HEART HEALTH

Ask a Pharmacist

Do I Need to Stop or Change My Meds?

COVID-19 is a very new virus, and there is a lot that we still do not know about it. There have been some recent claims or speculation about how certain drugs may interact with the COVID-19 infection, but nothing yet has been proven. Some of the medications discussed throughout media sources recently include angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and non-steroidal anti-inflammatory drugs (NSAIDs), all of which are very common among CCA patients.

There is a protein, ACE2, in our bodies that the COVID-19 virus binds to and thereby enters targeted cells. An early concern was that patients on medications like ACE inhibitors, ARBs, or NSAIDs that also work on ACE2, may be at an increased risk of getting COVID-19 or having worse outcomes. However, this has not been proven, and in fact, there are recent suggestions that the opposite occurs with ACE inhibitors and ARBs, and that being on one of these medications may be beneficial in the setting of COVID-19.

Below, we aim to help you understand your risks and the best plan of action in these uncertain times. As always, it is highly recommended that you speak to your healthcare provider before changing any of your medications.

ACE inhibitors and ARBs

What are ACE inhibitors and angiotensin receptor blockers (ARBs)?
ACE inhibitors and ARBs are medications commonly used to treat high blood pressure or heart failure and include lisinopril, enalapril, losartan, irbesartan, and valsartan.

Should I continue to take my ACE inhibitor or ARB?

To date, there is no data to support this hypothetical concern. The American College of Cardiology (ACC) and American Heart Association (AHA) both recommend continuing to take ACE inhibitors or ARBs as directed by your healthcare provider. Recently there has been one small study published that provided encouraging data for continuing the use of ACE inhibitors and ARBs. While this evidence is preliminary, it is promising that the benefit of these medications in cardiovascular health may outweigh the risk in COVID-19. Overall, the use of guideline-directed medical therapy is key in controlling blood pressure, and stopping them could lead to a heart attack or stroke.

In conclusion, the FDA, WHO, and CDC are currently unaware of any scientific literature connecting the use of NSAIDs, ACE inhibitors, or ARBs and worsening or causing COVID-19 infections. The information being reported is mainly from purely observational studies, and not based on scientific data. New studies are planned, and we will continue to keep you updated as any new information emerges.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

What are NSAIDs?
NSAIDs include medications you may know more commonly as ibuprofen (Motrin, Advil), naproxen (Aleve), celecoxib (Celebrex), and aspirin. They are commonly used to reduce fevers and relieve mild pain.

Is it safe to continue taking NSAIDs?

There are currently no studies that suggest taking NSAIDs increase your risk of getting COVID-19 or worsening outcomes with COVID-19 infection. The European Society of Cardiology (ESC) and the Food and Drug Administration (FDA) are both unaware of any scientific data to support the worsening of COVID-19 infection associated with NSAID use. The concern to avoid the use of these medications is theoretical, and at this time, patients can continue to use them safely and as directed. The National Institute for Health (NIH) suggests using the lowest dose of NSAIDs, for the shortest period of time, to provide relief of pain and fever, and this is especially important for those with cardiac conditions and kidney issues.

Is there an alternative medication I can take for fever or pain?

If you are looking for a medication to help with pain and fever reduction that is not an NSAID, Tylenol (acetaminophen) is an option! The CDC currently states that acetaminophen (Tylenol) is an appropriate choice to help reduce pain and fever related to COVID-19 infection. Over-the-counter (OTC) products are safe and effective when you follow the directions on the label and use them as directed by your healthcare provider. The maximum daily recommended dose of acetaminophen (Tylenol) is 3,000 mg per day.

Is it safe to take my ‘baby’ Aspirin?

Yes! A low or “baby” dose, 81 mg, aspirin is commonly taken for heart health. The findings of “aspirin worsening COVID-19” are unfounded. It is very important to continue aspirin therapy as it has significant benefits, especially after a heart attack, a coronary stent, or stroke. Aspirin works by a different mechanism of action than other NSAIDs, and thus the cardio-protective effect and the reduction in risk of cardiovascular events outweigh any theoretical risk of aggravation of COVID-19 symptoms.

Please call Capital Cardiology Associates or the Clinical Pharmacy Team at Capital Cardiology Associates for more information, questions, or concerns.

Stay well and wash your hands!

Written by Emily Kronau Pharm Intern, Dylan Carmody Pharm Intern, Emily Plumadore PharmD, Kate Cabral PharmD, BCCP

References:
1. Center for Drug Evaluation and Research. FDA advises patients on use of NSAIDs for COVID-19 [Internet]. U.S. Food and Drug Administration. FDA; [cited 2020Apr3]. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19
2. Coronavirus [Internet]. World Health Organization. World Health Organization; [cited 2020Apr3]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
3. Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2020 [cited 2020Apr3]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/index.html
4. Uncertainty Surrounds Use of OTC Anti-Inflammatory Drugs in Patients With COVID-19 [Internet]. Pharmacy Times. [cited 2020Apr9]. Available from: https://www.pharmacytimes.com/news/uncertainty-surrounds-use-of-otc-anti-inflammatory-drugs-in-patients-with-covid-19
5. New Study Provides First Clinical Insight into ACE-inhibitors and ARBs in patients with COVID-19 [Internet]. Pharmacy Times. [cited 2020Apr13]. Available from: https://www.pharmacytimes.com/news/new-study-provides-first-clinical-insight-into-ace-inhibitors-and-arbs-in-patients-with-covid-19
6. HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19 [Internet]. American College of Cardiology. 2020 [cited 2020Apr13]. Available from: https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19