COVID-19 and NSAIDs: Primum non nocere

Changes in pharmacist's recommendations of over-the-counter treatments for the common cold during the COVID-19 pandemic

BACKGROUND

The common cold is one of the most frequently occurring illnesses worldwide. The aim of this study was to determine which OTC anti-common cold medications were most often recommended by pharmacists and if the COVID-19 pandemic affected such recommendations.

METHODS

Non-interventional, observational research trial using a self-developed questionnaire to collect data on pharmacists' recommendations for anti-common cold OTC treatment. The data were collected during the COVID-19 pandemic (December 2021-February 2022) in four large community network pharmacies in Lodz (Poland) and then compared with an analogue period of time before the pandemic (December 2019-February 2020).

RESULTS

During COVID-19 pandemic there was a significant (p < 0.05) reduction in paracetamol, acetylsalicylic acid, metamizole magnesium, inosines, alpha-mimetics, mucolytics, homeopathics, and sore throat products and an increase in other tablets/capsules and add-on product recommendations. There was a significant relationship (p < 0.05, OR > 1) between the recommended frequency of paracetamol, inosines, sore throat products (each symptom), metamizole magnesium (headache, fever), acetylsalicylic acid (headache, fever, fatigue), NSAIDs, alpha-mimetics (headache, rhinorrhea), pseudoephedrine (rhinorrhea), homeopathics (headache), herbal products (fatigue), antihistamines (rhinorrhea, cough), and mucolytics (headache, fever, cough).

CONCLUSIONS

Favorable prices (before COVID-19 pandemic) and reports on common NSAIDs side effects (beginning of the pandemic) led to high sale of paracetamol. Increased awareness of clinical effectiveness of some medications or their reduced availability influenced their limited recommendations.

Surface engineering of carbon microspheres with nanoceria wrapped on MWCNTs: a dual electrocatalyst for simultaneous monitoring of molnupiravir and paracetamol

In the present study, nanoceria-decorated MWCNTs (CeNPs@MWCNTs) were synthesized using a simple and inexpensive process. Molnupiravir (MPV) has gained considerable attention in recent years due to the infection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Since some people infected with COVID-19 experience fever and headaches, paracetamol (PCM) has been prescribed to relieve these symptoms. Therefore, there is an urgent need to monitor and detect these drugs simultaneously in pharmaceutical and biological samples. In this regard, we developed a novel sensor based on nanoceria-loaded MWCNTs (CeNPs@MWCNTs) for simultaneous monitoring of MPV and PCM. The incorporation of CeNPs@MWCNTs electrocatalyst into a glassy carbon microsphere fluorolube oil paste electrode (GCMFE) creates more active sites, which increase the surface area, electrocatalytic ability, and electron transfer efficiency. Interestingly, CeNPs@MWCNTs modified GCMFE demonstrated excellent detection limits (6.0 nM, 8.6 nM), linear ranges (5.0-5120 nM, 8.0-4162 nM), and sensitivities (78.6, 94.3 μA μM-1 cm-2) for simultaneous detection of MPV and PCM. The developed CeNPs@MWCNTs electrocatalyst modified GCMFE exhibited good repeatability, anti-interference capability, stability, and real-time analysis with good recovery results, which clearly indicates that it can be used for real-time industrial applications.

Pharmacovigilance follow-up of patients in the context of the COVID-19 pandemic

INTRODUCTION

In the context of COVID-19 pandemic, a national pharmacovigilance survey was set up in March 2020. The purpose of this survey was to ensure continuous monitoring of adverse drug reactions (ADRs) in patients with COVID-19, not only related to the drugs used in this indication but also related to all drugs administered to these patients or suspected of having promoted the infection.

MATERIAL AND METHODS

This descriptive study was based on data extracted from the French Pharmacovigilance Database from 1 January 2020 to 30 September 2021. Misuse was also analysed through the MESANGE project. The ADRs were classified according to three groups: "drugs used to treat COVID-19", "other drugs administered to COVID-19 positive patients" and "drugs suspected of having promoted COVID-19". The data were also presented according to 2 periods (period one was from January to June 2020 and period two from July 2020 onwards).

