French doctors noticed that some people with COVID-19 seem to have done worse if treated with NSAIDS (non-steroidal anti-inflammatory drugs).

This isn’t by any means the strongest type of evidence (it’s called a ‘case study’ or ‘case series‘) but the worry has a plausible rationale.

COVID-19 enters human cells by binding to a receptor called the ACE-2 receptor. NSAIDS stimulate cells to present more ACE-2 receptors to the outside world. So people with NSAIDS might get higher viral doses because there are more “doorways into” the cell for the virus.

We don’t know for sure if this is the case, but the World Health Organization is advising against using NSAIDS for now.

NSAIDS are often just called “anti-inflammatories.” They include (but are not limited to): ibuprofen (Motrin or Advil), Naprosyn (Naproxen, Aleve), ketorolac (Toradol), celexicob (Celebrex), and diclofenac (Voltaren, Arthrotec).

Topical NSAIDS (e.g., Voltaren cream) are probably relatively safe since there is so little systemic absorption. But if you can avoid them so much the better.

Since there’s no advantage to using NSAIDS, and possibly some downsides, if you’re treating you or your kids for pain or fever over the next few months, best to stick to Tylenol (acetaminophen, often called paracetamol in the rest of the world, so you may see it mentioned if you read the WHO or other international writings, such as those coming out of the UK. It’s all the same stuff.).

This is not medical advice, but for reference the maximum daily adult dose of Tylenol is 1000 mg every four hours, to a max of 4000 mg (4 g) per day.

That’s 3 regular tablets of 325 mg every 4 hours, or two extra strength 500 mg tabs every four hours. But don’t exceed 4 g per day.

If you have liver problems, you should not exceed 2 g per day.

Do not consume alcohol while using acetaminophen.

Children’s dose is 15 mg/kg every 4-6 hours. Older children using this formula may come out with doses bigger than 1000 mg at a time–1000 mg is the adult max at a time, and there’s no benefit (and some danger) from taking more than that. So don’t give kids more than 1000 mg even if this formula suggests you should.

Newborns (3 months or less) are slightly different; with a baby that small, you should probably be assessed by a doctor if they seem to have pain or fever, since those little kiddies can get sicker faster.

Will update if we learn more.

Ask your doctor for advice if you are prescribed NSAIDS for regular use.

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