Ibuprofen in the Management of Viral Infections: The Lesson of COVID‐19 for Its Use in a Clinical Setting

Abstract

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are commonly used for the management of fever, pain, and inflammation. However, they have always been considered to have a double‐faced role, according to their capacity to manage inflammation but also their possible reduction of immune system response and diagnosis delay. This last point could favor a dramatic increase of viral infection diffusion, possibly leading to a more severe outcome. The advent of severe acute respiratory syndrome coronavirus 2 excluded the use of NSAIDs, particularly ibuprofen, and then indicated this drug as the better NSAID to manage infected outpatients and prevent complications. Several authors described the role of NSAIDs and ibuprofen in preventing cytokine storm and modulating the immune system. However, the development of both adverse drug reactions (i.e., gastrointestinal, renal, hepatic, and cardiovascular) and drug interaction recalled the necessity of prescribing the better NSAID for each patient. In this narrative review, we describe the role of NSAIDs, particularly of ibuprofen, in the management of viral symptoms, suggesting that the NSAID may be chosen considering the characteristics of the patient, the comorbidity, and the polytherapy.

NSAIDs for early management of acute respiratory infections

“…By targeting COX isoforms, NSAIDs affect the production of proinflammatory cytokines, as well as some intracellular signaling pathways in inflammatory cells potentially preventing the damage caused by cytokine storms and hyperinflammatory states associated with viral infections [ 24 ▪▪ ]. The inhibition of COX by NSAIDs leads to clinically relevant benefits: in addition to the reduction of inflammatory symptoms, NSAIDs have shown, if used promptly in the early phase of the infection, to have the potential of inhibiting disease progression towards complications and hospitalizations [ 25 , 26 ].…”

“…In these last years, extensive evidence has been accumulated – including experimental research, observational clinical studies, randomized clinical trials, and meta-analyses – that now confirms that NSAIDs are not associated with increased susceptibility to SARS-CoV-2, nor with worsening of COVID-19, and do not impair the effectiveness of COVID-19 vaccinations. Therefore, recent reviews conclude that there is no basis to recommend limiting the use of NSAIDs [ 12 , 24 ▪▪ , 37 ▪▪ , 38 ]. In a large retrospective, multicenter cohort of inpatients diagnosed with COVID-19 from 1 March to 17 April 2020, 466 out of 1305 patients (35.7%) had assumed NSAIDs.…”