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Are patients with hypertension and diabetes at increased risk for COVID-19?

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Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#91

Post by skookum »

Alex3917 wrote: post #57
mrb wrote: post #36

French sources specifically mention severe cases of covid-19 in "young and healthy" patients (eg. see https://lefigaro.fr/sciences/coronavirus-alerte-sur-l-ibupro... ) but this important piece of information has NOT been relayed by international medias. Jean Paul Hamon, medical doctor and president of the Federation of French Doctors said on TV to NOT take NSAIDs (anti-inflammatory drugs) if #covid19 is suspected. Th…

Why would young and healthy patients be taking "massive amounts of NSAIDs" if they didn't have co-morbidities? This doesn't really make any sense. Normally when you see young people taking large doses of NSAIDs, it's because they're either elite athletes or have an autoimmune disease or something.

In the mountain sports community Ibuprofen is jokingly referred to as "Vitamin I". I know a lot of people who take it regularly to push through the soreness of multiple days of physical activity.

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#92

Post by AstralStorm »

alkonaut wrote: post #69
gopalv wrote: post #64

Earlier quoted context omitted.

> Why would young and healthy patients be taking "massive amounts of NSAIDs" if they didn't have co-morbidities? This doesn't really make any sense. There are enough people who have no idea that hang-over + pop-2-advil is a deadly combination in this situation. Also a lot of the "new year, new body" resolution folks start too hard at the gym & then push through with NSAIDs. Young people, particularly the fit, do go t…

"Massive amounts" to me sounds like at least the max dose for at least a week. Taking 2 ibuprofen in a day against a flu like headache is what your doctor recommends, probably. Not exactly a massive amount even if repeated for a week.

There is 2 standard EU OTC Ibuprofen which is 400 mg and 2 South Korean Ibuprofen which is 2000 mg. Indian formulations also come extra strong.

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#93

Post by AstralStorm »

sdenton4 wrote: post #44
geofft wrote: post #15

The actual title of this article is, "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?" The relevant portion about ibuprofen, lightly edited to make it more readable, is: > Coronaviruses bind to their target cells through ACE2. The expression of ACE2 is substantially increased in patients with diabetes, who are treated with ACE inhibitors and ARBs. Hypertension is also tr…

These sorts of things are exactly the reason to try to slow the spread down. Ibuprofen /might/ be a bad idea. We currently have the time to notice that, and hopefully find out whether it's true by looking at hundreds of cases instead of tens of thousands.

Generally taking Ibuprofen chronically might be a bad idea.

We don't know how chronic the chronic is through. So to stay on the safe side, use as little as needed to control bigger fever and pain.

This unlike antibiotics (not for viral infections) where you are supposed to take exactly the recommended amount for recommended time, preventing resistance.

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#94

Post by earthtourist »

nradov wrote: post #76
earthtourist wrote: post #48

Any information on cough suppressants? Whether they're a good or bad for people with COVID-19? I've had my doctor recommend against cough suppressants in the past. But I've had trouble sleeping with a bad cough, and so if cough suppressants make sleep possible, it seems like a net-win. Is there any data yet?

Are you asking about dextromethorphan or some other cough suppressant? I don't think there's any real evidence one way or the other yet.

Yes, dextromethorphan. Thanks.

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#95

Post by wolfi1 »

onetimemanytime wrote: post #77
wolfi1 wrote: post #10

Earlier quoted context omitted.

are those ACE inhibitors also prescribed in China? I really doubt that

any reason to doubt it? I mean they are made of flesh and blood as well.

hypertension is a western disease

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#96

Post by arcticbull »

calebsurfs wrote: post #62
arcticbull wrote: post #60

Earlier quoted context omitted.

Which is itself the leading cause of acute liver failure in the US. The active dose is very close to the lethal dose, much more so than naproxen or ibuprofen.

The active dose is nowhere near the lethal dose. It is however close to the dose where you could see some minor damage to the liver. It causes problems because people are addicted to opioid drugs that are typically combined with acetaminophen, not because they are loading up on acetaminophen itself.

This isn't really a debate:

- "Liver toxicity from acetaminophen poisoning is by far the most common cause of acute liver failure in the United States, researchers reported" [1] in 2005. It was also true before the opioid epidemic really began.

- "The recommended dose of acetaminophen in adults is 650 to 1,000 mg every 4 to 6 hours, not to exceed 4,000 mg in a 24-hour period." [2]

- "Single doses of more than 150 mg/kg or 7.5 g in adults have been considered potentially toxic." [2]

- "The minimal dose associated with liver injury can range anywhere from 4 to 10 g" [2]

The active dose is very close to the dose at which liver damage occurs (4X single dose or 1X daily dose) and also a fatal dose (10X single dose or 2.5X daily dose). Further, it's exacerbated by alcohol use, which is why you should never drink and then take Tylenol.

Wheres, ibuprofen the safety margin is 120X a single dose and 40X a daily dose. For naproxen, it's 63X a single dose or 21X a daily dose [3].

[1] https://www.medpagetoday.org/psychiatry/depression/2233?vpas...

[2] https://www.uspharmacist.com/article/acetaminophen-toxicity-...

[3] https://www.advilaide.com/safety/overdose

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#97

Post by [deleted] »

DanBC wrote: post #67
calebsurfs wrote: post #62

Earlier quoted context omitted.

The active dose is nowhere near the lethal dose. It is however close to the dose where you could see some minor damage to the liver. It causes problems because people are addicted to opioid drugs that are typically combined with acetaminophen, not because they are loading up on acetaminophen itself.

Paracetamol is dangerous in overdose, and the therapeutic dose is pretty close to the overdose amount. The therapeutic index is approx 10. Compare that to morphine, which has a therapeutic index of about 70. (although the therapeutic index is tricky to use because of dose response curves) We know that paracetamol is commonly used in both accidental and deliberate overdose. And this is true in countries that don't hav…

[deleted]

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#98

Post by arcticbull »

jakub_g wrote: post #63
arcticbull wrote: post #60

Earlier quoted context omitted.

Which is itself the leading cause of acute liver failure in the US. The active dose is very close to the lethal dose, much more so than naproxen or ibuprofen.

Ibuprofen is OTOH much riskier and disadvised for many groups of patients, like those with gastric problems (Ulcertativ Colitis, Crohn's etc.) The problem is often due to people overdosing, often due to mixing different pills that each contain paracetamol. Each cure becomes poison after a threshold.

> Each cure becomes poison after a threshold.

Right, and I'm saying that threshold is much lower for Tylenol than other NSAIDs, separate of whether it's disadvised for certain demographics. That's fact.

Re: Are patients with hypertension and diabetes at increased risk for COVID-19?

#99

Post by robocat »

robocat wrote: post #53
topkai22 wrote: post #32

Earlier quoted context omitted.

Good summary, althoughI would be more forceful about aspirin- don't use it for children under 12 without a medical professional recommending it. While Reyes syndrome is rare, acetaminophen and ibuprofen are equally effective, available, and do not carry the risk.

Taking too much acetaminophen (Paracetomol) is the most common cause of acute liver failure in the United States. There has been a huge PR push (in advertising etc) against Aspirin and for other NSAIDs. Of course, take care, but don’t be sucked in by marketing.

To add to that:

1. High dose aspirin might have been implicated in causing higher death rates from 1918 influenza: https://academic.oup.com/cid/article/49/9/1405/301441 (daily doses of 8 to 31.2 grams, are above the maximum safe dose)

2. But low dose aspirin has been studied and effects are not apparent e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737981/

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