COVID-19 Over-the-Counter Medication Considerations

Exploring the risks and benefits of OTC medications for COVID-19
COVID-19 OTC Meds: Balancing Risks & Benefits

The COVID-19 virus can cause symptoms including weariness, fever, coughing, and sore throat. The most recent recommendations for the use of over-the-counter (OTC) medications for COVID-19 were released in January by the US Centers for Disease Control and Prevention (CDC). According to its recommendations, the majority of COVID-19 patients have moderate illnesses and may recuperate at home with over-the-counter medications like ibuprofen (Motrin, Advil) or acetaminophen (Tylenol).

It’s more complex, according to researchers from Florida Atlantic University’s Schmidt College of Medicine and other academic institutions. They recommend that the whole benefit-to-risk profile of the patient be taken into consideration while choosing an over-the-counter drug to treat minor COVID-19 symptoms. Furthermore, they contend that each patient should have a healthcare practitioner make clinical choices for them.

In a review that was published in The American Journal of Medicine, scientists examine the possible advantages and disadvantages of aspirin, acetaminophen, and non-steroidal anti-inflammatory medicines (NSAIDs) like ibuprofen when choosing over-the-counter medications to treat moderate COVID-19 symptoms.

COVID-19 has been treated with conventional nonspecific NSAIDs such as longer-acting naproxen and shorter-acting ibuprofen. These commonly used over-the-counter medications block both isoforms of the cyclooxygenase enzyme in a reversible and non-specific manner. This leads to a methodical decrease in prostaglandin production, which has anti-inflammatory and fever-lowering properties.

However, the researchers warn that while aspirin has fewer adverse effects, ibuprofen and naproxen have comparable but more severe side effect profiles, including peptic ulcers and gastroenteritis.

One of the most widely used over-the-counter medications in the United States and across the world, acetaminophen relieves fever, allergy symptoms, headaches, myalgia, cold symptoms, and, most recently, COVID-19. Because acetaminophen has fewer adverse effects on the mucosal gastrointestinal tract, it was first promoted as an aspirin substitute for the treatment of mild to moderate pain.

The writers issue a warning that acetaminophen can be harmful to the liver and cause abrupt liver failure, even at daily dosages of 4,000 milligrams, which are typically regarded as safe for adults. Over 100,000 calls to Poison Control Centers in the United States are related to acetaminophen each year. Over 2,600 hospital admissions and 450 fatalities in the US are attributed to acute liver failure under these conditions.

Acetylsalicylic acid, often known as aspirin, prevents prostaglandins from being produced, which are in charge of regulating temperature, inflammation, and pain. According to the authors, aspirin has anti-inflammatory, antipyretic or anti-fever, analgesic, and anti-platelet qualities. When taken orally, aspirin is quickly absorbed and has a half-life of about four hours, during which time the kidneys metabolize it primarily.

The anti-inflammatory properties of aspirin, according to the researchers, could help with fever and body pains associated with COVID-19. However, they emphasize that medical professionals should consider these in light of the elevated risks of bleeding, particularly gastrointestinal bleeding. Furthermore, people may already be more susceptible to bleeding and irregular clotting because of COVID-19 itself.

“We believe that healthcare providers should make individual clinical judgments for each of his or her patients in the selection of OTC drugs to treat symptoms of COVID-19. This judgment should be based on the entire benefit-to-risk profile of the patient,” said Charles H. Hennekens, M.D., Dr.PH, senior author, first Sir Richard Doll Professor, and senior academic advisor in FAU’s Schmidt College of Medicine.

“We believe that the individual health care provider knows far more about each of his or her patients than anyone, including expert members of guideline committees.”

The authors conclude that when all the information is available, medical professionals may make the most informed individual clinical decisions for their patients, and politicians can make the best decisions for the public’s health.

To produce logical guidelines, the authors contend that the current body of evidence is insufficient and has to be supplemented by credible data from large-scale randomized studies that were planned. Additionally, they think that recommendations should only offer direction to medical professionals. These factors now provide new therapeutic difficulties for medical professionals when recommending over-the-counter medications to treat COVID-19.

“The astute and judicious individual clinical decision-making of health care providers for each patient based on all these considerations has the potential to do far more good than harm. Finally, guidelines should guide individual health care providers,” said Hennekens.

For More Information: Guidance for healthcare providers on newest guidelines for over-the-counter drug treatment of mild symptoms of COVID-19, The American Journal of Medicine, https://www.amjmed.com/article/S0002-9343(24)00140-2/abstract