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Covid-19 Primary Care Resources

NSAIDs and Covid-19

NSAIDs reduce acute symptoms (such as fever). Further evidence is needed regarding effect on long term Covid outcomes

This information is sourced from NICE:

This rapid guideline is for acute use of NSAIDs for people with or at risk of COVID-19

The EMA advises that, when starting treatment for fever or pain in Covid-19, patients and healthcare professionals should consider all available treatment options, including paracetamol and NSAIDs

The available evidence suggests that:

  •  Although the anti-inflammatory effects of NSAIDs reduce acute symptoms (such as fever)
  • They may either have no effect on, or worsen, long-term outcomes, possibly by masking symptoms of worsening acute respiratory tract infection
  • Further evidence is needed to confirm this, and to determine whether these results also apply to infections such as COVID-19
  • Patients and healthcare professionals can continue using NSAIDs (like ibuprofen) as per the approved product information
  • Current advice includes that these medicines are used at the lowest effective dose for the shortest possible period

The information below is from March 2020, prior to the publication of the NICE guideline. It is included for context:

This information is sourced from NB medical:

The theoretical mechanism here is that NSAIDs may dampen the immune response, prolonging illness.

On 18th March 2020 Stephen Powis, NHS England Medical Director, clarified the position saying that:

  • In view of the current lack of clarity the Committee of Human Medicines and NICE have been asked to review the evidence. It is therefore suggested that, in the interim, for patients who have confirmed Covid-19 or believe they have Covid-19, that they use paracetamol in preference to NSAIDs.
  • Those currently on NSAIDs for other medical reasons (e.g. arthritis) should not stop them.”

BMJ editorial 27th March 2020 states:

‘It seems that intermittent or occasional use [of NSAIDs] could help patients with covid-19, for example, to relieve night time symptoms and aid sleep if paracetamol is inadequate, given the importance of sleep in immune defence’

‘People taking low dose aspirin for secondary prevention of cardiovascular disease should continue their treatment. Aspirin has anti-inflammatory effects only at much higher doses (eg, 1-4g a day)’