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COVID-19: should dentists reconsider their pain medication prescriptions?

Reporting | - Posted: Mar 25, 2020 | Last Updated: 7 months ago
Posted: Mar 25, 2020 | Last Updated: 7 months ago
COVID-19: should dentists reconsider their pain medication prescriptions?


The scientific community has been having a wide debate on one question related to coronavirus: do drugs such as Ibuprofen increase the chance of having a severe or fatal COVID-19 infection?
One doctor, Dr Fahad Umer, an assistant professor at Aga Khan University, was particularly interested in this question because of his line of work. He specializes in operative dentistry and endodontic surgery. In his specialty dentists can often prescribe Ibuprofen for their patients. At one point he even tweeted that perhaps dentists should stick to acetaminophen instead.
He corresponded with @HealthSAMAA to raise these points. They have been lightly edited for clarity and ease of understanding:
A recent letter published in scientific journal Lancet by Lei Fang has sparked a wide debate in social media and the scientific community regarding the safety of Angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) and Ibuprofen.
(What is an ACE? According to the Mayo Clinic website: ACE inhibitors help relax your veins and arteries to lower your blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder. Angiotensin II also releases hormones that raise your blood pressure.)
It was argued in the Lancet correspondence that human pathogenic coronaviruses bind to their target cells (or, simply put, spread in the body) through ACE-2 or angiotensin-converting enzyme 2. Therefore, drugs which upregulate the receptors for ACE-2 drugs (or increase the cell’s response to receiving ACE-2 drugs) such as Ibuprofen may increase the chance of having a severe or fatal COVID-19 infection.
(Simply put, coronavirus spreads through one enzyme and if you take a drug that generally works by increasing that enzyme’s absorption into your cells, you are making it easieryou’re your cells to get coronavirus).
With all this in mind, should dentists change the way they prescribe when it comes to Ibuprofen or aspirin which are nonsteroidal anti-inflammatory drugs?
Although the hypothesis put forward by Lei Fang seems logical, it has not been scientifically proven to be correct. There are no experimental or clinical data to support the assessment that there are any harmful effects of Ibuprofen. The WHO Twitter account clearly states: “Based on currently available information, the WHO does not recommend against the use of Ibuprofen.” (our emphasis).
What is more, the upregulation (or speedier absorption) of ACE-2 receptors by Ibuprofen is based on the testing on rats. There are no known human studies which have described this upregulation and even if there is a substantial upregulation of ACE-2 receptors, its clinical significance in humans is not yet known.
The COVID-19 pandemic is a rapidly evolving situation. What we know today may turn out to be entirely different tomorrow.
Therefore, in my humble opinion, there is a lack of scientific evidence to suggest that our prescription patterns be modified for now.

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