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DavidJuurlink's profile
David Juurlink
David Juurlink
David Juurlink
@DavidJuurlink

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David Juurlink

@DavidJuurlink

Professor and Head, Clinical Pharmacology & Toxicology @UofT. Internist @Sunnybrook. Drug safety researcher @ICESOntario. Inexplicably fortunate husband.

Toronto
ices.on.ca/About-ICES/ICE…
Joined January 2012

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    David Juurlink‏ @DavidJuurlink 16 Mar 2020

    Do NSAIDs (ibuprofen, naproxen, etc.) somehow worsen coronavirus infection? Lots of people asking this question. As far as I can tell it's not based on very much. /1

    7:01 AM - 16 Mar 2020
    • 539 Retweets
    • 1,071 Likes
    • 'Bert Anish Patel Cheryl Koehn Carlo V Caballero MD Jesse MacKinnon Dr. Erin Tree Kate Ducak Benoit Arsenault Nick Lindholm, MD
    64 replies 539 retweets 1,071 likes
      1. New conversation
      2. David Juurlink‏ @DavidJuurlink 16 Mar 2020

        The idea seems to have taken off because of comments from France's Health Minister Olivier Véran, who is himself a physician https://www.theguardian.com/world/2020/mar/14/anti-inflammatory-drugs-may-aggravate-coronavirus-infection … /2

        3 replies 11 retweets 74 likes
        Show this thread
      3. David Juurlink‏ @DavidJuurlink 16 Mar 2020

        This bit in particular has been making the rounds. (For what it's worth, “… ask your doctor’s advice” is only helpful if your doctor has been informed about the basis of the concern.) /3pic.twitter.com/EGVjipI9Dx

        4 replies 9 retweets 94 likes
        Show this thread
      4. David Juurlink‏ @DavidJuurlink 16 Mar 2020

        It’s conceivable that, via prostaglandin inhibition or some other mechanism, NSAIDs might influence coronavirus replication, infectivity, or the host response. Whether any such effect would be harmful or beneficial I don't know. /4

        4 replies 12 retweets 94 likes
        Show this thread
      5. David Juurlink‏ @DavidJuurlink 16 Mar 2020

        But interestingly, with SARS (another coronavirus), there’s evidence indomethacin (an old school NSAID) selectively *inhibits* viral RNA synthesis https://www.intmedpress.com/servefile.cfm?suid=35d8dc5e-70f4-491f-acad-e35f99be9211 … /5pic.twitter.com/KGuQAlALtY

        6 replies 24 retweets 137 likes
        Show this thread
      6. David Juurlink‏ @DavidJuurlink 16 Mar 2020

        As for SARS-CoV-2, here’s a recent correspondence in BMJ suggesting naproxen might inhibit viral replication. This too is largely speculative. https://www.bmj.com/content/368/bmj.m406/rr-9 … /6

        2 replies 21 retweets 108 likes
        Show this thread
      7. David Juurlink‏ @DavidJuurlink 16 Mar 2020

        My best guess is simply that people take NSAIDs for viral symptoms, and the sickest of these later show up in hospital. Alternatively, maybe NSAIDs are just a marker of pre-existing illness. Not rocket science, but entirely plausible. /7

        9 replies 26 retweets 249 likes
        Show this thread
      8. David Juurlink‏ @DavidJuurlink 16 Mar 2020

        Bottom line: At present there doesn't seem to be much evidence that NSAIDs actually worsen coronavirus infection. More details on the French cluster would be welcome. Insights appreciated. Will add to this thread if more comes to light. / end (for now)

        28 replies 95 retweets 427 likes
        Show this thread
      9. David Juurlink‏ @DavidJuurlink 19 Mar 2020

        David Juurlink Retweeted Dr. Angela Rasmussen

        Addendum: Some have speculated that NSAID-induced upregulation of ACE2 might facilitate coronavirus infection. Here's a thread on that.https://twitter.com/angie_rasmussen/status/1238946941758615553?s=20 …

        David Juurlink added,

        Dr. Angela RasmussenVerified account @angie_rasmussen
        1. More ACE2 doesn't necessarily mean more infected cells. Viruses require other host proteins to replicate besides the receptor to do necessary functions like copy their genomes, make virus proteins, and package new viral particles.
        Show this thread
        1 reply 9 retweets 24 likes
        Show this thread
      10. End of conversation
      1. Bohdan A. Oryshkevich, MD, MPH‏ @ykramerezha 16 Mar 2020
        Replying to @DavidJuurlink

        But the experience is also small.

        0 replies 0 retweets 0 likes
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      1. pepperpoo  🇨🇦‏ @hynesight709 16 Mar 2020
        Replying to @DavidJuurlink

        @DavidJuurlink this is a question I’ve always wondered. Is it better to treat a low grade fever or let it go to possibly fight off the virus?

        0 replies 0 retweets 5 likes
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