Indomethacin: Can It Counteract Bradykinin Effects in COVID-19 Patients?
Myasar Alkotaji1,2, Radhwan N Al-Zidan2
1College of Pharmacy, University of Nineveh, Mosul, Iraq.
Insights
COVID-19 survivors often experience persistent dry cough and myalgia due to bradykinin imbalance. Indomethacin, an anti-inflammatory drug, may effectively treat these symptoms by reducing bradykinin levels.
Area of Science:
- Pharmacology
- Infectious Diseases
- Respiratory Medicine
Background:
- COVID-19 presents a significant global health challenge, with persistent symptoms like dry cough and myalgia affecting many patients and survivors.
- Elevated bradykinin levels, potentially due to reduced degradation, are observed in COVID-19 patients, suggesting a link to symptoms.
- A similarity exists between COVID-19-induced dry cough and cough caused by angiotensin-converting enzyme inhibitors, both potentially mediated by bradykinin.
Purpose of the Study:
- To investigate the potential of treatments for angiotensin-converting enzyme inhibitor-induced dry cough for managing COVID-19-related symptoms.
- To explore the efficacy of indomethacin in treating persistent dry cough, generalized pain, and myalgia associated with COVID-19.
Main Methods:
- Reviewing existing evidence on treatments for angiotensin-converting enzyme inhibitor-induced dry cough.
- Evaluating indomethacin's pharmacological properties, including its cyclooxygenase-suppressing and bradykinin-lowering effects.
- Assessing indomethacin's known efficacy in managing angiotensin-converting enzyme inhibitor-induced dry cough.
Main Results:
- Indomethacin effectively suppresses cyclooxygenase, thereby reducing inflammatory mediators like bradykinin.
- Indomethacin has demonstrated effectiveness in treating dry cough induced by angiotensin-converting enzyme inhibitors.
- Indomethacin is a well-established, cost-effective, and readily available medication.
Conclusions:
- Indomethacin is proposed as a potential therapeutic agent for managing COVID-19-induced dry cough and other bradykinin-mediated symptoms.
- The drug's mechanism of action aligns with addressing the bradykinin imbalance observed in COVID-19 patients.
- Indomethacin offers a low-cost, accessible treatment option for post-COVID-19 symptoms.
Abstract:
COVID-19 represents the biggest health challenge. Although the mortality rate of COVID-19 is low, the high numbers of infected people and those with post-COVID-19 symptoms represent a real problem for the health system. A high number of patients with COVID-19 or people recovered from COVID-19 suffer from a dry cough and/or myalgia. Interestingly, an imbalance in bradykinin was observed in COVID-19 patients, which might be due to the accumulation of bradykinin as a result of a reduction in the degradation of bradykinin. This finding inspired the idea of possible similitude between the dry cough that is induced by angiotensin-converting enzyme inhibitors and the COVID-19-induced dry cough. Both of these types of cough are mediated, at least partially, by bradykinin. They both manifested as a persistent dry cough that is not responded to traditional dry cough remedies. However, several drugs were previously investigated for the treatment of angiotensin-converting enzyme inhibitor-induced dry cough. Here, we hypothesized that such treatment might be useful in COVID-19-induced dry cough and other bradykinin-related symptoms such as generalized pain and myalgia. In this article, evidence was presented to support the use of indomethacin as a potential treatment of COVID-19-induced dry cough. The choice of indomethacin was based on its ability to suppress the cyclooxygenase enzyme while also lowering the level of the inflammatory mediator bradykinin. Furthermore, indomethacin has been shown to be effective in treating angiotensin-converting enzyme inhibitor-induced dry cough. Moreover, indomethacin is a long-established, low-cost, effective, and readily available medication.
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