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

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

The advice is to just stick to acetominophen/paracetamol.

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.  

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.  

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

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

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.

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

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.

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.

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...