Protection & Treatment

Uncertainty about NSAID use — Some clinicians have suggested the use of non-steroidal anti-inflammatory drugs (NSAIDs) early in the course of disease may have a negative impact on disease outcome. These concerns are based on anecdotal reports of a few young patients who received NSAIDs early in the course of infection and experienced severe disease. In light of these concerns, some providers are using acetaminophen in place of NSAIDs for reduction of fever. However, there have been no clinical or population-based data that directly address the risk of NSAIDs. The European Medicines Agency (EMA) and the WHO do not recommend that NSAIDs be avoided when clinically indicated.

The product insert has been updated by the FDA regarding NSAIDs and COVID-19 to read the following: 

Special Alerts

NSAID COVID-19 Safety Alert March 2020

The FDA is aware of news reports stating that the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, could worsen coronavirus disease (COVID-19). The FDA is not aware of scientific evidence connecting the use of NSAIDs with worsening COVID-19 symptoms. However, all prescription NSAID labels warn that "the pharmacological activity of NSAIDs in reducing inflammation, and possibly fever, may diminish the utility of diagnostic signs in detecting infections."

In addition to concerns about NSAIDs and COVID-19, there is no disagreement regarding the risks of NSAIDs and vascular disease. 

 

ALERT: US Boxed Warning

Serious cardiovascular thrombotic events (excluding NeoProfen):  Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction, and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.  Ibuprofen is contraindicated in the setting of coronary artery bypass graft (CABG) surgery.

BOTTOM LINE: 

UseTylenol (acetaminophan) for fever or aches with a maximum dose of 1 gram every 6 hours and no more than 4,000mg in 24 hours. 

 

Source: UPTODATE; CDC; FDA

COVID-19: Melatonin as a potential adjuvant treatment

 

Author: Rui Zhang, Xuebin Wang, Leng Ni, Xiao Di, Baitao Ma, Shuai Niu, Changwei Liu, Russel J. Reiter

Publication: Life Sciences

Publisher: Elsevier

Date: Available online 23 March 2020

© 2020 Published by Elsevier Inc.

This article summarizes the likely benefits of melatonin in the attenuation of COVID-19 based on its putative pathogenesis. The recent outbreak of COVID-19 has become a pandemic with tens of thousands of infected patients. Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and often death. Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile. There is significant data showing that melatonin limits virus-related diseases and would also likely be beneficial in COVID-19 patients. Additional experiments and clinical studies are required to confirm this speculation.

Putative pathogenesis of COVID-19 and potential adjuvant use of melatonin.