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Which pharmaceutical pain and fever reducers to take (or not take) for Covid-19

 
pollinator
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Ibuprofen may not be recommended as it degrades the immune response.

The advice is to just stick to acetominophen/paracetamol.

As for Chloroquine, I didn't know that was still available.  Mostly it's hydroxychloroquine these days and the safe dose is 5 mg/Kg for those conditions it's indicated for.
 
Graham Chiu
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https://www.sciencedirect.com/science/article/pii/S0924857920300820?via%3Dihub

Chloroquine 500 mg twice daily is being used.
And possibly 600 mg daily of Hydroxychloroquine - quite a bit above the normal dose.
 
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Graham Chiu wrote:Ibuprofen may not be recommended as it degrades the immune response.

The advice is to just stick to acetominophen/paracetamol.



I have seen discussion of this by several practicing docs who are unconvinced that the immune response degradation is of clinically-significant extent.  As in, the degradation can be measured, but they don't have any clinical evidence that it's enough to affect medical outcomes.  

Balanced against which is, apparently, some (not a conclusive amount) of evidence that covid-19 patients are experiencing hepatic (liver) strain/damage.  So acetaminophen (which comes with liver toxicity) is also of concern.  

Both of the discussions I saw involved the doctors concluding that they'd prefer to alternate between ibuprofen and acetaminophen to minimize both problems.  

Here are entry links to a couple of Twitter threads on this:

https://twitter.com/angie_rasmussen/status/1238946937916682241

https://twitter.com/notdred/status/1238806682458882049
 
Graham Chiu
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Dan Boone wrote:

Graham Chiu wrote:Ibuprofen may not be recommended as it degrades the immune response.

The advice is to just stick to acetominophen/paracetamol.



I have seen discussion of this by several practicing docs who are unconvinced that the immune response degradation is of clinically-significant extent.  As in, the degradation can be measured, but they don't have any clinical evidence that it's enough to affect medical outcomes.  



I got my information from a CDC webinar held a couple of days ago.

Dan Boone wrote:
Balanced against which is, apparently, some (not a conclusive amount) of evidence that covid-19 patients are experiencing hepatic (liver) strain/damage.  So acetaminophen (which comes with liver toxicity) is also of concern.  



NSAIDs are one of the most common causes of hepatitis.  I'd stick to acetaminophen in the recommended doses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861975/

In patients with end-stage liver disease, adverse events from analgesics are frequent, potentially fatal, and often avoidable. Severe complications from analgesia in these patients include hepatic encephalopathy, hepatorenal syndrome, and gastrointestinal bleeding, which can result in substantial morbidity and even death. In general, acetaminophen at reduced dosing is a safe option. In patients with cirrhosis, nonsteroidal anti-inflammatory drugs should be avoided to avert renal failure


 
Dan Boone
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Graham Chiu wrote:I'd stick to acetaminophen in the recommended doses.



Everybody makes these decisions for themselves, I'm just sharing the information that I have.
 
Graham Chiu
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Let me rephrase what I said.

As a practising medical specialist (rheumatologist), I am advising my hospital and private patients to avoid the use of NSAIDs in the management of this condition should they develop it.

Everyone else can get their advice from their primary care physicians.
 
Graham Chiu
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https://dgs-urgent.sante.gouv.fr/dgsurgent/inter/detailsMessageBuilder.do?id=30500&cmd=visualiserMessage

Urgent advisory from the French government. Avoid the use of Ibuprofen in the management of this disease.

I presume they'll release their evidence shortly.
 
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Graham Chiu wrote:

As a practising medical specialist (rheumatologist), I am advising my hospital and private patients to avoid the use of NSAIDs in the management of this condition should they develop it.

Everyone else can get their advice from their primary care physicians.



I very much appreciate your input here.  

My husband's neurologist urged him to stop taking ibuprofen a few years back so he doesn't use it at all.  I still have some around that I rarely use...it's good to know that NSAIDs are not a good choice for this virus.

EDIT...and thanks for the update in your last post above on 'why' we should not use them for this virus.



 
Graham Chiu
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From The Lancet

At least seven relatively large-scale case studies have reported the clinical features of patients with COVID-19.1,  5,  6,  7,  8,  9,  10 In this Comment, we assess how the liver is affected using the available case studies and data from The Fifth Medical Center of People's Liberation Something or other General Hospital, Beijing, China. These data indicate that 2–11% of patients with COVID-19 had liver comorbidities and 14–53% cases reported abnormal levels of alanine aminotransferase and aspartate aminotransferase (AST) during disease progression (table). Patients with severe COVID-19 seem to have higher rates of liver dysfunction.



