Concern about the appropriate role of nonsteroidal anti-inflammatory drugs 
(NSAIDs) in COVID-19 speculate that NSAIDs, in particular ibuprofen, may 
upregulate the entry point for the virus, the angiotensin-converting enzyme 
(ACE) 2 receptors and increase susceptibility to the virus or worsen symptoms in 
existing disease. Adverse outcomes with COVID-19 have been linked to cytokine 
storm but the most effective way to address exaggerated inflammatory response is 
complex and unclear. The Expert Working Group on the Commission of Human 
Medicines in the UK and other organizations have stated that there is 
insufficient evidence to establish a link between ibuprofen and susceptibility 
to or exacerbation of COVID-19. NSAID use must also be categorized by whether 
the drugs are relatively low-dose over-the-counter oral products taken 
occasionally versus higher-dose or parenteral NSAIDs. Even if evidence emerged 
arguing for or against NSAIDs in this setting, it is unclear if this evidence 
would apply to all NSAIDs at all doses in all dosing regimens. Paracetamol 
(acetaminophen) has been proposed as an alternative to NSAIDs but there are 
issues with liver toxicity at high doses. There are clearly COVID-19 cases where 
NSAIDs should not be used, but there is no strong evidence that NSAIDs must be 
avoided in all patients with COVID-19; clinicians must weigh these choices on an 
individual basis.