Fact Check – Is Ibuprofen Safe? COVID-19 Coronavirus and Medications that Weaken Your Immune System

Some medications are known to weaken the immune system, and would therefore compromise the body’s capacity to fight off diseases such as the COVID-19 Coronavirus.

There has been a lot of concerns about the safety of Ibuprofen use during the COVID-19 Coronavirus outbreak, so we’ll examine the facts from credible and authoritative sources about this drug and several other to determine the truth.

What is Ibuprofen?

Ibuprofen is a widely used non-steroidal anti-inflammatory drug (NSAID) which is used for used for its analgesic, anti-inflammatory, and antipyretic properties, in other words, the short-term relief of fever, mild to moderate pain and inflammation (redness, swelling and soreness).

Ibuprofen might ease some of the symptoms of:

• headaches, such as migraines or tension headaches
• sinus pain
• toothache and pain after dental procedures
• backache, muscular aches and pains
• menstrual cramps and period pain
• sore throat
• joint or tendon sprains and strains such as tennis elbow
• arthritis
• fever or high temperature

Please note that ibuprofen only provides temporary relief and will not cure your condition.

How Ibuprofen Works

The simple explanation:

Ibuprofen works by reducing the body’s ability to produce compounds known as prostaglandins, which are important mediators of inflammation, fever and pain. Prostaglandins act locally at a site of injury to initiate the body’s protective responses of inflammation and pain, or to initiate a fever as part of the immune response to infection caused by a variety of microorganisms and viruses.When prostaglandins in the body are reduced, fever eases off, and pain and inflammation is reduced.

Additionally, prostaglandins also perform other important functions, such as maintaining the lining of the the digestive tract, regulating kidney function, and controlling the function of platelets, the tiny cells in the bloodstream which form blood clots to stop bleeding.

The drug Ibuprofen blocks both of these groups of functions of prostaglandins, as it is non-selective, which leads to some of the side effects associated with it, such as stomach cramps and irritation, as well as bleeding.

The longer explanation:

ibuprofen produces analgesic and anti-inflammatory effects by inhibiting the synthesis of prostaglandins. The enzyme inhibited by NSAIDs is the cyclo-oxygenase (COX) enzyme. The COX enzyme exists in two isoforms: COX-1 and COX-2.

• COX-1 is primarily responsible for synthesis of prostaglandins important for maintaining a healthy gastrointestinal (GI) tract, renal function, platelet function, and other normal physiologic functions.
  
• COX-2 is induced and responsible for synthesizing prostaglandins that are important mediators of pain, inflammation, and fever. However, it is known that there is some crossover of COX-1 and COX-2 effects in some situations, and COX-2 activity is important for some biological effects.

Ibuprofen is not selective for either COX-1 or COX-2, it block both enzymes.

Which Medications Contain Ibuprofen?

Formulations which contain Ibuprofen are sold under various brand or trade names:

US Brand Names: Advil, Ibuprofen, Midol, Motrin, Proprinal, PediaCare Children’s Pain Reliever/Fever Reducer, PediaCare Infant’s Pain Reliever/Fever Reducer

Australian Brand Names: Act-3, Advil, Brufen, Bugesic, Butafen, Butalgin, Caldolor, Dimetapp , Fenpaed, Ibuprofen , Iprofen, Nurofen, Panafen IB, Panafen IB Mini Cap, Pedea, Proven, Rafen, Tri-Profen,

When to NOT take Ibuprofen

Ibuprofen should NOT be used:

• Just before or after heart bypass surgery (coronary artery bypass graft or CABG).
  
• During the last 3 months of pregnancy as it may may harm the unborn baby. Do not use this medicine without a doctor’s advice if you are pregnant, or if you are breastfeeding as it is not known whether ibuprofen passes into breast milk or can affect a nursing baby.
  
• For children younger than 2 years old without the advice of a doctor.
  
• If you have ever had an asthma attack, hives, or severe allergic reaction after taking aspirin, acetaminophen (panadol, tylenol) or any NSAIDs such as ibuprofen, celecoxib, diclofenac, naprosyn and others.

Ibuprofen, like all NSAIDs, can also make heart, liver or kidney disease worse.