RESULTS

Among 2189 included cases, 67.1% were serious. Cases were mainly related to "other drugs administrated to COVID-19 positive patients" (58.5%) followed by "drugs used to treat COVID-19" (33.7%) and "drugs suspected of having promoted COVID-19" (7.8%). Drugs used to treat COVID-19 and their main safety profile were different depending on the period: mostly hydroxychloroquine (51%) with heart injury and lopinavir/ritonavir (42%) with liver injury for the first period, and dexamethasone (46%) with hyperglycemia and tocilizumab (28%) with liver injury for the second period. The drugs suspected of worsening COVID-19 differed in both periods especially for non-steroidal anti-inflammatory drugs mainly reported in period 1 (41.5% versus 8.2% in period 2). Other immunosuppressive drugs were in the majority in the second period (85.7%), with mainly methotrexate (15.3%), anti-CD20 (15.3%) and anti-TNF alpha (10.5%). No confirmed safety signal was identified among other drugs administered to patients with COVID-19. The profile of ADRs and suspected drugs was similar between the 2 periods. The study of misuse in outpatient settings identified in both periods mainly hydroxychloroquine, azithromycin, ivermectin and zinc±vitamin C.

DISCUSSION

This survey, based on real-time pharmacological and medical assessment of ADRs and weekly meetings in a specific national committee, made it possible to identify relevant safety signals which contribute to patient care with no delay. The main safety signal highlighted was serious cardiac damage under hydroxychloroquine, alone or combined with azithromycin and also with lopinavir/ritonavir. This signal has contributed to the evolution of the recommendations for these 2 drugs. The methodology of this survey has been taken over and is still going on for the pharmacovigilance monitoring of vaccines against COVID-19, for monoclonal antibodies used against COVID-19 and also for Paxlovid® (nirmatrelvir/ritonavir) which benefit from dedicated surveys.

Synergistic effect of gold nanoparticles anchored on conductive carbon black as an efficient electrochemical sensor for sensitive detection of anti-COVID-19 drug Favipiravir in absence and presence of co-administered drug Paracetamol

Favipiravir (FVP) is introduced as a promising newly developed antiviral drug against the coronavirus disease 2019 (COVID-19). Therefore, the accurate determination of FVP is of great significance for quality assessment and clinical diagnosis. Herein, a novel electrochemical sensing platform for FVP based on gold nanoparticles anchored conductive carbon black (Au@CCB) modified graphite nanopowder flakes paste electrode (GNFPE) was constructed. Morphological and nanostructure properties of Au@CCB have been investigated by TEM, HRTEM, and EDX methods. The morphology and electrochemical properties of Au@CCB/GNFPE were characterized by SEM, cyclic voltammetry (CV), and EIS. The Au@CCB nanostructured modified GNFPE exhibited strong electro-catalytic ability towards the oxidation of FVP. The performance of the fabricated Au@CCB/GNFPE was examined by monitoring FVP concentrations in the absence and presence of co-administered drug paracetamol (PCT) by AdS-SWV. It was demonstrated that the proposed sensor exhibited superior sensitivity, stability, and anti-interference capability for the detection of FVP. The simultaneous determination of a binary mixture containing FVP and the co-administered drug PCT using Au@CCB/GNFPE sensor is reported for the first time. Under optimized conditions, the developed sensor exhibited sensitive voltammetric responses to FVP and PCT with low detection limits of 7.5 nM and 4.3 nM, respectively. The sensing electrode was successfully used to determine FVP and PCT simultaneously in spiked human plasma and pharmaceutical preparations, and the findings were satisfactory. Finally, the fabricated sensor exhibited high sensitivity for simultaneous detection of FVP and PCT in the presence of ascorbic acid in a real sample.

Assessment of drugs administered in the Middle East as part of the COVID-19 management protocols

The pandemic spread of coronavirus (COVID-19) has been reported first at the end of 2019. It continues disturbing various human aspects with multiple pandemic waves showing more fatal novel variants. Now Egypt faces the sixth wave of the pandemic with controlled governmental measures. COVID-19 is an infectious respiratory disease-causing mild to moderate illness that can be progressed into life-threatening complications based on patients- and variant type-related factors. The symptoms vary from dry cough, fever to difficulty in breathing that required urgent hospitalization. Most countries have authorized their national protocols for managing manifested symptoms and thus lowering the rate of patients' hospitalization and boosting the healthcare systems. These protocols are still in use even with the development and approval of several vaccines. These protocols were instructed to aid home isolation, bed rest, dietary supplements, and additionally the administration of antipyretic, steroids, and antiviral drugs. The current review aimed to highlight the administered protocols in the Middle East, namely in Egypt and the Kingdom of Saudi Arabia demonstrating how these protocols have shown potential effectiveness in treating patients and saving many soles.

