Re: Non-steroidal anti-inflammatory drugs and covid-19
We read with interest Professor Little’s editorial (BMJ 2020;368:m1185) and the rapid responses that followed.
Professor Little noted that “….it seems likely that that intermittent or occasional use could help patients with COVID-19—for example, to relieve nighttime symptoms and aid sleep if paracetamol is inadequate…”. Dr. Ioannou suggested that indomethacin might have a role in the treatment of COVID-19.
As primary care physicians based in the Brooklyn and Queens boroughs of New York City, we have treated a great many COVID-19 patients. Our experience with indomethacin has been positive and beneficial to patients. To date we have prescribed indomethacin for more than 60 patients with COVID-19 and suspected COVID-19. Many patients with COVID-19 symptoms are not sufficiently sick to require hospitalization but experience extensive musculoskeletal pain, incessant (and exhausting) coughing, and chest pain associated with inspiratory effort. We have found that treatment with indomethacin relieves the pain, stops coughing, and leads to a feeling of general wellbeing. Patients report “not feeling sick anymore.” This may be because they are able to manage several hours of uninterrupted sleep for the first time in days.
We have not seen this beneficial effect with hydroxychloroquine treatment or with ibuprofen and we have formed the impression that it is specifically related to indomethacin.
The first patient that we treated was one of our own colleagues. We now routinely prescribe indomethacin 25-50mg, twice daily to patients who have passed the early stage of COVID-19 and who are experiencing intractable coughing.
We do not advance indomethacin as a cure for COVID-19 but as a symptomatic treatment that helps patients. In the light of our experience and the conclusion of the WHO Scientific Brief1, we feel that the use of indomethacin in COVID-19 patients is justified and that the drug should be made available to relieve suffering when required.
We hope to collate our results and write a formal report when the rate of infection in New York City subsides.
Robert Rothstein, MD
Jonathan Leibowitz, MD
Aline Benjamin, MD
Christine Clark BSc, MSc, Ph.D., FRPharmS
Competing interests: No competing interests