Ask a doctor if Ibuprofen is safe for you to take if you have any of the following conditions, especially if you are over 65:

• asthma
• a history of stomach ulcers or bleeding, or gastro-oesophageal reflux disease (reflux)
• a history of heart attack, stroke, blood clots, or are already taking low-dose aspirin to prevent heart disease
• liver or kidney disease
• fluid retention
• a connective tissue disease such as Marfan syndrome, Sjogren’s syndrome, or lupus
• high blood pressure, high cholesterol, diabetes, or if you smoke.

Does Ibuprofen Weaken the Immune System?

Looking at the available research at the time of writing of this article, researchers have found that ibuprofen, along with other drugs such as tylenol, aspirin and naproxen, all strongly inhibit antibody production in human cells in in stimulated human peripheral blood mononuclear cells (PBMC) in vitro. To be clear, in vitro refers to tests conducted outside of the body, in a test tube so to speak, whereas in vivo refers to tests carried out in a living body.

Why not in vivo testing? Obviously, for ethical reasons, it’s not possible to infect healthy people who have and haven’t taken Ibuprofen (and no other medication) with some form of live disease pathogen to gauge their immune response. They could possibly do it with something else that elicits an immune response, such as a influenza vaccine, and they have. The quoted unpublished research suggests that human subjects vaccinated with influenza vaccine taking NSAIDs had a decrease in antibodies against certain influenza antigens. Further research is required to determine what effect taking ibuprofen at various times, before or after vaccination, has on antibody production.

Ibuprofen Immune System Research, the Details

To quote the research conducted by the Center for Vaccine Biology and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY USA, titled “Ibuprofen and other widely used non-steroidal anti-inflammatory drugs inhibit antibody production in human cells”, published in 2009 (bolded emphasis below is mine).

Quoted abstract:

“The widely used non-steroidal anti-inflammatory drugs (NSAIDs) function mainly through inhibition of cyclooxygenases 1 and 2 (Cox-1 and Cox-2). Unlike Cox-1, Cox-2 is considered an inducible and pro-inflammatory enzyme. We previously reported that Cox-2 is upregulated in activated human B lymphocytes and using Cox-2 selective inhibitors that Cox-2 is required for optimal antibody synthesis. It is not known whether commonly used non-prescription and non-Cox-2 selective drugs also influence antibody synthesis. Herein, we tested a variety of Cox-1/Cox-2 non-selective NSAIDs, namely ibuprofen, tylenol, aspirin and naproxen and report that they blunt IgM and IgG synthesis in stimulated human peripheral blood mononuclear cells (PBMC). Ibuprofen had its most profound effects in inhibiting human PBMCs and purified B lymphocyte IgM and IgG synthesis when administered in the first few days after activation. As shown by viability assays, ibuprofen did not kill B cells.
The implications of this research are that the use of widely available NSAIDs after infection or vaccination may lower host defense. This may be especially true for the elderly who respond poorly to vaccines and heavily use NSAIDs.”

Extract from introduction:

“Herein, we have investigated, (1) the effect of aspirin, ibuprofen, naproxen and tylenol on antibody synthesis in human peripheral blood mononuclear cells; (2) the time-frame and the concentrations of ibuprofen required to blunt antibody synthesis and (3) the effect of ibuprofen on B cell lymphocytes. Overall, our findings reveal that over-the-counter NSAIDs have potent negative effects on human B lymphocytes and on antibody production.”

Extract from conclusion:

“The connection between NSAIDs and antibody synthesis is just beginning to be discovered. Given that NSAIDs inhibit Cox activity and Cox-2 is expressed in activated B lymphocytes and is required for optimal antibody production, it is pertinent to predict that NSAID therapy can have repercussions on antibody synthesis. Our preliminary observations (unpublished data) show that human subjects vaccinated with influenza vaccine taking NSAIDs had a decrease in antibody against certain influenza antigens. A full clinical study is required to determine if vaccinated subjects taking NSAIDs, e.g. ibuprofen, at different time points before or after vaccination will show a decrease in antibody synthesis.

