When it comes to the COVID-19, there is a lot of confusion and misinformation everywhere, especially in social media. There is a lot of rumors about medications and as a pharmacist to be, I would like to get these questions answered.
ACEI's and ARB's: "These medications increase the risk of getting COVID-19 or having serious complications from it"
Angiotensin-Converting Enzyme Inhibitors (ACEI's) and Angiotensin II receptor blockers (ARB's) are used to dilate blood vessels and reduce high blood pressure. Medications such as lisinopril and benazepril are examples of ACEI's as well as the commonly known losartan and valsartan that are examples of ARB's. These medications work in a way that might upregulate the ACE2 receptors, the ones in which the SARS-COV-2 (the virus that causes COVID-19) uses to get into our cells.
Clarification: At this point, the risk is hypothetical. Currently, there is no evidence that these two drug classes increase the risk of getting COVID-19 or that it worsens the infection. On the other hand, I would like to instead emphasize that it is very important not to stop these medications, especially patients with a history of a recent heart attack, heart failure with reduced ejection fraction, or chronic kidney disease due to these rumors and consult with your physician first.
*All of this information goes along with the current thinking of the American Heart Association, American College of Cardiology, and the Heart Failure Society of America. *
NSAIDs: "NSAIDs may increase the risk of severe COVID-19"
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used over-the-counter (OTC) medications to treat fever, pain, and inflammation. Examples include ibuprofen (Advil), naproxen (Aleve), aspirin (Bayer, Excedrin), and more.
These rumors were followed by a tweet from France's health minister, which seems to be an extension of a warning made in 2019 in France stating that NSAIDs may make infections worse, based on data mostly with strep. In addition, it is also speculated that these medications can upregulate ACE2 receptors.
Clarification: Up to this day, the FDA has not found any pertinent evidence that can confirm this hypothesis. That is the reason why there are health care professionals that still recommend the use of NSAIDs. In this case, it is safe to take acetaminophen (Tylenol or Panadol in Puerto Rico) to treat fevers or minor pain instead of NSAIDs (Advil, Excedrin, Aleve, etc) as a first-line option.
Supplements: "I need immune system boosters, they are sold out almost everywhere.
There is a high demand for products marketed to be "Immune system boosters" such as Emergen-C, Airborne, and anything that contains vitamin C, D, zinc, echinacea, elderberry, etc.
Clarification: There is no good evidence that demonstrates that such supplements prevent COVID-19 or other viruses but it doesn't hurt to take them if you feel more comfortable doing so. It is very important to take these as directed and not exceed the recommended amounts.
References
pharmacist,therapeuticsearch.com. Dispel Misinformation About Meds and Supplements for COVID-19. https://pharmacist.therapeuticresearch.com/Content/Segments/PRL/2020/Apr/Dispel-Misinformation-About-Meds-and-Supplements-for-COVID-19-S2004014 (accessed 2020 Apr 6)
ACC.org. HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19. https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19 (accessed 2020 Apr 6)
FDA.gov FDA Advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19. https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19 (accessed 2020 Apr 6)
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