Liver damage in patients with coronavirus infections might be directly caused by the viral infection of liver cells. Approximately 2–10% of patients with COVID-19 present with diarrhoea, and SARS-CoV-2 RNA has been detected in stool and blood samples.11 This evidence implicates the possibility of viral exposure in the liver. Both SARS-CoV-2 and SARS-CoV bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter the target cell,7 where the virus replicates and subsequently infects other cells in the upper respiratory tract and lung tissue; patients then begin to have clinical symptoms and manifestations. Pathological studies in patients with SARS confirmed the presence of the virus in liver tissue, although the viral titre was relatively low because viral inclusions were not observed.3



https://www.thelancet.com/journals/langas/article/..2468-1253(20)30057-1/fulltext where .. is Peter India India Sierra - the forum software has a bug and is rejecting the link as it thinks I'm using an abbreviation
 
Dan Boone
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Here's a helpful rundown written in plainer English about various statements from sources of medical authority on the idea of avoiding ibuprofen:

Experts Discuss Link Between Anti-Inflammatory Drugs And Covid-19

I'll include one excerpt that suggests to me that the Lancet article, in particular, has perhaps been misunderstood in the popular press:


Others have linked the claims to an article published in The Lancet earlier this month, based on observations of COVID-19 patients in China.

The observations suggest the disease is more severe in people with certain pre-existing conditions, including hypertension, diabetes, or cardiovascular disease. The article's authors hypothesize this may be due to medications used to treat these conditions, including ibuprofen. But the emphasis here is on "hypothesized." The article itself has not been peer-reviewed and it came to no hard and fast conclusions. Rather it suggested a possible avenue for future research.

A subsequent post clarifies there are indications ibuprofen may have a negative effect but no clear evidence and more research is needed to test the hypothesis.

"It is not a recommendation to use certain medications or not," Prof. Dr. Michael Roth, research group leader at the Department of Biomedicine at University Hospital Basel and co-author of the article, said in a statement.

 
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here is the latest info on covid 19--corona virus from one of the most reputable sources in the world.. no hype, no nonsense, just the facts

https://www.pasteur.fr/en/medical-center/disease-sheets/covid-19-disease-novel-coronavirus
 
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I have not read all of the posts.....

something which helps me when i am felling achy or sick. Is to take Fermented cod liver oil Or Blue Ice Royal Blend

My aches go away right away!

I would also strongly suggest raw garlic!
 
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Graham Chiu wrote:https://www.sciencedirect.com/science/article/pii/S0924857920300820?via%3Dihub

Chloroquine 500 mg twice daily is being used.
And possibly 600 mg daily of Hydroxychloroquine - quite a bit above the normal dose.



I can't find the paper I was reading on it now but the dosage recommendations were as follows:

hydroxychloroquine 400mg 2x day for one day followed by 200mg 2x day for four more days

OR

chloroquine phosphate 500mg 1x or 2x day for ten days

I can't vouch for the accuracy, but since I can get Plaquenil, I'll be using that.
 
Trace Oswald
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"Hydroxychloroquine (EC50=0.72 μM) was found to be more potent than chloroquine (EC50=5.47 μM) in vitro. Based on PBPK models results, a loading dose of 400 mg twice daily of hydroxychloroquine sulfate given orally, followed by a maintenance dose of 200 mg given twice daily for 4 days is recommended for SARS-CoV-2 infection, as it reached three times the potency of chloroquine phosphate when given 500 mg twice daily 5 days in advance."

from  Oxford Academic
 
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I have found this channel well researched and reliable. Coincidentally, the first question answered is about which pharmaceuticals to take during Covid-19

 
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Originally the BBC reported that anti-inflammatories might possibly cause an issue, but then published this https://www.bbc.com/news/51929628
and another one showing how the information travelled around the internet and didn't come from a reputable source. https://www.bbc.com/news/blogs-trending-51931394
 
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I don't have time to read all the sides of this, so I'll just add that there are discussions elsewhere on permies about the benefits of a fever so long as it's not scary high - viruses don't replicate as easily the warmer the body is, so that fever is one of the techniques your body is using to fight the virus. Aches and pains may benefit from a warm "hot-water-bottle" and are also a signal from your body to lie down and rest!

Yes, making a decision about what to take if you get to the scary level ahead of time has its place - but maybe if you're getting to that place, a hospital should actually be the first choice!
 
Dan Boone
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Interesting Wired magazine article breaks down the controversy:

The Ibuprofen Debate Reveals the Danger of Covid-19 Rumors: An online furor over whether it’s safe to use the fever reducer reveals how people are sharing incomplete—and sometimes bad—information

Two weeks ago, national and world health authorities—and armchair experts and worried well-meaning people—were warning anyone concerned about Covid-19 to avoid ibuprofen. Now, facing contradictory evidence, they’ve backed off that claim.

But the brief online furor over whether it’s safe to use the fever reducer, and the attention paid to the claim that it might be dangerous, are important, both for how people protect themselves in this pandemic and also for how we consume news about it.

...

That the advice against ibuprofen got circulated at all is a study in good intentions complicated by biases and possibly by misinformation as well. It showcases how the stress of a global pandemic is causing bad and incomplete information to rise as people rush to deploy whatever protections might be available on the shelf.

The trouble over ibuprofen began March 11...

 
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