Ibuprofen or Acetaminophen (Paracetamol) for COVID-19?
Acetaminophen may be a better fever reducer for COVID-19 but no patient data support that assertion yet.
For reasons that are not entirely clear, WHO (World Health Organization) recommended against using non-steroidal anti-inflammatory drugs (NSAIDs) to reduce fever in people with COVID-19. I could not find any data or published study from patients with COVID-19 that supports this latest recommendation, so I am not sure this is how WHO came to their decision. However, I did find some science to support the concept that acetaminophen, the active ingredient in Tylenol, could be a better choice than ibuprofen.
NSAIDs, such as ibuprofen (the active ingredient in Motrin and Advil), aspirin, and naprosyn (also known as naproxen, the active ingredient in Aleve) inhibit enzymes called COX-1 and COX-2. The mechanism of action of acetaminophen is not clear, although it’s action may be in the brain. Both acetaminophen and NSAIDs are fever reducers. NSAIDs also reduce inflammation.
Both should only be taken at the dosages recommended, because they have specific tissue toxicities. NSAIDs can be toxic to the kidneys and acetaminophen to the liver. Acetaminophen or NSAIDs are present in many different common cold, cough, and sinus medications. Read the labels carefully before taking either acetaminophen or an NSAID in addition to a cold, cough, or sinus medication to ensure that the medication does not already contain one of these.
The coronavirus SARS-CoV2, which causes COVID-19, uses a protein called ACE2 to enter cells. ACE2 is a multifunctional protein. One of its major physiological functions is to lower blood pressure by inhibiting the renin-angiotensin system. The renin-angiontensin system regulates blood pressure in response to kidney function. Thus, ACE2 affects kidney function and the cardiovascular system.
The enzymes that NSAIDs inhibit also regulate kidney function. Thus, the combination of SARS-CoV2 and NSAIDs could have undesirable effects on kidney function and consequently the cardiovascular system. The safer option in most people could be acetaminophen to reduce the fever in cases of SARS-like infections that use ACE2 as the cellular receptor for entry.
Related Reading
Kuba K, Imai Y, Ohto-Nakanishi T, Penninger JM. Trilogy of ACE2: a peptidase in the renin-angiotensin system, a SARS receptor, and a partner for amino acid transporters. Pharmacol. Ther. 128, 119–128 (2010). DOI:10.1016/j.pharmthera.2010.06.003
Hörl WH. Nonsteroidal Anti-Inflammatory Drugs and the Kidney. Pharmaceuticals (Basel) 3, 2291–2321 (2010). DOI:10.3390/ph3072291
Melville NA, Nainggolan L, Are warnings against NSAIDs in COVID-19 warranted? Medscape Medical News (17 March 2020) https://www.medscape.com/viewarticle/926940 (accessed 18 March 2020)
Coronavirus (COVID-19). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/index.html (accessed 18 March 2020)
