non-drug interventions to manage their pain and fever associated with infection. If you can avoid taking an NSAID, you might as well. Always stick to the recommended dosing of acetaminophen.

This article and information is time-sensitive and is not intended to be medical advice for your situation.

Please feel free to drop a comment below if you have found some actual data on this assertion. Stay safe and stay home until the coast is clear!

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  1. Cynthia Leung

    Thanks for this. I too find it disturbing to hear so much discussion about avoiding NSAIDs when the evidence is so limited. It is changing and evolving but so difficult to manage the public’s reaction to the information and the need to explain. At the end of the day, it is causing confusion to a situation that is already unsettling. Stay safe!


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Written By Eric Christianson

March 18, 2020

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