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Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists

BMJ 2020; 368 doi: (Published 17 March 2020) Cite this as: BMJ 2020;368:m1086

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Re: Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists

Dear Editor,

Having erroneously neglected ibuprofen, further drugs were considered. The Italian Ministry of Health was fully persuaded by the Government Scientific Committee that the only therapeutic drug correctly suitable for addressing the early symptoms of COVID-19 was acetaminophen, i.e. paracetamol. In an official document dated Nov 30th 2020, the Italian Government recommended only paracetamol and watchful waiting, to address fever and pain during the early onset of COVID-19 or in mild COVID-19 (1).

In a recent paper of mine, held with coauthors and experts in the field (2), we highlighted why acetaminophen worsens the development of COVID-19, so leading patients to a compulsory hospitalization and possibly death. Having recommended only paracetamol and not NSAIDs led to the catastrophic effect observed in 2020, at least until April 26 2021, when the Italian Government added NSAIDs in the official protocol.

The recent evidence that COVID-19 is an endothelial dysfunction due to inflammation, which assessed the autoptic data, which leads to immuno-thrombosis in the micro-circulation (3), should suggest that paracetamol worsens an immuno-thrombotic event, by reducing glutathione, exacerbating pro-oxidative mechanisms, reducing endothelia prostacyclin production and lately promoting the formation of active platelet microparticles (PMPs), which induce thrombosis.

So far, only a civil outcry held by a social organization of physicians, psychologists, caregivers, lawyers and practitioners is raising, on the basis of their experience on patients healed with EBM and their full professional practice, this evidence to the attention of politics and the mainstream, so to thoroughly revise home therapy against COVID-19. The Association, funded by Erich Grimaldi, claims the crucial and urgent warning that paracetamol is dangerous during the early symptoms of COVID-19 including fever and must be reduced or removed from early home therapy. Their civil effort may have rescued many individuals from undergoing hospitalization and ultimately even death.

Yes, someone rejected ibuprofen and selected paracetamol, which was highly used during the March 2020 tragic increase in mortality in Italy. The recent Remuzzi's paper clearly shows that patients using paracetamol instead of COX-2 inhibiting NSAIDs exhibited a higher risk of hospitalization (4).

2. Pandolfi S, Simonetti V, Ricevuti G, Chirumbolo S. Paracetamol in the home treatment of early COVID-19 symptoms: a possible foe rather than a friend for elderly patients? J Med Virol. 2021 Jun 25. doi: 10.1002/jmv.27158
3. Bonaventura A, Vecchié A, Dagna L, Martinod K, Dixon DL, Van Tassell BW, Dentali F, Montecucco F, Massberg S, Levi M, Abbate A. Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19. Nat Rev Immunol. 2021 May;21(5):319-329.
4 Suter F, Consolaro E, Pedroni S, Moroni C, Pastò E, Paganini MV, Pravettoni G, Cantarelli U, Rubis N, Perico N, Perna A, Peracchi T, Ruggenenti P, Remuzzi G. A simple, home-therapy algorithm to prevent hospitalisation for COVID-19 patients: A retrospective observational matched-cohort study. EClinicalMedicine. 2021 Jun 9:100941. doi: 10.1016/j.eclinm.2021.100941

Competing interests: No competing interests

29 June 2021
Sergio Pandolfi
Clinical neurosurgeon
Villa Mafalda Clinics
via Monte delle Gioie 5, 00199 Rome