When a person falls ill, the immediate need for relief from fever, headache, and body aches often leads to the medicine cabinet, where ibuprofen is a common and trusted option. Ibuprofen belongs to a class of medications called non-steroidal anti-inflammatory drugs, or NSAIDs, which work by blocking enzymes that promote inflammation and pain. The emergence of COVID-19 introduced significant uncertainty regarding which over-the-counter treatments were appropriate for managing its specific set of symptoms. This confusion stemmed from early, theoretical concerns that required health organizations to conduct a rapid review of the drug’s safety profile in the context of the novel coronavirus.
Current Medical Guidance: Is Ibuprofen Safe to Use?
The current consensus from major health organizations, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), is that ibuprofen is safe to use for managing COVID-19 symptoms. Both ibuprofen and acetaminophen are widely accepted over-the-counter options for treating fever, muscle pain, and headache associated with the virus. The National Institutes of Health (NIH) treatment guidelines also state there is no difference between NSAIDs and acetaminophen for fever reduction in patients with or without COVID-19.
Ibuprofen primarily works by inhibiting cyclooxygenase (COX) enzymes, which stops the production of prostaglandins that cause pain and inflammation throughout the body. This mechanism makes it effective at reducing the aches and systemic inflammation that accompany a viral infection.
Acetaminophen, or paracetamol, reduces fever and pain but has only minor anti-inflammatory activity, which sets it apart from ibuprofen. However, medical professionals often suggest acetaminophen as a first-line defense for symptom management, especially in individuals with certain underlying health conditions. The preference for acetaminophen is not due to any evidence that ibuprofen worsens COVID-19, but rather its potential for fewer organ-specific side effects in patients with existing risk factors. Therefore, for most otherwise healthy individuals seeking relief from typical COVID-19 discomfort, ibuprofen remains a valid and effective choice.
The Source of Early Concerns
The widespread questioning of ibuprofen’s safety originated from a theoretical hypothesis published early in the pandemic, which was quickly amplified by a public statement from French health authorities. This initial concern focused on the angiotensin-converting enzyme 2 (ACE-2) receptor, the protein that the SARS-CoV-2 virus uses to enter human cells.
The hypothesis suggested that ibuprofen might upregulate, or increase the expression of, ACE-2 receptors on the surface of cells. A theoretical increase in these receptors could potentially provide the virus with more entry points, leading to a higher risk of infection or more severe disease. This idea was largely based on a single study conducted on diabetic rats, and a corresponding human study was not available to support the claim.
This theoretical risk caused the WHO to initially recommend against ibuprofen for COVID-19 symptoms as a precaution, a position they retracted shortly after. Major health bodies quickly reviewed the limited evidence and determined that the theoretical risk did not translate into observable harm or worse clinical outcomes for patients using the drug for symptomatic relief. Ultimately, the initial caution was withdrawn, confirming that no scientific data supported discouraging ibuprofen use for COVID-19.
Specific Conditions Where NSAIDs Should Be Avoided
While ibuprofen is generally safe for COVID-19 symptom relief, its use must be approached with caution in patients who have specific pre-existing health conditions, regardless of a viral infection. NSAIDs are known to carry risks for certain organ systems, and severe viral illness can compound these issues.
Kidney Concerns
One of the most significant concerns involves the kidneys, as NSAIDs can occasionally be associated with acute kidney injury. The drug’s mechanism of inhibiting prostaglandins can disrupt the normal blood flow regulation in the kidneys, which is especially problematic if a person is dehydrated or already experiencing severe illness. Individuals with pre-existing kidney disease, heart failure, or those taking certain blood pressure medications like diuretics or ACE inhibitors are at a heightened risk.
Gastrointestinal Risks
Ibuprofen also carries a known risk of gastrointestinal side effects, including stomach ulcers and bleeding, because its inhibition of COX enzymes reduces protective factors in the stomach lining. Patients with a history of gastrointestinal bleeding or ulcers should generally avoid NSAIDs. In these high-risk scenarios, individuals should strictly consult with a healthcare professional before taking ibuprofen, as acetaminophen is typically the safer alternative to manage fever and pain.