TREATING FEVER AND PAIN in the time of COVID-19
Many people are asking doctors for information about whether it is safe to use NSAID drugs now. Examples of this drug class include ibuprofen (generic, Advil, Motrin), naproxen (generic, Aleve), diclofenac (generic, Voltaren, Arthrotec), celecoxib (Celebrex), meloxicam (Mobicox) and many others.
Feeling an increase in your body temperature can tell you if you are sick. And, fever is an important vital sign which can alert doctors and nurses about your clinical condition. However, it is not usually medically necessary to suppress fever.
The science is unsettled about the relationship between COVID-19 and NSAIDs and there are contradictory viewpoints because we lack high quality evidence on which to base recommendations.
Please check our list of links for emerging evidence and clinical recommendations for COVID-19.
We offer this common sense review about treating pain and fever for viral infections:
- Relieving fever and treating pain are comfort measures that can help people stay active and/or maintain good eating and sleeping patterns, but are NOT needed to shorten the duration of illness.
- Acetaminophen (generic and Tylenol, also the same as paracetamol and Panadol, etc.) can help some types of pain and can lower the temperature in fever. Follow package instructions and do not use more than 3,000 mg per day.
Advantages of acetaminophen:
- It does not cause bleeding, is not known to harm the heart or increase blood pressure, and is rarely harmful to the kidney.
- It can be used cautiously even in liver disease except for liver failure.
Therefore acetaminophen has been regarded for decades as the safest drug to use for pain or fever. Some over-the-counter medicines contain acetaminophen. Be careful not to consumer more than 3000 mg per day.
- NSAID (non-steroidal anti-inflammatory drugs including ASA/aspirin) are sometimes helpful or prescribed for acute inflammation (e.g. acute gout or arthritis). While many people use NSAIDs for chronic arthritis or muscular pain or headache, it is less clear whether they work any better than placebo. They can be stopped safely if you prefer not to use them. These drugs can also lower fever.
- Disadvantages of NSAIDs (other than low-dose ASA/aspirin): All NSAIDs, and ASA/aspirin, have the potential to cause ulcers and bleeding from the stomach or duodenum. This can sometimes be very serious or even fatal. In people with impaired kidney function or heart disease, NSAIDs can worsen both. They may also have a small effect of increasing heart attacks. Therefore they should always be used with caution.
- ASA/aspirin is different. It can prevent strokes and heart attacks, and at the low doses used for this purpose (81-325mg/d), it does not harm the kidneys or heart function. If you have been prescribed ASA/aspirin, do not stop taking it without asking your doctor.
- Is it dangerous to take NSAIDs now? There has been speculation and conflicting information in the media that NSAIDS (not low dose ASA/aspirin) could worsen lung problems from viral pneumonia, including Covid-19. This question cannot be answered because we currently lack high quality evidence. See our list of links if you have a professional interest.
- Acetaminophen (if available) is the best choice for fever or minor pain.
- Use NSAIDs only if the advantages for pain truly outweigh the potential disadvantages.
- Remember that it is rarely necessary to lower your temperature.
- Fever is one of the key vital signs that allow nurses and doctors to recognize whether a sick patient is improving or worsening. If you are sick and need to seek advice or treatment, measure your temperature (if you have a thermometer), and your heart rate, and be prepared to report them accurately.