NSAIDs and COVID-19: A Systematic Review and Meta-analysis

Background

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been discouraged for the treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, fearing that they could increase the risk of infection or the severity of SARS-CoV-2.

Methods

Original studies providing information on exposure to NSAIDs and coronavirus disease 2019 (COVID-19) outcomes were retrieved and were included in a descriptive analysis and a meta-analysis with Cochrane Revue Manager (REVMAN 5.4), using inverse variance odds ratio (OR) with random- or fixed-effects models.

Results

Of 92,853 papers mentioning COVID-19, 266 mentioned NSAIDs and 61 mentioned ibuprofen; 19 papers had analysable data. Three papers described NSAID exposure and the risk of SARS-CoV-2 positivity, five papers described the risk of hospital admission in positive patients, 10 papers described death, and six papers described severe composite outcomes. Five papers studied exposure to ibuprofen and death. Using random-effects models, there was no excess risk of SARS-CoV-2 positivity (OR 0.86, 95% confidence interval [CI] 0.71–1.05). In SARS-CoV-2-positive patients, exposure to NSAIDs was not associated with excess risk of hospital admission (OR 0.90, 95% CI 0.80–1.17), death (OR 0.88, 95% CI 0.80–0.98), or severe outcomes (OR 1.14, 95% CI 0.90–1.44). With ibuprofen, there was no increased risk of death (OR 0.94, 95% CI 0.78–1.13). Using a fixed-effect model did not modify the results, nor did the sensitivity analyses.

Conclusion

The theoretical risks of NSAIDs or ibuprofen in SARS-CoV-2 infection are not confirmed by observational data.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40264-021-01089-5.

French Pharmacovigilance Public System and COVID-19 Pandemic

The current COVID-19 pandemic is an exceptional health situation including for drug use. As there was no known effective drug for COVID-19 at the beginning of the pandemic, different candidates were proposed. In this short article, we present the French public pharmacovigilance activities during this health crisis. Although COVID-19 is a confounding factor per se, owing to its potential for multi-organ damage including the heart and kidney, the quality of the transmitted data in adverse drug reaction reports, the timeliness of feedback from clinicians, and the real-time pharmacological and medical analysis by the French network of the regional pharmacovigilance centers made it possible to swiftly identify relevant safety signals. The French National Agency of Medicine was thus able to validate the data and convey their findings very early. This decentralized organization based on medical and pharmacological evaluation of case reports has proven to be efficient and responsive in this unique and challenging healthcare emergency.

Paracetamol-Induced Glutathione Consumption: Is There a Link With Severe COVID-19 Illness?

COVID-19 pandemic is posing an unprecedented sanitary threat: antiviral and host-directed medications to treat the disease are urgently needed. A great effort has been paid to find drugs and treatments for hospitalized, severely ill patients. However, medications used for the domiciliary management of early symptoms, notwithstanding their importance, have not been and are not presently regarded with the same attention and seriousness. In analogy with other airways viral infections, COVID-19 patients in the early phase require specific antivirals (still lacking) and non-etiotropic drugs to lower pain, fever, and control inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol (PAC) are widely used as non-etiotropic agents in common airways viral infections and hence are both theoretically repurposable for COVID-19. However, a warning from some research reports and National Authorities raised NSAIDs safety concerns because of the supposed induction of angiotensin-converting enzyme 2 (ACE2) levels (the receptor used by SARS-CoV2 to enter host airways cells), the increased risk of bacterial superinfections and masking of disease symptoms. As a consequence, the use of NSAIDs was, and is still, discouraged while the alternative adoption of paracetamol is still preferred. On the basis of novel data and hypothesis on the possible role of scarce glutathione (GSH) levels in the exacerbation of COVID-19 and of the GSH depleting activity of PAC, this commentary raises the question of whether PAC may be the better choice.