NSAIDs: A Double Edged Sword in Viral Infections

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are used as analgesics and antipyretics in viral infections, as supportive therapy is the mainstay of treatment. However, their role in the course of the illness is still ambiguous. Several experimental evidences carried out on various viral infections about the role of NSAIDs in the course of illness are contradictory; some reported possible antiviral effects and some negate it. NSAIDs inhibit PGs and also have their own actions on immune system and viruses. NSAIDs have stimulatory effects on T lymphocytes, Nitric Oxide (NO) and interferons, but inhibitory effects on neutrophils, macrophages and antibodies formation. NSAIDs are used as adjunctive treatment in infectious diseases in which cytokines storm plays a role in the pathogenicity. However, in other studies their effects on immune system were associated with unresolved symptoms and complications. The worth saying in this entity is the evidence-based studies of antimicrobial activity of NSAIDs. NSAIDs are proven to inhibit the entry of virus to the cells like in ZIKV, as well as they inhibit the replication of many viruses like the inhibitory effect of naproxen on SARS-CoV-2 replication. However, they fail to show any direct antiviral activity in adenovirus infections, and Ibuprofen increases the shedding of RSV in a bovine model. Indeed, there are many contradictory published studies between various viruses, patients’ cases, and whether it’s a study on animals or humans. More randomized clinical trials are mandatory to exactly elucidate if use of NSAIDs, during viral infections especially COVID-19, modify and abort the course of viral infection by exerting beneficial therapeutic effects or the use of them is accompanied by delirious hazards and negatively impact the health of the patient.