Science and Research
The scientific consensus is clear. Over-the-counter (OTC) ibuprofen/Advil remains safe to use as directed. The current scientific literature does not show that OTC ibuprofen/Advil makes COVID-19 health outcomes worse, and the world’s leading health authorities have confirmed there is no evidence to recommend that COVID-19 patients avoid OTC ibuprofen.
No overall increased risk of COVID-19 related death associated with current prescribed NSAID use.
In two similarly designed studies, researchers studied prescribed NSAID users and non-users and “..found no evidence of a harmful effect of routinely prescribed NSAIDs on COVID-19 related death.” They separately evaluated a general population (Study 1) and a population with rheumatoid arthritis or osteoarthritis (Study 2); NSAID users and nonusers did not have a difference in risk for COVID-19 related deaths when adjusted for differences between them in the two study populations. The researchers conclude that “...people currently prescribed NSAIDs for their long-term conditions should continue their treatment as part of their routine care.”
Wong AYS, et al. Ann Rheum Dis 2021;0:1–9. doi:10.1136/annrheumdis-2020-219517
The use of NSAIDs [like ibuprofen] does not lead to more severe coronavirus outcomes.
In this study of 9,236 Danish residents who tested positive for COVID-19 between February 27th and April 29th, 2020, the use of NSAIDs [like ibuprofen] within 30 days of the positive test was not associated with an increased risk of hospitalization, ICU admission, mechanical ventilation, renal replacement therapy or mortality.
Lund LC, Kristensen KB, Reilev M, et al. PLoS Med. 2020;17(9):e1003308. Published 2020 Sep 8. doi:10.1371/journal.pmed.1003308
Journal of Clinical Medicine Study: August 10, 2020
No evidence that routine NSAID use was associated with higher COVID-19 mortality
This [multicentre, prospective, observational study of 1,222 adult patients hospitalised with COVID-19 in eight UK hospitals] found no evidence that routine NSAID use was associated with higher COVID-19 mortality… therefore, patients should be advised to continue taking these medications until further evidence emerges.”
Bruce E, Barlow-Pay F, Short R, Vilches-Moraga A, Price A, McGovern A, Braude P, Stechman M, Moug S, McCarthy K, Hewitt J, Carter B, Myint P. J Clin Med. 2020 Aug 10;9(8):E2586.
Clinical Microbiology and Infection Study: June 12, 2020
Ibuprofen use not associated with worse clinical outcomes from COVID-19
In this [retrospective cohort study of 403 patients with COVID-19 from Shamir Medical Centre, Israel] ibuprofen use was not associated with worse clinical outcomes, compared with paracetamol [acetaminophen]. In patients with fever, there was no difference in clinical outcomes between ibuprofen and paracetamol [acetaminophen] users.
Rinott E, Kozer E, Shapira Y, Bar-Haim A, Youngster I. Clin Microbial Infect, 2020 Jun 12; S1198-743X(20)30343-8.
Chest Study in Vancouver, BC, Canada: March 2020
Current evidence is not strong enough to infer a causal link of a harmful effect of ibuprofen in patients with COVID-19
An early study in Vancouver, BC, Canada, concluded that the current epidemiologic evidence is not strong enough to infer a causal link of a harmful effect of ibuprofen in patients with COVID-19, and we need to be cautious when drawing conclusions from evidence that is derived from mechanistic or theoretical pharmacology, as they are not always corroborated with data from clinical trials.
Sodhi M, Etminan M. Safety of Ibuprofen in Patients With COVID-19: Causal or Confounded?. Chest. 2020;158(1):55-56. doi:10.1016/j.chest.2020.03.040]
American Headache Society, July 2020
There is no specific evidence at this time against the use of NSAIDs in patients with or without COVID‐19
A recent study, published in Headache in July 2020, concluded that there is no specific evidence at this time against the use of NSAIDs in patients with or without COVID‐19. Authors recommend a patient should be assessed for any other chronic diseases, underlying or pre-existing illnesses or conditions (i.e., co-morbid medical conditions) that may limit the use of NSAIDs and recommend a discussion of risks and benefits with all patients prior to prescribing NSAIDs.
