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Overview

In response to the public health emergency posed by COVID-19, NHS England has established a rapid policy development process to aid clinicians in offering best care and advice to patients with or at risk of COVID-19. This summary sets out the clinical policy for the acute use of non-steroidal anti-inflammatory drugs (NSAIDs) in people with or at risk of COVID-19. The chronic use of NSAIDs is outside of the scope of this guidance.

Plain language summary

There have been some reports of possible adverse effects of the use of NSAIDs in acute respiratory tract infections more generally, which has led to suggestions to use paracetamol preferentially for fever/pain in such situations.

There is currently no evidence that the acute use of NSAIDs causes an increased risk of developing COVID-19 or of developing a more severe COVID-19 disease.

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.

If used, the lowest effective dose of NSAID should be used for the shortest period required to control symptoms. This is in line with the European Medicines Agency (EMA) statement on the 18 March 2020.

The long-term use of NSAIDs is outside of the scope of this policy, with the intention to undertake a separate review. The current advice for patients taking long-term NSAIDs for chronic conditions from the EMA and CAS alert is to continue this treatment, which may require re-assessment of medication should COVID-19 infection arise.

Evidence summary

The EMA advises that, when starting treatment for fever or pain in COVID-19, patients and healthcare professionals should consider all available treatment options, including paracetamol and NSAIDs.

Each medicine has its own benefits and risks which are reflected in its product information, and which should be considered along with EU national treatment guidelines, most of which recommend paracetamol as a first treatment option for fever or pain.

In line with EU national treatment guidelines, patients and healthcare professionals can continue using NSAIDs (like ibuprofen) as per the approved product information. Current advice includes that these medicines are used at the lowest effective dose for the shortest possible period.

Patients who have any questions should speak to their doctor or pharmacist.

There is currently no reason for patients taking ibuprofen to interrupt their treatment. This is particularly important for patients taking ibuprofen or other NSAIDs for chronic diseases.

The available evidence suggests that, although the anti-inflammatory effects of NSAIDs reduce acute symptoms (such as fever), they may either have no effect on, or worsen, long-term outcomes, possibly by masking symptoms of worsening acute respiratory tract infection. Further evidence is needed to confirm this, and to determine whether these results also apply to infections such as COVID-19.

There have been some reports of possible adverse effects of the use of NSAIDs in acute respiratory tract infections more generally, which has led to suggestions to use paracetamol preferentially for fever/pain in such situations.

There is currently no evidence that the acute use of NSAIDs causes an increased risk of developing COVID-19 or of developing a more severe COVID-19 disease.

Full guideline:

www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0211-NSAIDs-RPS_14-April.pdf

NHS England. Acute use of non- anti-inflammatory drugs (NSAIDs) in people with or at risk of COVID-19 (RPS2001). April 2020.

Contains public sector information licensed under the Open Government Licence v3.0.

Published date: 14 April 2020.