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Are ACE inhibitors and ARBs safe to use in patients with coronavirus (COVID-19)?
- There have been some concerns internationally about a possible link between ACE inhibitor medications (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) and increased risk of infection with coronavirus (COVID-19) and worsened outcomes.
- At this stage, peak international and Australian cardiology bodies strongly recommend that patients stay on their current anti-hypertensive therapy.
- See the Heart Foundation website for further information.
Should anti-viral or adjunctive drugs be prescribed for patients with confirmed coronavirus (COVID-19) infection?
- Interim clinical guidelines for the management of patients with COVID-19 have been released by the following peak professional bodies:
- These guidelines clearly state that there are no proven pharmaceutical treatments for coronavirus (COVID-19) (other than supportive care). No antiviral or immunomodulatory agent has thus far been proven effective in clinical trials, and they may even be harmful and/or in short supply.
- At this stage, treatment of coronavirus (COVID-19) with antivirals is considered ‘experimental’ and should only occur within the context of controlled intervention trials.
- Two controlled interventional trials of antiviral therapies for coronavirus (COVID-19) are recruiting hospitalised patients in Australia and New Zealand: REMAP-CAP (endorsed by ANZICS), and ASCOT (endorsed by ASID).
Can hydroxychloroquine be used for prophylaxis?
- There is no clinical evidence that hydroxychloroquine is effective as prophylaxis against coronavirus (COVID-19).
- Hydroxychloroquine is in short supply and should be prioritised for use in recognised indications including autoimmune conditions and Q-fever endocarditis.
- The Pharmaceutical Society of Australia (PSA) have advised pharmacists to refuse the dispensing of hydroxychloroquine unless it is for a recognised indication.
Are ibuprofen and other non-steroidal anti-inflammatories safe to use in patients infected with coronavirus (COVID-19)?
- There have been some concerns internationally that use of ibuprofen, or other non-steroidal anti-inflammatories (NSAIDs) during coronavirus (COVID-19) infection may lead to an increased risk of complications or death.
- There is currently no published peer-reviewed scientific evidence to support a direct link between use of ibuprofen and more severe infection with coronavirus (COVID-19).
What are the recommendations for influenza vaccination?
With coronavirus (COVID-19) spreading across Australia, this year it is more important than ever to ensure that patients receive the seasonal influenza vaccination. Influenza vaccination should be given as soon as possible. The regular influenza season may coincide with the peak of the current coronavirus (COVID-19) pandemic, potentially placing additional burden on the Australian health system.
- Influenza vaccine distribution to immunisation providers has commenced. Adjuvanted influenza vaccines are available for people aged 65 years and over.
- From 1 May 2020, the flu vaccine will be mandatory for people wanting to visit an aged care facility (including aged care workers).
- Claims that influenza vaccination may increase the risk of coronavirus (COVID-19) infection have been circulating on social media. There is no convincing evidence to support these claims.
- For guidance and service delivery models for providing immunisation services, please see our Victorian immunisation services factsheet - 14 April 2020 (Word)
Can Tamiflu still be given to patients with mild flu-like symptoms?
The antiviral medication Tamiflu (oseltamivir) is not effective against coronavirus (COVID-19). Tamiflu is used to treat influenza. In otherwise healthy adults who have a low risk of complications, treatment with a neuraminidase inhibitor (such as Tamiflu) reduces duration of influenza symptoms by less than one day on average, when treatment is started within 48 hours of symptom onset. Such limited benefit must be balanced against the potential adverse effects of antiviral treatment, including nausea, vomiting, headaches and neuropsychiatric events.
It is recommended that Tamiflu be reserved for use in patients:
- Who need to be admitted to hospital for management of influenza.
- With moderate-severity or high-severity community-acquired pneumonia, during the influenza season.
- Who are at higher risk of poor outcomes from influenza (e.g. pregnant women).