In conclusion, we report that a panel of widely used NSAIDs blunts antibody synthesis in human PBMCs and in purified B cells. Ibuprofen’s ability to reduce antibody production was concentration- and time-dependent and likely occurred via Cox-2 inhibition. Our results call for awareness regarding the consequences that NSAIDs can have on immunity. NSAIDs are one of the most commonly used drugs; they are recommended for all age categories, are prescribed for relieving transient pain or in cases of serious inflammatory diseases. By decreasing antibody synthesis, NSAIDs also have the ability to weaken the immune system which can have serious consequences for children, the elderly and the immune-compromised patients.”

In a similar US study published in Immunity & Ageing in 2018, “Immune response to influenza vaccination in the elderly is altered by chronic medication use” researchers examined the how the immune responses to the two influenza A virus strains of the trivalent inactivated influenza vaccine (TIV) were affected by patient’s history of using the prescription drugs Metformin, NSAIDs or Statins.

They found evidence for differential antibody (Ab) production, B-cell phenotypic changes, alteration in immune cell proportions in individuals with a history of long-term medication use, compared with non-users. Researchers also noticed a diminished response to the vaccine in the elderly on Metformin, while the patients on NSAIDs or Statins had higher baseline responses compared in comparison, but response levels were still reduced.

Assessing Risk

It’s important to recognise that the use of any medication carries some risk and can produce unwanted side effects. Human biochemistry is very complicated, and throwing a man-made chemical into a complex biological system we don’t fully understand will not produce a ‘magic bullet’ effect. What is guaranteed, is that such an action will have some unintended effect.

In respect to reliable information, I suggest you do your own fact checking and search the medical research cited online. Use only authoritative medical research sources for your information (though interpreting it may not be easy without a background in biomedical science). and not the mass media news channels or any potentially biased sources.

Let’s not be naive, in this money-driven western world where ethics are deemed to be relative, there are plenty of reason for parties with vested interests to misrepresent the facts. According to the Маrkеt US rероrt titled, “Global Іbuрrоfеn Маrkеt bу Туре (UЅР аnd ЕР), Ву Fоrm Туре (Таblе, Сарѕulе, аnd Suspension), Ву Ѕаlеѕ Сhаnnеl (Rеtаіl, Оnlіnе, Нуреrmаrkеt & drug ѕtоrе) аnd bу Rеgіоn – Global Fоrесаѕt tо 2028.”, the global іbuрrоfеn mаrkеt іѕ estimated at UЅ$ 6,888.4 million in 2018 and projected tо rеасh UЅ$ 8,716.8 million bу 2028.

Medical Disclaimer. THIS WEBSITE IS NOT INTENDED FOR THE PURPOSE OF PROVIDING MEDICAL ADVICE. All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.

References:

1. Drugs.com: Ibuprofen – https://www.drugs.com/ibuprofen.html
2. Australian Government Department of Health, Healthdirect: Active ingredient: ibuprofen – https://www.healthdirect.gov.au/medicines/medicinal-product/aht,21286/ibuprofen
3. PharmGKB (managed at Stanford University): Ibuprofen Pathway, Pharmacodynamics – https://www.pharmgkb.org/pathway/PA166121942
4. Ibuprofen – Mark G. Papich DVM, MS, DACVCP, in Saunders Handbook of Veterinary Drugs (Fourth Edition), 2016
5. Bancos S, Bernard MP, Topham DJ, Phipps RP. Ibuprofen and other widely used non-steroidal anti-inflammatory drugs inhibit antibody production in human cells. Cell Immunol. 2009;258(1):18–28. doi:10.1016/j.cellimm.2009.03.007
6. Agarwal D, Schmader KE, Kossenkov AV, Doyle S, Kurupati R, Ertl HCJ. Immune response to influenza vaccination in the elderly is altered by chronic medication use. Immun Ageing. 2018 Aug 31;15:19. doi: 10.1186/s12979-018-0124-9. PMID: 30186359; PMCID: PMC6119322.
7. Market US – Global Іbuрrоfеn Маrkеt bу Туре (UЅР аnd ЕР), Ву Fоrm Туре (Таblе, Сарѕulе, аnd ѕuѕреnѕіоn), Ву Ѕаlеѕ Сhаnnеl (Rеtаіl, Оnlіnе, Нуреrmаrkеt & drug ѕtоrе) аnd bу Rеgіоn – Global Fоrесаѕt tо 2028.