Is Tylenol or Ibuprofen Safer for Fever and Coronavirus? 

Man in bed with the flu

Information is coming in daily that changes what we know, and that causes confusion for doctors, scientists and everyone else. What seems certain one day (coronavirus is NOT transmitted through talking or breathing, no need to wear a mask) is thrown into doubt the next (maybe it IS transmitted through breathing and talking, wear a mask).

The whole question of the safety of ibuprofen started when a group of doctors from the University Hospital Basel, in Switzerland, and Aristotle University of Thessaloniki, in Greece published a Commentary (opinion piece) in a medical journal called Lancet. In the Commentary the doctors noted that it is known that ACE inhibitors used for heart health lowered the ACE-1 protein and increased ACE-2 enzymes. In normal times that’s a minor side effect that doesn’t cause problems. However the coronavirus can hijack the ACE-2 protein to travel through your body. For more information on ACE inhibitors see ACE Inhibitors in the Time of Coronavirus.

Then the doctors writing the Commentary compared that process to ibuprofen’s method of action. Ibuprofen (Advil, Motrin) is in a category of drugs called NSAIDs which stands for non-steroidal anti-inflammatory drugs. Ibuprofen lowers inflammation and causes the body to (also) increase production of ACE-2 proteins. Could it be, the doctors suggested, that those taking ibuprofen were inadvertently opening a pathway for coronavirus?

Commentaries in medical journals are a way for doctors to share ideas with other doctors and medical researchers. It is unusual for a health official to take action on what was speculation. But the French Minister of Health tweeted, “Taking anti-inflammatories (ibuprofen, cortisone…) could be an aggravating factor for the infection” based on the Commentary.

How do we know?

To determine if ibuprofen (or any drug) aids the transmission or course of coronavirus then we need to study people who have a similar severity of coronavirus and have taken ibuprofen in about the same amounts at about the same time.  We determine this by asking a lot of questions: did they take it before they were sick for some other reason? Did they only take it after the onset of coronavirus symptoms? How much did they take and how often, what else did they take? And compare that group against people who didn’t take any ibuprofen and are sick with coronavirus.

Should we take Tylenol instead of ibuprofen?

Let’s start with the reminder that it is often better to let a fever run its course and not try to lower it with acetaminophen or ibuprofen. “A fever is not a bad thing,” Jennifer Shu, MD, FAAP, Children’s Medical Group, P.C., in Atlanta, GA told MedShadow. “In fact, it can be a good sign that the immune system is kicking in.”

Tracking a fever helps to tell if you are getting better or worse. However, if the fever is keeping you from being able to eat or sleep, or if it goes over 102 degrees, it may be time to treat it.

There is no proof or study that indicates ibuprofen is bad for a coronavirus or COVID-19 victim to take.

What to take for a fever

While some are avoiding ibuprofen because of the speculation, it’s important to know that in normal times, ibuprofen is usually not the first choice for seniors – the age group most hit by COVID-19.  Pharmacy Times reports: “‘Most deaths from COVID-19 have been among older people and those with underlying health conditions, such as cardiovascular disease. We already know that NSAIDs should be prescribed with caution for people who have underlying health conditions,’ Charlotte Warren-Gash, associate professor of Epidemiology at the London School of Hygiene and Tropical Medicine, told Science Media Centre.”

Separate from the speculation about Ibuprofen and COVID-19, ibuprofen can cause nausea, constipation, stomach pain, bleeding and ulcers. It can harm the kidneys if one takes too much.

However, Tylenol (acetaminophen) is not without risk. Acetaminophen is the number one cause of death by liver damage, so do NOT take more than 3000 mg /day. When you add up how much acetaminophen you are taking make sure to include any acetaminophen in cough syrups, cold/flu remedies and some prescription drugs like Percocet and Vicodin.

Drinking cool fluids, taking cool baths, wearing light clothes all help to keep you comfortable when suffering from a fever.

What Experts Say

World Health Organization: Based on currently available information, WHO does not recommend against the use of ibuprofen. Twitter, March 18, 2020

Anthony Fauci, MD, head of the National Institute of Allergy and Infectious Diseases: “Bottom line is I have not seen any firm data to indicate there’s a problem or to prove that there’s not a problem.” In any case, “if you really want to just bring the temperature down,” Tylenol every 6 hours is the way to go, Fauci added. Twitter, March 19, 2020

FactCheck: No Evidence to Back COVID-19 Ibuprofen Concerns. March 30, 2020

Harvard’s advice: “… it still seems prudent to choose acetaminophen first, with a total dose not exceeding 3,000 milligrams per day.

However, if you suspect or know you have COVID-19 and cannot take acetaminophen, or have taken the maximum dose and still need symptom relief, taking over-the-counter ibuprofen does not need to be specifically avoided.” April 10, 2020

Conclusion

There is a lot to understand in the news these days, and because the doctors have not had time to conduct studies, both doctors and patients have to make decisions with little information. But by looking at evidence based research and the accessible commentary from experts, unpacking fact from fiction becomes a little easier for us all.


Suzanne B. Robotti

Suzanne B. Robotti

Suzanne Robotti founded MedShadow Foundation in 2012. Learn more about Su and her mission.


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