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Guidelines
Prescription Medications for Community Patients

Prescription Medications for Community Patients

Guidance intended for use by Primary Care Physicians and Pharmacists

ACEi and ARBs

Current evidence does not support that ACEi and ARBs are associated with the worsening of COVID-19 related outcomes

These drugs save lives and should be continued in patients who are already receiving them for their heart failure, hypertension, ischemic heart disease or kidney disease with proteinuria

Immunosuppressants

  • While there is a relationship between viral infections (such as shingles) and higher doses of corticosteroids it is important that discussions about corticosteroids including dosing and ongoing use must be made with the prescribing physician, and as always the lowest dose that treats symptoms should be used
  • Care should be taken to avoid, identify and treat adrenal insufficiency when patients who are on corticosteroids (or have been in the last 3 months) develop severe illnesses including COVID-19

Patients should continue on immunomodulating / immunosuppressive therapy for inflammatory bowel disease (IBD), autoimmune diseases including but not limited to the kidney, skin or joints or solid organ transplants, unless a specialist recommends otherwise. Stopping medication could result in a flare and place the patient at higher risk

If a biologic infusion or injection must be delayed because the patient has COVID-19, or because they are self-isolated, the patient should contact their specialist to consider rescheduling

Respiratory conditions requiring the use of Inhaled Corticosteroids (ICS) or Oral Corticosteroids (OCS)

Patients of all ages with asthma or COPD who use inhaled corticosteroids (ICS) or oral corticosteroids (OCS) as controller/preventer therapy should remain on their medicines exactly as prescribed by their physician(s) prior to the COVID-19 pandemic

Using ICS or OCS as prescribed is necessary for protecting those with asthma or COPD from flare-ups, which can lead to the need for emergency care or hospitalization

Exacerbations of asthma or COPD should be treated according to usual protocols, including steroid treatment if warranted

There is no scientific evidence to support that ICS or OCS should be avoided in patients with asthma or COPD during the COVID-19 pandemic

NSAIDs including ASA

Patients using NSAIDs including ASA for chronic conditions should remain on these medications

Current evidence does not support that NSAIDs worsen symptoms of COVID-19

Acetaminophen is generally recommended for the treatment of fever

Additional Information

  • These recommendations are meant to support patient care decisions on a case by case basis and are not meant to replace individualized clinical judgement
  • This document is also not designed to inform on COVID-19 treatment regimes. For patient specific questions please contact the patient’s known specialist, or if not available, use the COVID-19 tele-advice line
  • This guidance document has been put together by the leadership team of the Medicine Strategic Clinical Network in consultation with primary care and specialty care
  • The document contains information based on current available evidence and will be updated as new information becomes available
  • Please refer to the web version of this document for the most current information
  1. CDC. Management of Patients with Confirmed 2019-nCoV CDC. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html.
  2. Sparks, MA, South, A., Welling, P., Luther, JM, Cohen, J., Byrd, JB, Burrell, LM, et. al. Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19. CJASN (2020).
  3. Hypertension Canada’s Statement on: Hypertension, ACE-Inhibitors and Angiotensin Receptor Blockers and COVID-19. March 13, 2020. https://hypertension.ca/wp-content/uploads/2020/03/2020-30-15-Hypertension-Canada-Statement-on-COVID-19-ACEi-ARB.pdf.
  4. Rubin, D.T., Feuerstein, J.D., Wang, A.Y., Cohen, R. D. AGA Clinical Practice Update on Management of Inflammatory Bowel Disease During the COVID-19 Pandemic: Expert Commentary.
  5. Crohn’s and Colitis Canada. COVID-19 and IBD. https://crohnsandcolitis.ca/Living-with-Crohn-sColitis/COVID-19-and-IBD.
  6. Recommendations for inhaled asthma controller medications. Global Initiative for Asthma. https://ginasthma.org/recommendations-for-inhaled-asthma-controller-medications/.
  7. Global Initiative for Chronic Obstructive Lung Disease. https://goldcopd.org/gold-covid-19-guidance/.
  8. American Academy of Allergy, Asthma, and Immunology. https://www.aaaai.org/conditionsandtreatments/library/asthma-library/covid-asthma.
  9. Canadian Thoracic Society. Information for Healthcare Professionals and the Respiratory Community. Asthma and COPD Position Statements. April 2020. https://cts-sct.ca/covid-19/.
  10. AHS. Novel Coronavirus (COVID-19) Frequently Asked Questions – for Primary Care. https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-primary-care-faq.pdf.
  11. Government of Canada. Informational Update. No scientific evidence that ibuprofen worsens COVID-19 symptoms. https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/72633a-eng.php.