Indomethacin provides rapid relief from covid symptoms

The interim results of a randomised comparison between indomethacin and paracetamol in covid-19 showed stark differences in efficacy, confirming the positive results of early trials of indomethacin. IMI spoke to Dr Rajan Ravichandran and Professor Krishna Kumar to find out more.

In May 2021 the first patients were recruited to a randomised trial comparing indomethacin and paracetamol in hospitalised patients with mild-moderate covid-19 (oxygen saturation 94-95%).¹ The target had been to recruit 300 patients but, “when we reached about 200 the clinicians felt that the results were so good and so different from the group that was receiving paracetamol – we thought it was high time that we should bring to the notice of the world how effective indomethacin has been – and [that] lives can be saved with indomethacin”, says Dr Ravichandran.

“What’s interesting with covid is that it’s not just a virus which is producing the patient’s morbidity and mortality”, he explains. After the virus enters the body it proliferates and can trigger an inflammatory reaction that can be very severe. The combination of initial infection followed by severe inflammation can result in poor outcomes, he adds.

“Indomethacin ….is the only drug that is both anti-viral and anti-inflammatory”, says Dr Ravichandran.  In contrast, other drugs that have been used in the management of covid-19 have single actions – for example remdesivir has antiviral activity and corticosteroids and antibodies have anti-inflammatory actions. In addition indomethacin has an anti-bradykinin action. “The manifestation of myalgia and cough in covid is because of bradykinin and indomethacin has a unique anti-bradykinin action so it produces rapid relief for both myalgia and cough”, he says. Furthermore, at low doses indomethacin has antiplatelet action, like aspirin.  Last but not least, indomethacin does not suppress the immune system so antibody formation is not hindered. “So  it’s going to be an anti-viral, anti-inflammatory, anti-platelet, anti-bradykinin and of course it also promotes the formation of antibodies to covid so I think it’s a tailor made drug for covid – and it has been under-utilised”, he summarises.  Moreover, “it is agnostic to variants because it works after [viral] entry to the cell and it enhances the cell defence mechanism”, Professor Krishna Kumar notes. It does not matter how the virus enters cells or which variant is involved, the action of indomethacin is not affected, he emphasises.

Reference

Use of Indomethacin for mild and moderate Covid -19 patients. A Randomized Control Trial (Preprint) https://www.medrxiv.org/content/10.1101/2021.07.24.21261007v2

Professor Ramarathnam Krisha Kumar works at the Indian Institute of Technology, Madras. He is a biomedical engineer and has worked with Dr Ravichandran for many years.

Dr Rajan Ravichandran is Director of Nephrology at MIOT International Hospitals, Chennai. He has been designing and conducting trials of indomethacin in covid-19 for the past 18 months.

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