This post was written by Ryan Singerman, DO, PPG – Family Medicine.
Everyone recognizes life has changed. Our world has been turned upside down over COVID-19. Very few areas have been left unphased. The avalanche of information, both good and bad, has led to many feeling unsure of where to turn or what advice to follow. With all the mounting uncertainty, we’ve had many questions posed to our providers regarding medications and COVID-19. This article is part of an effort to get sound, evidence-based, actionable data out to our patients. Let’s take a closer look at each medication category:
ACE Inhibitors/ARBs
There have been several small reports that expressed concern that medications including lisinopril, enalapril, losartan, irbesartan and others would place patients who had COVID-19 at risk and were actively intubated. Since these initial reports, it has been found that these medications may be beneficial, not harmful. Some people who are in advanced stages of kidney failure, and being hospitalized, are having these medications adjusted by their care team. According to the New England Journal of Medicine, current evidence supports continuing these medications in the outpatient setting unless directed otherwise by your provider. If these medications are stopped without adequate replacement it can cause dangerous elevations in blood pressure, resulting in stroke, heart attack and kidney damage.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Medications like ibuprofen, naproxen, meloxicam and celecoxib are all commonly used over the counter to treat mild pain and fever. There was a small study in Europe that raised concerns about the possible worsening of outcomes in people who had COVID-19 and were taking these medications at the same time. This has been studied further and the FDA has not found any evidence to support the claim. Additionally, it’s unnecessary for healthy individuals to stop taking these medications for fear of contracting COVID-19.
Immunosuppressants
These medications are used to treat patients with organ transplants, rheumatoid diseases, dermatologic conditions and may include some chemotherapy agents. It’s very well established that people who are immunocompromised are at higher risk of developing COVI-19, as they are with most infectious diseases. However, halting your therapeutic agents on your own could be disastrous to your health and should not be done. Risks of organ rejection, worsening of disease or rampant cancers are far more likely than contracting COVID-19. The prevailing wisdom is to adhere to the CDC guidelines for isolation and minimizing infectious contact via strict handwashing and mask wearing.
Potential treatments of hydroxychloroquine and chloroquine
There has been a lot of media attention on these medications for a variety of reasons. Unfortunately, there are serious and significant consequences that can arise from taking them. The FDA has announced on Friday, April 24, 2020, "Hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.” Any off-label use of these medications outside of controlled trials is explicitly dangerous and not recommended. Consumption of these medications without the express guidance of a provider is extremely dangerous and not supported by any evidence.
Remember, if you have any questions or concerns regarding a medication, please speak with your primary care provider. Also, unless you have been explicitly directed by your provider, please do not stop taking a medication.
Helpful resources regarding medications
Ace Inhibitors/ARBs in patients with COVID-19
FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19
Immunosuppressants: CDC Guidelines for isolation and minimizing infection
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