Supplements for COVID-19?

By Nina Chhabra on March 9, 2020

**UPDATE AS OF 4/27/2020** We previously mentioned below that it may be better to avoid NSAIDS such as ibuprofen for relief of COVID-19 related symptoms, however, the FDA issued a statement on 3/19/2020 that they are "NOT aware of scientific evidence connecting the use of NSAIDs...with worsening COVID-19 symptoms."**

We’ve been getting a lot of questions about what supplements can help to boost immunity, especially with the virus known as COVID-19 (i.e., novel coronavirus).

We cannot stress enough that first and foremost, hand hygiene is the most important thing you can be doing right now, and do it often.  Wash your hands with warm water and soap for at least 20 seconds, or for as long as it takes you to sing “happy birthday to you” twice. The other thing you should be mindful of is to avoid contact with your face and your eyes.

Social distancing is also very real- if you can work from home, you should. Many cities are currently banning gatherings of 50 or more people and shutting down schools, restaurants, and bars.  Stay home whenever possible during this time. This will help prevent the spread of the virus. Remember, it can take up to two weeks for someone to show signs and symptoms. It is also very important to stay home if you are feeling sick.

Wearing a mask can also help protect you from spreading the virus. Often times, people are asymptomatic, so by wearing a mask you can help reduce the spread of COVID-19.  For the most up to date guidance from the CDC, click here.

Some supplements that you can take that can help boost immunity include:

• Vitamin C- can help reduce the severity and duration of a cold, but typically this occurs if you start taking vitamin C before feeling ill. 500 mg- 1000 mg of vitamin C twice a day is a good starting dose to try to help boost immunity. 
• Zinc- may have some anti-viral properties. Doses of 15-30 mg of zinc per day are presumed to be possibly safe, short term, for one to two weeks. Zinc can interact with other medications (antibiotics and antivirals), and long term use of high doses of zinc can cause copper deficiency.
• Vitamin D- may help reduce the number of respiratory illnesses, especially for those for are deficient. Supplementing with 1,000-2,000 international units per day may be beneficial. Vitamin D levels can be monitored, and it is recommended to not exceed blood levels of 50ng/mL of vitamin D.
• Quercetin- a naturally occurring antioxidant/flavonoid that may have benefits for allergic rhinitis and possibly in exercise-induced respiratory infections¹. Quercetin may interact with some antibiotics known as fluoroquinolones (ciprofloxacin, levofloxacin) and could also interact with other medications that are metabolized through your liver system knows as the cytochrome p450 enzyme system (3A4 and 2C9). These drugs may include warfarin, midazolam, cyclosporine, drugs known as the "statins" (atorvastatin, pravastatin, rosuvastatin, simvastatin), medications known as non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, voltaren), tamoxifen, and possibly losartan.  There is also a possibility it may interact with people with hypothyroidism. Use in caution in these patients. Doses of 500 mg twice daily have been studied and shown to be possibly safe for up to twelve weeks.
• Bromelain- is an enzyme that comes from the stalk of the pineapple. It has shown to have some activity in reducing symptoms for acute sinusitis². It can, however, interact with blood thinners such as warfarin, and also certain antibiotics such as tetracyclines. Use with caution for these agents³. Bromelain is measured in GDU (gelatin digestion units) and provides 2,400 GDU per gram⁴. Doses of bromelain may range from 200 mg- 2000 mg per day⁵.

Although there are no studies that show the effects of using ibuprofen and other non-steroidal anti-inflammatory drugs known as NSAIDS for managing coronavirus, anecdotal reports show that these agents may worsen symptoms for patients, and may result in a more severe illness or prolonged illness. It is recommended to use acetaminophen for muscle aches and fevers for patients who may are diagnosed with COVID-19, or are concerned they may be infected with it.

Currently, there is not an appropriately robust understanding related to the effect of these supplements to warrant broad use at this time. Although these supplements have some evidence to suggest boosted immunity with their use, we do not have solid data to indicate they can reduce the risks associated with COVID-19. Please also note these doses are for adult patients. We do not have enough literature to support this use in the pediatric population.

As always, it is best to check with your health care provider or pharmacist before starting a new supplement to avoid any possible drug- drug interactions, or drug-herbal interactions.