View source for Template:COVID contraindicated therapies

<noinclude><languages/></noinclude>
<translate>

==Contraindicated Therapies== <!--T:1-->

<!--T:2-->
*[[Special:MyLanguage/NSAIDS|NSAIDS]]
**There is anecdotal evidence to suggest that NSAIDs could potentially harm patients infected with COVID-19.<ref> Willsher, Kim. “Anti-Inflammatories May Aggravate Covid-19, France Advises.” The Guardian, Guardian News and Media, 14 Mar. 2020, www.theguardian.com/world/2020/mar/14/anti-inflammatory-drugs-may-aggravate-coronavirus-infection. </ref>
**Some experts suggest avoiding NSAIDs altogether while recommending the use of paracetamol/acetaminophen instead.  <ref> Day, Michael. “Covid-19: Ibuprofen Should Not Be Used for Managing Symptoms, Say Doctors and Scientists.” Bmj, 2020, p. m1086., doi:10.1136/bmj.m1086. </ref>
**It is important to note that there is no strong evidence to suggest NSAIDs should be avoided in general in COVID-19 patients<ref>Pergolizzi JV Jr, Varrassi G, Magnusson P, et al. COVID-19 and NSAIDS: A Narrative Review of Knowns and Unknowns. Pain Ther. 2020;9(2):353-358. doi:10.1007/s40122-020-00173-5</ref>
*[[Special:MyLanguage/ACEi|ACEi]]/[[Special:MyLanguage/ARBs|ARBs]]
**There is an increase in mortality in patients with both hypertension and COVID-19 infection. <ref> Wu  C, Chen  X, Cai  Y,  et al.  Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China.  JAMA Intern Med. Published online March 13, 2020. doi:10.1001/jamainternmed.2020.0994</ref>
**ACEi and ARBs, used in the treatment of hypertension, has been postulated to contribute to the increased mortality by upregulating membrane-bound angiotensin-converting enzyme 2 (ACE2) which allows COVID-19 entry into human cells. <ref> Fang, Lei, et al. “Are Patients with Hypertension and Diabetes Mellitus at Increased Risk for COVID-19 Infection?” The Lancet Respiratory Medicine, vol. 8, no. 4, 2020, doi:10.1016/s2213-2600(20)30116-8. </ref>
**Currently, however, there is insufficient evidence to recommend against using ACEi and ARBs in patients with COVID-19. <ref> Patel AB, Verma A. COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence? JAMA. Published online March 24, 2020. doi:10.1001/jama.2020.4812 </ref>
*Nebulizers
** Avoid nebulizers as they are generally ineffective and may aerosolize virus
** [[Special:MyLanguage/Albuterol|Albuterol]] with spacer is safer, though probably ineffective unless co-occuring reactive airway disease 
***MDI equivalents: [[Special:MyLanguage/Albuterol|Albuterol]] or [[Special:MyLanguage/ipratropium|ipratropium]]
****<20 kg or 5yrs old: 4-5 puffs with a spacer every 20 minutes. 4 breaths between puffs.
****>20 kg or 5yrs old: 8-10 puffs with a spacer every 20 minutes. 4 breaths between puffs.
</translate>