IBUPROFEN

What is ibuprofen?

Ibuprofen is a nonsteroidal anti-inflammatory (NSAID) medication commonly used to relieve pain and reduce fevers. Unlike acetaminophen, it also has some anti-inflammatory properties and can be used for inflammatory diseases such as osteoarthritis and rheumatoid disorders.

How can ibuprofen help alleviate certain long COVID symptoms?

Ibuprofen works by reversibly inhibiting enzymes in our body called COX-1 and COX-2 that help reduce fever, pain, and inflammation. It is also believed to reduce pro-inflammatory substances called cytokines and inhibit the activation of other immune cells that can cause inflammation.

The prevalence of post-COVID pain is estimated to be up to 63.3%, and patients with chronic pain can have exacerbated symptoms after COVID.¹ There are multiple possible mechanisms behind post-COVID pain. Post-COVID pain may be caused by the virus entering and attacking musculoskeletal and nervous systems, including the brain. Persistent inflammation from overactivated inflammatory pathways and excessive activation of blood clotting can also contribute to pain. Various types of pain can also be caused by COVID, such as headaches, neuropathic pain, musculoskeletal pain, chest pain, arthralgia, and fibromyalgia.

While other prescription medications are typically used to treat headaches, neuropathic pain, chest pain, and fibromyalgia, ibuprofen can be used to relieve short-term headaches, musculoskeletal pain, arthralgia, and myalgias that persist or worsen after COVID; however, it should not be used to treat COVID or to reduce the duration of COVID symptoms. Post-COVID headache can also be treated first-line with acetaminophen or NSAIDs like ibuprofen.²

What evidence supports ibuprofen’s use for long COVID?

Early on in the pandemic, anecdotal reports suggested that NSAIDs could potentially increase susceptibility to COVID due to their ability to increase expression of ACE2 receptors that are targeted by the SARS-CoV-2 virus.³ However, several studies have since debunked this theory and have shown that the use of NSAIDs is not associated with increased COVID severity or risk of all-cause mortality.⁴

A survey of 696 COVID patients in Italy reported that the use of standard analgesics such as ibuprofen in the post-acute phase of COVID had a temporary reduction in pain severity.⁵ NSAIDs can also be effective in managing migraines and are commonly used for headaches as well.⁶ While there are few studies investigating the use of ibuprofen for long COVID pain, the use of NSAIDs for pain is well-established and can be used safely in many patients post-COVID. Chronic use of NSAIDs, however, should be discussed with a healthcare provider. 

What are some things to be aware of when taking ibuprofen? 

Ibuprofen is not recommended in people at risk for or with existing cardiovascular disease, GI disease, kidney impairment, chronic liver disease, or people at higher risk of bleeding. Use of NSAIDs is associated with an increased risk of serious cardiovascular events such as heart attacks and strokes. New-onset hypertension can also occur with NSAIDs and can exacerbate heart failure. There is also a higher risk of gastrointestinal adverse events such as gastrointestinal bleeding or ulcers. Do not take ibuprofen for more than 10-15 days per month for headaches. Ibuprofen should be taken with food, and you should let your doctor know if you are taking ibuprofen regularly for long COVID symptoms.

References:

1)      El-Tallawy SN, Perglozzi JV, Ahmed RS, Kaki AM, Nagiub MS, LeQuang JK, Hadarah MM. Pain Management in the Post-COVID Era-An Update: A Narrative Review. Pain Ther. 2023 Apr;12(2):423-448. doi: 10.1007/s40122-023-00486-1

2)     Chhabra N, Grill MF, Singh RBH. Post-COVID Headache: A Literature Review. Curr Pain Headache Rep. 2022 Nov;26(11):835-842. doi: 10.1007/s11916-022-01086-y

3)     Kushner, P., McCarberg, B.H., Grange, L. et al. The use of non-steroidal anti-inflammatory drugs (NSAIDs) in COVID-19. npj Prim. Care Respir. Med. 32, 35 (2022)

4)     Reese JT, Coleman B, Chan L, Blau H, Callahan TJ, Cappelletti L, Fontana T, Bradwell KR, Harris NL,      Casiraghi E, Valentini G, Karlebach G, Deer R, McMurry JA, Haendel MA, Chute CG, Pfaff E, Moffitt R, Spratt H, Singh J, Mungall CJ, Williams AE, Robinson PN. NSAID use and clinical outcomes in COVID-19 patients: A 38-center retrospective cohort study. medRxiv [Preprint]. 2021 Dec 22:2021.04.13.21255438. doi: 10.1101/2021.04.13.21255438

5)     Galluzzo V, Zazzara MB, Ciciarello F, Tosato M, Bizzarro A, Paglionico A, Varriano V, Gremese E, Calvani R, Landi F on behalf of Gemelli against COVID-19 Post-Acute Care Team. Use of First-Line Oral Analgesics during and after COVID-19: Results from a Survey on a Sample of Italian 696 COVID-19 Survivors with Post-Acute Symptoms. J Clin Med. 2023; 12(8):2992.

6)    Arca KN, Smith JH, Chiang CC, Starling AJ, Robertson CE, Halker Singh RB, Schwedt TJ, Kissoon NR, Garza I, Rozen TD, Boes CJ, Whealy MA, VanderPluym JH. COVID-19 and Headache Medicine: A Narrative Review of Non-Steroidal Anti-Inflammatory Drug (NSAID) and Corticosteroid Use. Headache. 2020 Sep;60(8):1558-1568. doi: 10.1111/head.13903