Patients taking ACE-I and ARB drugs (ending in “pril” or “sartan”)
Many patients are prescribed an ACE-I or ARB drug (ending in “pril” or “sartan”). These are used to treat a wide range of health conditions, including high blood pressure, kidney disease, and heart conditions. There is lots of high quality evidence that these medicines improve people’s health.
If you take an ACE-I or ARB medicine, it is strongly recommend that you continue to take your usual therapy. You should not stop taking these medicines without discussing it with your doctor first.
There has been some speculation in the media that ACE-I and ARB drugs might increase the risk and severity of Coronavirus (COVID-19) infection. This will provoke anxiety for many people taking these medicines and leave them uncertain about the best action to take.
There is a lack of any evidence supporting these claims of harmful effect of ACE-I and ARB. Patients are assured that they should continue these medicines unless told otherwise by a healthcare professional.
For some people, particularly those with heart failure, stopping the drugs suddenly can lead them to become unwell. This can cause people to become more breathless and may create uncertainty about whether symptoms are due to infection (such as COVID-19), or to underlying health problems.
This advice will be updated as needed while health experts review the available evidence.
GENERAL ADVICE (i.e. NOT SPECIFIC TO COVID-19) FOR PATIENTS TAKING ONE OR MORE OF THE FOLLOWING MEDICATIONS:
ACEi e.g., enalapril, lisinopril, perinopril, or ramipril
ARBs e.g. candesartan, losartan, irbesartan or valsartan
Diuretics (water tablets) e.g. furosemide, indapamide, bumetanide, spironolactone, or eplerenone
Anti-inflammatories e.g.ibuprofen, naproxen, diclofenac, or indomethacin
Diabetes drugs including metformin, canagliflozin, dapagliflozin, empagliflozin and ertugliflozin. If you develop a dehydrating illness (diarrhoea, vomiting or a high temperature associated with not eating and drinking adequately) you should consult a HealthCare Professional. If the Healthcare Professional advises stopping any of the above medications, then they should also advise when to restart your medication once you have recovered from the illness. Typically, this would be after 24 to 48 hours of eating and drinking normally.
Ordering More Medicines Than Usual
To help manage the supply of medicines across the country, we need to make sure everyone has access to their normal medicines at the appropriate time. We’re urging patients not to over-order their repeat prescriptions or request advance medicine supplies. Order as you would normally do. Do not ask for an increased supply if you don’t need it, only order one month at a time, unless you’ve been advised differently by your healthcare professional.
To make the process easier, some patients will start having their regular prescription sent to the pharmacy automatically through the Electronic Repeat Dispensing service. This will mean you don’t need to contact the surgery to order your regular prescription, and the pharmacy can better plan what medicines to order and when they need to be ready for you to collect.
Electronic Repeat Dispensing
Electronic Repeat Dispensing (eRD) allows GPs to authorise your repeat medication for up to one year. Prescriptions are then automatically sent to the pharmacy at regular intervals (for example, every month). This will mean you don’t need to contact the surgery to order your regular prescription, and the pharmacy can better plan what medicines to order and when they need to be ready for you to collect.
If your condition changes or you stop a medicine, your GP can amend your prescription for the future instalments. You can change pharmacies at any time during the duration of the eRD prescription. If clinically appropriate you can request the next issue early or obtain more than one prescription, for example when going on holiday.
410 million repeat prescriptions are generated every year - equivalent to an average of more than 375 per GP per week. Switching 80% of these to eRD could save 2.7 million hours of GP and practice time, meaning more time to care for patients.
Ibuprofen and Other Anti-Inflammatory Medicines
There is currently no strong evidence that ibuprofen can make coronavirus (COVID-19) worse.
But until we have more information, take paracetamol to treat the symptoms of coronavirus, unless your doctor has told you paracetamol is not suitable for you.
Patients who have confirmed COVID-19 or believe they have COVID-19 should use paracetamol in preference to ibuprofen or other anti-inflammatory medicines.
Those currently taking ibuprofen or another non-steroidal anti-inflammatory (such as naproxen or diclofenac) on the advice of a doctor for other medical reasons (e.g. arthritis) should not stop them without checking first.
Patients with Asthma, COPD or other lung conditions
Using your inhalers as prescribed will help cut your risk of an asthma attack being triggered by any respiratory virus, including coronavirus. Carry your reliever inhaler every day.
Even at this busy time for the NHS, getting early support for any problems with your lungs is critical to keep you well and out of hospital.
Some people with lung conditions are prescribed rescue packs of steroid tablets. If you're normally advised to have a rescue pack available to treat your lung condition then it's a good idea to check you have one.
Some patients with COPD who have exacerbations and normally have a rescue pack as part of their personalised action plan should continue to use these as recommended in their personalised plan.
Advice from the British Lung Foundation and Asthma UK is that rescue packs are not recommended for people with asthma as standard. If someone’s asthma is bad enough to consider rescue steroids, then it is essential that they are assessed by a healthcare professional.
If you have asthma, more health advice is available on the Asthma UK website: https://www.asthma.org.uk/advice/triggers/coronavirus-covid-19/
The British Lung Foundation also have a page providing useful advice: https://www.blf.org.uk/support-for-you/coronavirus
Patients With Mild Asthma Who Don’t Normally Have A Preventer Inhaler
If you only have mild asthma and your symptoms are controlled with a reliever inhaler (usually salbutamol or terbutaline), you don’t need to use a preventer inhaler.
Evidence shows that if your asthma is normally well controlled without needing to use a preventer inhaler (containing an inhaled steroid), you are unlikely to get any significant benefit from starting to use one.
We have seen an increase in the number of requests for preventer inhalers from people who don’t normally use them. At the same time, there has been a recent stock shortage of these inhalers. It is very important we make sure the people who rely on these inhalers can continue to get them so that their asthma doesn’t get worse. We will only prescribe inhaled steroids to patients who have a clinical need for them.