Ask the Harvard Experts: Ibuprofen vs. Acetaminophen and COVID-19

Ask the Harvard Experts: Ibuprofen vs. Acetaminophen and COVID-19

Q: I usually take ibuprofen for aches or pains. Given the controversy about ibuprofen use during this coronavirus outbreak, is it still safe to use? Should I switch to acetaminophen now instead?

A: Indeed, the message has been mixed. Early on in the coronavirus outbreak, French doctors treating patients with COVID-19 observed that some patients taking ibuprofen were becoming more ill than those not taking it. Some of the doctors published strong recommendations against using ibuprofen for any symptoms that might indicate a coronavirus infection.

But these were only observations, which are easily influenced by bias and not supported by scientific evidence.

Still, what followed were contradictory stories about the safety of ibuprofen. In fact, the World Health Organization (WHO) initially recommended using acetaminophen instead of ibuprofen. That only lasted a couple days before the WHO position changed. Either could be used to reduce fever, aches and pains in people with symptoms of any viral infection, including COVID-19.

Taking ibuprofen clearly does NOT make a person more susceptible to getting a coronavirus infection. So, if you take ibuprofen for aches or pains related to arthritis, periodic headaches or muscle aches, you don’t need to stop now.

As always, the decision about using ibuprofen (Advil, Motrin) vs. acetaminophen (Tylenol) depends on which one tends to better relieve your symptoms and the risk of side effects for you personally.

While both ibuprofen and acetaminophen reduce fever and ease pain, acetaminophen does not calm inflammation. Both have precautions but are relatively safe when recommended doses are followed.

Long term use of ibuprofen and other NSAIDs like naproxen (Aleve, Naprosyn) are more likely to cause stomach ulcers, internal bleeding and kidney damage compared to acetaminophen. When possible, use ibuprofen in the lowest effective dose for the shortest period of time.

The worry about acetaminophen is liver damage, which can lead to liver failure and death when taken in higher than recommended doses. The safest total daily dose is no more than 3,250 milligrams spread out over 24 hours. Be sure to look at the ingredients on all the products you take and add up the amount of acetaminophen to avoid exceeding the limit. People who have liver disease or who drink alcohol regularly should check with their doctor before using acetaminophen.

What if you do get symptoms that could be due to coronavirus? My recommendation would be to start with acetaminophen. Or you could alternate low dose acetaminophen with ibuprofen every four to six hours, and that would moderate the amount of each one.

(Howard LeWine, MD, is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
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