Coronavirus tips: Should you take paracetamol rather than ibuprofen to treat symptoms?

On 3 June a trial was launched in the UK to test whether ibuprofen can help Covid-19 patients with breathing difficulties.

The team of researchers from King's College London and Guy's and St Thomas' hospital hope the treatment, if successful, could keep patients off ventilators and reduce hospital stays.

But this follows months of suggestions that ibuprofen was more dangerous than paracetamol for those with the virus.

On 17 March, the UK’s chief scientific adviser Sir Patrick Vallance said the “sensible thing” would be to avoid ibuprofen if you have coronavirus.

This followed comments made by French authorities warning that people shouldn’t be taking anti-inflammatory drugs such as ibuprofen and instead should be relying solely on paracetamol.

The NHS never updated its advice to say people should avoid ibuprofen - instead saying you should self-isolate and avoid antibiotics.

So is ibuprofen safe to take if you have coronavirus?

Why are we talking about paracetamol and ibuprofen with regards to Covid-19?

On 14 March the French health minister, Olivier Véran, tweeted: “The taking of anti-inflammatories could be a factor in aggravating the infection.

“In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

It is not clear whether Véran’s tweet was based on evidence from Covid-19 cases in France explicitly, or more generally on some studies which have previously suggested that non-steroidal anti-inflammatory drugs (known as NSAIDs) can weaken the immune system – something which could be dangerous when your body is trying to fight off the coronavirus.

So should people in the UK with suspected coronavirus be buying paracetamol rather than anti-inflammatory drugs? And if you do take anti-inflammatories, is this a problem or just less effective than paracetamol?

Is paracetamol safer than ibuprofen?

Public Health England (PHE) told The Independent there is not currently enough information on ibuprofen use and Covid-19 to advise people to stop using ibuprofen.

A spokesperson said: “Currently there is no published scientific evidence that ibuprofen increases the risk of catching Covid-19 or makes the illness worse. There is also no conclusive evidence that taking ibuprofen is harmful for other respiratory infections.”

They add that patients who have been prescribed NSAIDs for other long-term health problems should continue to take them as prescribed.

Dr Rupert Beale, group leader in cell biology of infection at The Francis Crick Institute agrees that there isn’t any “widely accepted additional reason to avoid it [NSAID drugs] for Covid-19”. He adds: “Patients taking cortisone or other steroids should not stop them except on advice from their doctor.”

On 14 April, the government's website published an update on research into the topic, stating: "The Commission of Human Medicines (CHM) Expert Working Group on coronavirus (COVID-19) has concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and susceptibility to contracting COVID-19 or the worsening of its symptoms.

Are there risks to taking ibuprofen for Covid-19?

PHE says there is currently no evidence that ibuprofen can make Covid-19 worse.

But Dr Tom Wingfield, senior clinical lecturer and honorary consultant physician at Liverpool School of Tropical Medicine, says that paracetamol may be preferable because it is less likely to cause side effects if taken over a long period.

Dr Wingfield says: “In the UK, paracetamol would generally be preferred over non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen to relieve symptoms caused by infection such as fever. This is because, when taken according to the manufacturer’s instructions in terms of timing and maximum dosage, it is less likely to cause side effects.”

The NHS says possible side effects of NSAIDs when taken for any length of time, include indigestion, stomach ulcers, headaches, drowsiness, dizziness, allergic reactions and in rare cases problem with your liver or kidneys.

Dr Charlotte Warren-Gash, associate professor of epidemiology at London School of Hygiene and Tropical Medicine agrees that if people have underlying health conditions they should take NSAIDs with caution.

“In England, NICE recommends prescribing the lowest dose for the shortest duration to prevent adverse effects such as gastrointestinal bleeding and cardiovascular or kidney problems,” she says.

Should I switch to paracetamol?

Both Dr Wingfield and Dr Warren-Gash agree it is not clear whether the advice given by French health minister Olivier Véran to switch to paracetamol is just following generic “good practice guidelines” or specifically related to data emerging from cases of Covid-19.

“For COVID-19, research is needed into the effects of specific NSAIDs among people with different underlying health conditions, which takes into account the severity of infection,” says Warren-Gash.

For now Public Health England says that people should not be worried about taking ibuprofen: “Most people with Covid-19 will have a mild illness and some people may need to take medicines, such as paracetamol or ibuprofen, to help with raised temperature, headache and other pains; always follow the instructions on the label if you do take these medicines and do not exceed the stated dose.”

On 16 April, the NHS updated its guidance on whether patients with coronavirus symptoms should take paracetamol or ibuprofen.

"The Commission on Human Medicines has now confirmed that there is no clear evidence that using ibuprofen to treat symptoms such as a high temperature can make coronavirus (Covid-19) worse," the health service wrote on its website.

"You can take paracetamol or ibuprofen to treat the symptoms of coronavirus. We recommend that you try paracetamol first, it has fewer side effects than ibuprofen and is the safer choice for most people."

The NHS added you should "always follow the instructions that come with your medicine".