Lippmann, Steven B

Rayamajhi, Niguma

Santhi, Sharanya S E

English

University of Louisville

University of Louisville Journal of Respiratory InfectionsOPINION PIECEAre Antipyretic Medications Compatible with SARS-CoV-2 Vaccines?Sharanya Shre Ezhilarasan Santhi, MBBS1; Niguma Rayamajhi, MBBS1; Steven B. Lippmann, MD1*1School of Medicine, University of Louisville, Louisville, KY, USA∗steven.lippmann@lousiville.eduRecommended Citation: Santhi SSE, Rayamajhi N, Lippmann SB. Are antipyretic medications compatible with SARS-CoV-2 vaccines?. Univ Louisville J RespirInfect 2022; 6(1):Article 10. doi: 10.55504/2473-2869.1242.Vaccine hesitancy is an issue that should be addressedto maximize protection from serious COVID-19. SARS-CoV-2 vaccination hesitancy in the United States rangesfrom 21 to 42%.[1] Fear of adverse effects and concernsabout safety are some of the main reasons for refusingto be immunized.[2, 3] Vaccinations can induce adversereactions, such as injection site tenderness, headache,myalgia, and arthralgia. Fever is occasionally a sys-temic side effect.[4] People often self-treat these prob-lems with antipyretic and/or analgesic drugs; physi-cians sometimes recommend these as well.The Centers for Disease Control and Prevention rec-ommend avoiding antipyretic or analgesic medicationsprophylactically before immunization.[5] However, ifinflammatory manifestations develop after vaccina-tion, such as fever, pain, or swelling, these medicationscan be utilized, if approved by a physician.[5] Nev-ertheless, self-administration of over-the-counter phar-maceuticals is widely prevalent and leads to the ques-tion of whether the antipyretic drugs hamper vaccineimmunogenicity.The mRNA vaccines enhance specific T-cell activity,stimulate cytokine production, and generate antibodiesthat can bind and neutralize the virus. This immunereaction can be impeded by antipyretic agents, suchas non-steroidal anti-inflammatory drugs (NSAIDs),acetaminophen, or aspirin.[6] In a randomized trial,serotype-specific IgG geometric mean concentrations(GMC) were measured after pneumococcal vaccina-tion, with acetaminophen administered concomitantlyin one group and delayed in another.[7] The IgG lev-els decreased in both, when compared to control pop-ulation, but reached statistical significance (P<0.0125)only in the concomitant group. The researchers cat-alogued decreased immune titers in five out of 13serotypes of the vaccine. Hence, when antipyreticdrugs are given a few hours after vaccination, thereappears to be less impact on antibody titers. It isunknown whether the antibody response reduction isclinically significant since protective levels of antibod-ies remained present in either case. It remains to beestablished whether antipyretic pharmacotherapies af-fect long-term T-cell-mediated immunity.The effect of duration and timing of antipyretic ther-apy on COVID-19 vaccine immunogenicity is yet tobe defined. Vaccine acceptance might be enhanced byincreased awareness of the availability of antipyretictherapies to diminish potential post-vaccination side-effects. Additionally, NSAID prophylaxis may offerprotection against vaccine-related pericarditis and/ormyocarditis.[8] Research may reveal that it is unneces-sary to avoid these drugs if immune responses are satis-factory despite their use. However, currently, it is pru-dent to discourage prophylactic antipyretic medicationbefore vaccination.Received: February 17, 2022Accepted: April 12, 2022Published: April 20, 2022Copyright: © 2022 The author(s). This original article isbrought to you for free and open access by ThinkIR: The Uni-versity of Louisville’s Institutional Repository. For more infor-mation, please contact thinkir@louisville.edu. This article isdistributed under the terms of the Creative Commons Attribu-tion 4.0 International License (CC BY 4.0), which permits un-restricted use, distribution, and reproduction in any medium,provided the original author and source are credited.Funding Source: The author(s) received no specific fundingfor this work.Conflict of Interest: All authors declared no conflict of inter-est in relation to the main objective of this work.ULJRI | https://ir.library.louisville.edu/jri/vol6/iss1/10 1ULJRI Are Antipyretic Medications Compatible with SARS-CoV-2 Vaccines?References1. El-Mohandes A, White TM, Wyka K, et al. COVID-19 vac-cine acceptance among adults in four major US metropoli-tan areas and nationwide. Sci Rep 2021; 11(1):21844. doi:10.1038/s41598-021-00794-6. PMID: 34737319.2. Shen SC, Dubey V. Addressing vaccine hesitancy: Clinicalguidance for primary care physicians working with parents.Can Fam Physician 2019; 65(3):175-81. PMID: 30867173.3. Dodd RH, Pickles K, Nickel B, et al. Concerns and moti-vations about COVID-19 vaccination. Lancet Infect Dis 2021;21(2):161-3. doi: 10.1016/s1473-3099(20)30926-9. PMID:33338440.4. Wu Q, Dudley MZ, Chen X, et al. Evaluation of the safetyprofile of COVID-19 vaccines: A rapid review. BMC Med2021; 19(1):173. doi: 10.1186/s12916-021-02059-5. PMID:34315454.5. Centers for Disease Control and Prevention (CDC).Preparing for your COVID-19 vaccination. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/prepare-for-vaccination.html. Accessed 17 February 2022.6. Prymula R, Siegrist CA, Chlibek R, et al. Effect ofprophylactic paracetamol administration at time of vaccina-tion on febrile reactions and antibody responses in children:Two open-label, randomised controlled trials. Lancet 2009;374(9698):1339-50. doi: 10.1016/s0140-6736(09)61208-3.PMID: 19837254.7. Wysocki J, Center KJ, Brzostek J, et al. A randomizedstudy of fever prophylaxis and the immunogenicity of routinepediatric vaccinations. Vaccine 2017; 35(15):1926-35. doi:10.1016/j.vaccine.2017.02.035. PMID: 28262330.8. Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19 vaccination in a large health care organization. N Engl JMed 2021; 385(23):2132-9. doi: 10.1056/NEJMoa2110737.PMID: 34614329.ULJRI | https://ir.library.louisville.edu/jri/vol6/iss1/10 2

Are Antipyretic Medications Compatible with SARS-CoV-2 Vaccines?

https://ir.library.louisville.edu/cgi/viewcontent.cgi?article=1242&context=jri

Are Antipyretic Medications Compatible with SARS-CoV-2 Vaccines?

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