Arca KN, Smith JH, Chiang CC, et al. COVID-19 and Headache Medicine: A Narrative Review of Non-Steroidal Anti-Inflammatory Drug (NSAID) and Corticosteroid Use [published online ahead of print, 2020 Jul 10]. Headache. 2020;10.1111/head.13903. doi:10.1111/head.13903]
Clinical Infectious Disease Study: July 27, 2020
Observational study reviews risk of prescription-strength NSAID use by hospitalized COVID-19 patients
An observational study from South Korea suggested that the harms associated with NSAID use may outweigh their benefits for patients with COVID-19; however, researchers looked only at patients hospitalized with COVID-19 who were prescribed prescription-strength, not OTC NSAIDs, and it is unclear if the prescribed NSAIDs were part of their COVID-19 treatment course or for one or more underlying serious health conditions.
Jeong HE, Lee H, Shin HJ, Choe YJ, Filion KB, Shin JY. Clin Infect Dis. 2020 Jul 27:ciaa1056. doi: 10.1093/cid/ciaa1056. Epub ahead of print. PMID: 32717066; PMCID: PMC7454423.
Adding Research Publications to What We Know About Advil (Ibuprofen) and COVID-19 – September 23, 2020
London School of Hygiene and Tropical Medicine: OpenSAFELY: Do adults prescribed Non-steroidal anti-inflammatory drugs have an increased risk of death from COVID-19?
Glossary of Terms
Comorbidities occur when someone has two or more other diseases, underlying or pre-existing illnesses/conditions at the same time. These may include a history of stomach problems, high blood pressure, heart disease, liver cirrhosis, kidney disease, asthma, or stroke.
Clinical trials are research studies performed in people that are aimed at evaluating a medical, surgical, or behavioral intervention. They are the primary way that researchers find out if a new treatment, like a new drug or diet or medical device (for example, a pacemaker) is safe and effective in people.
In a clinical trial, participants receive specific interventions according to the research plan or protocol created by the investigators, including the prescribing of drugs, use of medical devices, some medical procedures, or changes to behavior, such as diet.
Clinical trials may compare a new medical approach to a standard one that is already available, to a placebo that contains no active ingredients, or to no intervention. Some clinical trials compare interventions that are already approved for use.
When a new product or approach is being studied, it is not usually known whether it will be helpful, harmful, or no different than available alternatives (including no intervention). The investigators try to determine the safety and efficacy of the intervention by measuring certain outcomes in the participants.
NSAIDs, nonsteroidal anti-inflammatory drugs, are a group of chemical compounds that may be chemically unrelated, but share benefits such as analgesic (pain-relieving) and antipyretic (fever-reducing) effects.
When your body is hurt or aching, it produces chemicals that trigger pain signals. Ibuprofen, the main ingredient in Advil, blocks these signals at the source of injury to temporarily reduce pain and fever. Advil is an over-the-counter (OTC) NSAID.
For severe pain management, prescription NSAIDs are also available.
It is not always ethically or otherwise feasible to conduct the types of studies that provide clinically validated evidence such as from controlled, double-blind clinical studies, in which investigators proactively apply a treatment and look at how the intervention affects an outcome.
Observational studies collect, compare and contrast pre-existing information on a broad range of health factors. Scientists draw conclusions from reviewing existing information that can be collected from public health data bases, or hospital and insurance records to see if any correlations or connections exist between two or more factors.
While observational research can be valuable, it can also lead to premature or inaccurate conclusions based on the appearances of a correlation or connection, so it should not be used to establish or provide evidence for a cause-and-effect relationship between factors.
Over-the-counter drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs.
The term “patient outcomes” or “clinical outcomes” refers to the impact of a medical condition or results of a health intervention, including the prescribing of drugs, use of medical devices, some medical procedures, or changes to behavior, such as diet. It can also relate to the outcome experienced by a person suffering from a medical condition, such as an infection.
More specifically, it refers to whether patients suffering from a medical condition, or who are taking a specific medication, or undergoing a specific medical procedure or routine, experience any measurable or notable changes in their health status because of the medical condition or intervention. Patient outcomes commonly are used to determine and measure the effect a health intervention may have on the recovery from a medical condition, success of patient procedures or how well a medicine works.
Paracetamol is the U.K. generic name for acetaminophen. It is a common painkiller used to treat aches and pain and can also be used to reduce a high temperature.