Dengue dread: Why popping painkillers like aspirin or ibuprofen can turn fatal for you

Taking painkillers, particularly NSAIDs like aspirin, or ibuprofen can be dangerous for people infected with dengue. Here’s why.

Delhi government's Department of Drugs Control has asked the pharmacists in the city to not sell nonsteroidal anti-inflammatory drugs (NSAIDs) drugs like aspirin, ibuprofen and naproxen without doctor's prescription. In the letter to chemist associations in the city, KR Chawla, Head of the drugs control authority, said there is a possibility of vector-borne diseases to witness a spike in the coming weeks due to monsoon showers and the recent flooding. Painkillers, especially non-steroidal anti-inflammatory drugs (NSAIDs) can prevent blood platelets from forming blood clots which can cause internal bleeding and can be deadly for people suffering from vector-borne illnesses like dengue and chikungunya. (Also read: Dengue alert: Early signs of the deadly disease you shouldn't ignore amid rise in cases)

In some cases, dengue can progress to a more severe form called dengue hemorrhagic fever, which can cause internal bleeding and death.(Freepik)

"Taking painkillers, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen, can potentially be dangerous for individuals infected with vector-borne illnesses like dengue. The reason for this is related to the way these drugs affect blood clotting and platelet function," says Dr G Sneha Consultant Internal Medicine CARE Hospitals Banjara Hills, Hyderabad.

What is dengue?

"Dengue is a mosquito-borne illness that is found in tropical and subtropical regions around the world. The symptoms of dengue can vary from mild to severe, and they can include fever, headache, muscle pain, fatigue, nausea, vomiting, and rash. In some cases, dengue can progress to a more severe form called dengue haemorrhagic fever, which can cause internal bleeding and death. There is no specific treatment for dengue, but supportive care can help to relieve symptoms and prevent complications. If you think you may have dengue, it is important to see a doctor right away," says Dr. Aditya Chowti, Senior Consultant- Internal Medicine, Fortis Hospital, Cunningham Road, Bengaluru.

How NSAIDs interfere with blood clotting

"Dengue is a viral infection transmitted by mosquitoes, and it can cause symptoms such as fever, headache, joint and muscle pain, and in severe cases, it may lead to a condition called dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS). DHF and DSS are characterized by severe bleeding, low platelet count, and plasma leakage, which can be life-threatening. When someone takes NSAIDs, they can interfere with the normal blood clotting process by inhibiting an enzyme called cyclooxygenase (COX). This inhibition can lead to decreased platelet aggregation, making it difficult for the body to form blood clots, which are essential to stop bleeding," adds Dr G Sneha.

"In dengue infection, the virus itself affects the platelets, leading to a reduction in their number and functionality. This combined with the platelet-inhibiting effect of NSAIDs can worsen the bleeding tendency in dengue patients and increase the risk of severe complications. It may lead to prolonged bleeding, internal bleeding, or haemorrhage in critical organs, further complicating the patient's condition and possibly leading to fatal outcomes," adds the expert.

NSAIDs can cause renal damage

"NSAIDs can also harm the stomach lining and cause gastrointestinal discomfort. This might cause serious gastrointestinal bleeding and worsen the patient's health when he/she has dengue. Dengue fever also led to dehydration. Painkillers are frequently used by patients to lower fevers and treat symptoms. However, when taken while dehydrated, some medications, like ibuprofen, can cause renal damage. This combination can result in renal problems and potentially lethal effects because dengue already affects the kidneys, says Dr RR Dutta, HOD - Internal Medicine, Paras Health, Gurugram.

"The use of NSAIDs (non-steroidal anti-inflammatory drugs) or commonly referred as pain killers is a very common practice to treat such symptoms. NSAIDS like ibuprofen, aspirin etc reduce pain, for fever by decreasing the synthesis of substances (prostaglandins) responsible for fever or pain. But few of these substances are also responsible for platelet synthesis (thromboxane). The production of these substances is also affected. Illnesses like dengue are associated with varying degree of decrease in platelet count. Use of NSAIDS either contribute to the further lowering of platelet or hamper the recovery of platelet count. This increases the risk of bleeding, which at times, may be fatal in case of severely low platelet count. Furthermore, NSAIDS like aspirin, acetaminophen etc are toxic to liver in high doses. Mild liver dysfunction (transaminitis) is another commonly noted lab abnormality during illnesses like dengue. Use of aspirin, acetaminophen etc during such illnesses are associated with worsening of liver dysfunction and development of fatal illness i.e., encephalopathy (Reye syndrome) rarely, particularly in paediatric patients. Therefore, we should be careful and always consult doctors before use of any such NSAIDS," says Dr Rohit Garg, Consultant, Dept of Infectious Disease, Amrita Hospital, Faridabad.

"Due to these risks, it is recommended that individuals suspected or confirmed to have dengue should avoid taking NSAIDs and instead use acetaminophen (paracetamol) for pain and fever relief, as it does not have the same anti-platelet effects. However, even with acetaminophen, it is essential to follow the proper dosage guidelines and consult a healthcare professional if you suspect you have dengue or any other serious illness. Early diagnosis and appropriate medical care are crucial for managing vector-borne illnesses like dengue and reducing the risk of severe complications," says Dr G Sneha.