Can People with Confirmed or Suspected COVID-19 Use PAINKILLERS (Non-steroidal Anti-inflammatory Drugs)?

Non-steroidal anti-inflammatory drugs (NSAİİ) are among the most widely used groups of medicines. This broad group is used mainly for its pain-relieving and fever-reducing properties. In its published clinical guideline, the United Kingdom’s National Institute for Health and Clinical Excellence recommended that COVID-19 symptoms and fever should be treated with parasetamol (commonly known as parol) in preference to NSAİİ. However, scientific debate on this subject continues.

COVID 19 and Painkillers

NOTE: Non-steroidal anti-inflammatory drugs, also described as anti-inflammatory medicines that are not steroids, or NSAİİ for short, relieve pain, reduce fever and decrease inflammation. The term "non-steroid" is used to distinguish these medicines from steroids. NSAİİ are non-narcotic painkillers. The best-known members of this group are aspirin, ibuprofen, naproksen and diklofenak. Parol, Vermidon, Minoset are market names for parasetamol (asetaminofen), which is not included among NSAİİ because it has very little anti-inflammatory effect.

Concerns have been reported about the use of these medicines in acute conditions, including COVID-19 and other viral illnesses. Let us examine the debate about these medicines by highlighting five features of COVID-19, and extend the discussion to other drugs that can affect the immune system, such as medicines for cardiovascular diseases and antidiabetic medicines (diabetes medicines).

• The disease manifests with different severity in each individual – with substantial differences within individual age groups,
• The severity of the disease differs unusually markedly between different age groups,
• In most countries, men have higher rates of COVID-19 disease and death (mortality) than women,
• Higher mortality is seen in patients with cardiovascular disease, hypertension (high blood pressure) and type 2 diabetes,
• The appearance of severe disease findings may be delayed until 3 weeks after the first symptoms.

Another surprising point is that mortality among people with cardiovascular disease and type 2 diabetes is similar to that among people with chronic obstructive pulmonary disease (KOAH), who are thought to be at higher risk.

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Could there be a common unifying hypothesis underlying these observations? Could a relationship between immune function and viral replication (self-multiplication) explain them? Drugs that regulate or modify the immune system: are they receiving enough attention?

A small number of experts believe that NSAİİ should be avoided in suspected COVID-19 cases until further research is available. They refer to the possibility that these drugs may slow the recruitment of certain immune cells (polymorphonuclear cells) and delay the resolution of inflammation. In fact, this argument should also be considered for many other drugs. Could some medicines slow the mobilization of the immune system and cause the virus to multiply faster?

Many medicines, including drugs for cardiovascular disease and antidiabetic medicines (diabetes medicines), affect the immune system in complex ways. Aspirin, metformin and statins (cholesterol-lowering medicines) generally exert beneficial effects by reducing inflammatory processes in addition to their other effects. These groups of medicines are widely used by people over 40. Cardiovascular disease is known to be more common in men, who therefore tend to use more medicines for these conditions. For these reasons, the effects of these drugs on the immune system also need detailed investigation in future studies.

Beyond Reasoning, What Does the Scientific Evidence Say?

A systematic review of studies conducted to date shows that, in COVID-19 patients, adverse effects from using these types of medicines have not been scientifically demonstrated. An extensive review of 73 studies on acute viral illnesses found no evidence showing harmful effects from using these medicines (note: the studies concerned acute viral illnesses and were not conducted in COVID-19 patients). There is also evidence of no significant difference between parasetamol and ibuprofen (a type of NSAİİ).

Conclusion

Recently, numerous international medical specialty associations have warned that patients should not stop or change their medicines without asking their doctors. In conclusion, no patient should change their existing treatment on the basis of this reasoning, whose scientific foundations have not been established, without consulting their doctor. There is no scientific evidence substantiating concerns about NSAİİ in COVID-19.

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