Ibuprofen, popular drugs for hypertensive and diabetic patients - can they harm in COVID-19?
- I went around 5 pharmacies, everywhere they swept away paracetamol! - a Muscovite complains in social networks. - And you can't take ibuprofen, with coronavirus it is deadly.
In scientific communities on Facebook, they are actively discussing how to replace popular drugs for hypertensive patients. Some of them - the so-called ACE inhibitors (the names of the active ingredients of such drugs end in "pril") - can increase the risk of severe complications from coronavirus, biologists worry.
And recently the authoritative international journal "The Lancet" (The Lancet) published a publication where the same ACE inhibitors, ibuprofen and even thiazolidinediones, drugs for diabetes patients are mentioned (see below "On the subject"). Perhaps, in certain cases, such drugs can negatively affect the condition of patients with COVID-19, scientists (not doctors!) Cautiously suggest. At the same time, a sign with a warning has already gone for a walk on social networks: danger! They say that this is a "black list" of drugs that threaten serious complications and even death for patients with coronavirus.
PARACETAMOL OR IBUPROFEN?
“ Since February of this year, there have been frequent reports in the media about both potentially effective and possibly dangerous drugs for COVID-19 patients, ” says Nikolai Kryuchkov, an expert in the field of immunology, specialist in research, development and registration of medicines, Ph. D. … - For example, the French Ministry of Health recently reported serious adverse events in patients with a new coronavirus infection while taking ibuprofen. And recommended the use of paracetamol with a pronounced increase in body temperature (above 38 degrees. - Ed.).
- So, people are not hunting for paracetamol for nothing? At the same time, in the recommendations of the Russian Ministry of Health for the treatment of COVID-19 for doctors, ibuprofen is listed as one of the antipyretic drugs.
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- In fact, concerns about ibuprofen are not supported by most medical societies today. The World Health Organization also considers these fears unconvincing at the moment. It will take time to verify the conclusion made by the French experts.
- What then is most correct for patients to focus on now?
- Until I get more scientific information, I would generally lean towards paracetamol. But! Ibuprofen can also be used if the attending physician deems it more appropriate in a particular situation.
ABOUT MEDICINES FOR HYPERTENSION AND DIABETES PATIENTS
- And what about drugs - ACE inhibitors (those same "prils")? They are accepted by people with hypertension and diabetes mellitus.
- It is believed that long-term use of such drugs increases the amount of certain proteins, the so-called AT2 receptors, in the cells of the lungs and other human organs. Through these receptors, coronavirus infection occurs. A hypothesis is put forward: the more AT2 receptors in the body, the higher the danger of the virus penetrating into sensitive cells. This means that the severity of the coronavirus infection is greater. As a possible solution, it is proposed to replace such drugs with others that do not affect AT2 receptors.
- Hearing this, a person may think: I need to run to the doctor so that I am prescribed a new medicine.
- Suspicions of possible additional risks in patients with COVID-19 taking ACE inhibitors or AT blockers are not without grounds. However, it is very important to understand: there is no reliable evidence! The hypothesis will still be tested in the course of research.
Now the replacement of drugs of these two groups (ACE inhibitors or AT receptor blockers) in people not infected with coronavirus and in patients with COVID-19 is unreasonable. Moreover, any change in the treatment regimen for a chronic disease requires at least a visit to a doctor. That, in a pandemic, creates additional serious risks to the health and life of people.
COMMENTARY OF A CARDIOLOGIST
What do cardiologists think about the possible risks for their patients taking ACE inhibitors amid the COVID-19 epidemic? We asked about this, Professor of the Department of Preventive and Emergency Cardiology, Director of the Institute of Personalized Medicine at Sechenov University, Doctor of Medicine, cardiologist Philip Kopylov.
- Today we do not see reliable confirmation of this version in clinical practice. Therefore, there are no official recommendations, and doctors have no reason to replace patients with ACE inhibitors with other drugs.
The main thing is not to stop taking medications for hypertension in any case, doctors unanimously urge. Because people with high, abnormalized blood pressure are clearly at the highest risk for severe COVID.
The European Society of Cardiology (ESC) has issued an official call for physicians and patients. Do not trust unfounded reports that taking certain medicines for high blood pressure (ACE inhibitors) can worsen the condition of patients with coronavirus infection. ESC strongly recommends not changing therapy and continuing to take prescribed medications.
TO THIS TOPIC
What other medications are under suspicion
- Thiazolidinediones, drugs to reduce insulin resistance in diabetic patients.
A version is being put forward that these drugs, like ACE inhibitors, can increase the amount of proteins - AT-2 receptors, through which the coronavirus enters the body. “There are even fewer data in favor of this version than about the potential risk of antihypertensive drugs,” comments Nikolai Kryuchkov. Definitely, today there is no reason to refuse taking such drugs.
- Corticosteroids. Anti-inflammatory steroid drugs (as the people say, "hormonal" drugs against inflammation).
These drugs reduce systemic inflammation in the body. But - at a high price: corticosteroids "beat" the immune system. After all, inflammation is a protective immune response. “There is evidence that corticosteroids in the treatment of COVID-19 at certain stages can adversely affect the course of the disease. Since, by suppressing the immune system, they reduce the body's chances of defeating the coronavirus, explains Nikolai Kryuchkov. - At the same time, there are situations when you cannot do without corticosteroids. In particular, with the so-called cytokine storm, a very severe form of systemic inflammation."
The decision on the appointment of such drugs is made by the doctor, taking into account all the circumstances and the state of the body, the expert emphasizes.
INSTEAD OF OUTPUT
Coronavirus infection is a new disease in which there are still many mysteries for us, scientists and doctors say. Full-fledged research is still complicated by the fact that specialists have to throw all their strength into treatment, to save a huge stream of sick people. Therefore, the data now emerging may be conflicting. You also need to distinguish between scientific hypotheses that still need to be confirmed by clinical practice.
So take note of everything, but strive to follow the advice of experts who are verified and given officially, based on confirmed data, urged by doctors. Such recommendations are given by the World Health Organization, national health authorities (namely officially, in the form of documents, and not just statements from the lips of individual officials), as well as professional medical organizations - the European Society of Cardiology, etc.
ANNA DOBRYUKHA
