All relevant healthcare professionals working in primary and community care in England should by now have received the Important Information for Immediate Action distributed 17/03/20 via the Central Alert System on behalf of the Chief Medical Officer for NHS England.
The CMO message [CEM-CMO-2020-010] included the following information and advice:
- There appears to be some evidence that NSAIDs may have an adverse impact on pneumonia linked to SARS1.
- There is also some literature suggesting NSAIDs may increase complications from simple acute respiratory infections or slow recovery.
- The evidence is not conclusive.
- There appears to be no evidence that NSAIDs increase the chance of acquiring Covid-19.
- In view of the current lack of clarity the Committee of Human Medicines (an advisory body of MHRA) and NICE have been asked to review the evidence.
- 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
- This position will be kept under constant review.
The evidence supporting the CMO advice has been appraised by the Oxford CEBM team for their COVID-19 Evidence Service. Their verdict is as follows:
- there is a need for caution when using NSAIDs in the context of acute respiratory infections (ARI).
- NSAIDs do not significantly reduce total symptoms or duration of respiratory infections.
- Pre-existing medications and conditions need to be taken account of when deciding to prescribe NSAIDs for symptomatic ARI.
- The lowest effective dose should be prescribed for the shortest period of time.
- Parenteral use of NSAIDs during an ARI should be avoided.
- There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse. But 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.
- 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.