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NHS England

Paracetamol or ibuprofen can be used to treat the symptoms of COVID-19, says NHS England

A review by the Commission on Human Medicines expert working group on COVID-19 and the National Institute for Health and Care Excellence prompted NHS England to change its advice on non-steroidal anti-inflammatory drugs for symptoms of COVID-19.

Open access article

The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.

To learn more about coronavirus, please visit: https://www.rpharms.com/resources/pharmacy-guides/wuhan-novel-coronavirus

Ibuprofen paracetamol packets

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NHS England says that while there had been some reports of possible adverse effects of the use of non-steroidal anti-inflammatory drugs in acute respiratory tract infections, there was “no evidence” that this applied to COVID-19

The NHS has changed its advice on only taking paracetamol to treat the symptoms of COVID-19 and now says that patients can take either paracetamol or ibuprofen to self-medicate for symptoms, such as fever or headache.

The change in advice follows a review — commissioned by NHS England and carried out jointly by the Commission on Human Medicines (CHM) Expert Working Group on COVID-19 and the National Institute for Health and Care Excellence (NICE)— which concluded that there was insufficient evidence at present to establish a link between use of ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19 symptoms.

An accompanying statement, signed by June Raine, chief executive of the Medicines and Healthcare products Regulatory Agency (MHRA); Gilian Leng, chief executive of NICE; and Stephen Powis, national medical director for NHS England and NHS Improvement, and released on the 14 April 2020, said “the lowest effective dose of ibuprofen should be used for the shortest duration necessary to control symptoms [of COVID-19]”.

The statement also said that healthcare professionals should consider a patient’s individual risk factors, such as a history of cardiovascular or gastrointestinal illness, when prescribing ibuprofen, but that patients who have been prescribed NSAIDs for a long-term condition should keep taking them as normal.

The review prompted NHS England to publish a rapid policy development document on 14 April 2020, which set out the clinical policy for the acute use of NSAIDs in people with or at risk of COVID-19. 

The document says that while there had been some reports of possible adverse effects of the use of NSAIDs in acute respiratory tract infections, which had led to suggestions to use paracetamol preferentially for fever and pain in such situations, there was currently “no evidence” that this applied to COVID-19.

“When patients, carers or healthcare professionals are starting treatment for fever and/or pain in patients (adults or children) with confirmed or suspected COVID-19, all treatment options should be considered and selected based on the greatest benefit compared to potential harms using each medicine’s product information,” it added. 

Commenting on the change, Gino Martini, chief scientist at the Royal Pharmaceutical Society, said that the advice was “a sensible approach”.

“This advice is based on all the scientific evidence available to us and is a sensible approach,” he added. “The evidence will continue to be assessed to ensure that the public gets the most up-to-date and accurate guidance to help keep everyone safe and well during the pandemic.”

The CHM and NICE review was carried out after the MHRA issued a central alerting system alert on 17 March 2020, in which Powis advised using paracetamol in preference to ibuprofen in people with confirmed or suspected COVID-19, while acknowledging there was limited evidence that ibuprofen was either safe or harmful in these people.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207906

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