Know Your Medicines
Does ibuprofen make COVID-19 infection worse? What about my other pain? 布洛芬或其他非类固醇抗炎药与新冠肺炎COVID-19?

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The Take-Home Points:

Until more information is available, paracetamol would still be the preferred fever or pain medication, unless your doctor has told you paracetamol is not suitable for you (e.g. a bad reaction to paracetamol). If you are already taking ibuprofen or another non-steroidal anti-inflammatory (NSAID) on the advice of a healthcare professional, do not stop without first checking with your healthcare professional. If you are intending to self-medicate for fever or pain and have questions, do speak to your pharmacist or doctor for advice and evaluation. Should you experience severe cough, breathing difficulties, fever, or other COVID-19-like symptoms, do seek immediate medication attention rather than self-medication at this time. 

关键点:

除非你的医生告诉你扑热息痛(Paracetamol)不适合你(例如你对扑热息痛产生不良反应),否则在获得更多信息之前,扑热息痛仍然是首选的发烧或止痛药。如果你现在因为某种医疗原因在服用布洛芬或其他非类固醇抗炎药(NSAID),在没有得到医疗专业人士的建议之前, 请不要停止使用这些药物。如果你打算自行治疗发烧或疼痛病状,请先向你的药剂师或医生咨询意见和评估。如果你出现严重的咳嗽、呼吸困难、发烧或其他类似新冠肺炎的症状,应立即寻求专业治疗,而不是自行用药。

The Issue

Recent news and social media reports seem to suggest that the use of non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, could make COVID-19 infections easier and potentially could worsen its complications.

The Facts

Paracetamol is generally first choice treatment in most patients with fever, or mild to moderate pain, as it is safer than NSAIDs. NSAIDs are important in the control of inflammatory conditions like Rheumatoid Arthritis. Aspirin, a type of NSAID, is associated with the risk of Reye’s syndrome in children with viral infections. Ibuprofen is commonly used in children, as second-choice or as an add-on to paracetamol, because uncontrolled fever is more dangerous than the potential risk of Reye’s Syndrome.

There is currently no strong scientific evidence to advise people to stop using NSAIDs, especially if you are using it for chronic conditions such as rheumatoid arthritis. However, do note that self-medication with paracetamol and NSAIDs could mask symptoms of fever associated with COVID-19 infections, thus delaying medical attention if one does need it. World Health Organisation (WHO) has just issued an official statement of clarification that they do not recommend against the use of ibuprofen as well, as at 8am Singapore time on 19 Mar 2020.

Examples of common NSAIDs used in Singapore include ibuprofen, mefenamic acid, naproxen, indomethacin, celecoxib and etoricoxib.

事实:

新加坡常用的非类固醇抗炎药包括布洛芬 (Ibuprofen)、甲灭酸 (mefenamic acid)、萘普生 (naproxen)、吲哚美辛 (indomethacin)、塞来昔布 (celecoxib) 和依托昔布 (etoricoxib)。

目前为止,因为扑热息痛的用药性比非类固醇抗炎药更安全, 所以它仍是大多数发烧或轻微至中度疼痛患者的首选治疗方法。然而,非类固醇抗炎药在控制类似风湿关节炎等炎症方面还是具有很重要的功效。

常见的阿斯匹林也是一种非类固醇抗炎药,但是,因为阿斯匹林会造成一种副作用叫雷氏综合征,因此,医疗专业人士都不建议少于十二岁的孩童服用阿斯匹林。有鉴于此,布洛芬通常是治疗儿童发烧的第二选择, 或如果扑热息痛不能有效降低体温, 布洛芬也被建议同时服用来有效控制体温。

至今,还没有强而有力的科学证据来建议人们停止使用非类固醇抗炎药,特别是如果你正在使用非类固醇抗炎药来治疗慢性疾病,比如类风湿关节炎。但是,也请注意,服用扑热息痛和非类固醇抗炎药可能会掩盖与新冠肺炎感染相关的发烧症状,而造成延迟就医的可能性。世界卫生组织刚刚发布了一份官方声明,澄清他们在2020年3月19日新加坡时间上午8点之前,没有建议民众不要使用布洛芬。

 References/参考文献:

 

Authored by / 作者

Dr Wang Aiwen & Dr Doreen Tan Su-Yin / 王爱文 与 陈素音
Members of Pharmaceutical Society of Singapore / 新加坡药剂师协会会员