When the Covid-19 pandemic first hit the UK, thousands turned to the trusty painkiller ibuprofen to combat symptoms such as headaches and fever.
Then, within weeks, it was suggested that ibuprofen could actually make things worse by interfering with the immune system’s ability to fight off the virus.
Since then, several studies have found there is no such heightened risk, including research published last month by the University of Southern Denmark based on nearly 10,000 Covid-19 patients, which concluded that death rates were no higher among those taking ibuprofen.
We look at the treatments that can sometimes have the opposite of their intended effect [File photo]
But the scare reflects a genuine issue with some medicines, which can sometimes end up making symptoms worse rather than better.
This can be due to complex reasons, ranging from overuse of medications (which can change the way the body reacts to them), to drugs interfering with the body’s own defences.
Here, we look at the treatments that can sometimes have the opposite of their intended effect.
Decongestants leave you bunged up
Nasal decongestants are often the first port of call for anyone suffering with a blocked nose owing to colds, flu or allergies such as hay fever.
They work by shrinking tiny blood vessels inside the nasal cavity that have become inflamed due to the presence of a virus or allergen.
Most contain pseudoephedrine, a drug which causes the muscles that control these blood vessels to contract, allowing mucus and air to pass through the nose more freely. Relief can come in just 15 minutes.
Strict instructions say they should be used no more than three or four times a day for a maximum of seven days.
Any longer and they can make stuffiness worse, even if other cold or allergy symptoms have cleared up — a condition called rhinitis medicamentosa.
Nasal decongestants are often the first port of call for anyone suffering with a blocked nose owing to colds, flu or allergies such as hay fever [File photo]
Scientists think repeated use of drugs such as pseudoephedrine causes ‘fatigue’ in the muscles and nerves that make the blood vessels contract, which makes the receptors (proteins on the outside of cells that the drugs attach to) become less sensitive to them.
‘As the nasal tissue swells again, patients tend to use more of the decongestant spray — which just makes the problem even worse,’ says Antony Narula, an honorary consultant ear, nose and throat (ENT) surgeon at Imperial College Healthcare NHS Trust in London.
He warns prolonged use can even lead to permanent tissue changes that cause constant nasal obstruction and require surgery.
Patients who get bunged up with nasal sprays are often advised to switch to oral decongestants, as these don’t cause this side-effect.
When heartburn tablets worsen it
Heartburn drugs called proton pump inhibitors are among the most widely prescribed medicines on the NHS.
The drugs, which work by suppressing the release of acid by cells called proton pumps (found in the stomach lining), can make chronic heartburn even worse when patients first stop taking them.
Dr Jeremy Sanderson, a consultant gastroenterologist at Guy’s and St Thomas’ NHS Trust in London, explains that this is due to ‘rebound hyperacidity’.
‘When you stop taking the drugs, you are effectively releasing the brakes from the proton pump cells, and they initially react by producing more acid,’ he says.
‘Around half of all patients will suffer this rebound effect. I usually advise patients to go cold turkey for a couple of days, or use over-the-counter treatments such as Gaviscon until things settle down.’
Gaviscon helps by forming a protective layer on top of the stomach’s contents to stop acid leaking back into the gullet.
‘But a step-down approach, where patients take a 10mg dose instead of 20mg for a week before coming off the drugs, also works well,’ says Dr Sanderson.
He adds that some patients are switched to another type of drug, an H2 blocker, which is less likely to cause the acid rebound effect.
The drugs, which work by suppressing the release of acid by cells called proton pumps (found in the stomach lining), can make chronic heartburn even worse when patients first stop taking them [File photo]
Acne drug that triggers spots
Around 30,000 people in the UK take the drug Roaccutane for severe acne. It clears spots by reducing the amount of natural oil (called sebum) made by the skin, so the pores are less likely to block — but it takes time to work.
‘I warn my patients that, with Roaccutane, their acne will probably get worse before it gets better,’ says Dr Anshoo Sahota, a consultant dermatologist at Barts Health NHS Trust in London.
‘For 80 per cent, the flare-up is tolerable and lasts a couple of weeks, but for the other 20 per cent in whom it really gets bad, I often prescribe a short course of antibiotics to see them through.’
Antibiotics restrict the growth of bacteria on the skin that can make acne worse. ‘If it lasts a month or more, they may also need oral steroids to dampen down the inflammation,’ says Dr Sahota.
The drug has this effect because it initially causes the inner lining of hair follicles to break down. The debris from this breakdown causes a blockage — the perfect breeding ground for acne-causing bacteria.
But once this debris has been shed and sebum production has been lessened, then the skin dries out and begins to clear up. ‘It’s often a matter of perseverance,’ says Dr Sahota.
Antidepressants dampen mood
Depression medication can, in some cases, intially make the problem much worse — especially with the most commonly prescribed antidepressants, called selective serotonin reuptake inhibitors (SSRIs), which include drugs such as Prozac and Seroxat.
The Seroxat patient information leaflet, for example, warns ‘the risk of suicide may increase in the early stages of recovery’.
This is thought to be because the drugs work by increasing two key brain chemicals, serotonin and glutamate. Serotonin improves motivation and energy levels, while glutamate is linked with pleasure and learning.
Serotonin levels rise within a few hours of the first pill being taken, but it can take several weeks before glutamate increases.
The result is patients often feel energised but also agitated and devoid of pleasure. It can leave many feeling desperately anxious.
‘Some people experience suicidal thoughts when they start taking SSRIs,’ says Carmine Pariante, a professor of biological psychiatry at King’s College London.
‘Within a few weeks it usually passes. But it’s very important that doctors pick up those people in whom the side-effects are bad or intolerable.
‘Some people may need to be switched to another SSRI, to see if the side-effects subside.’
Pain pills that leave you in agony
Every year in the UK, doctors issue more than 20 million prescriptions for strong painkillers called opioids, which include codeine, co-codamol, tramadol and fentanyl.
The drugs work by attaching to receptors — proteins found on the outside of nerve cells in the brain and spinal cord — which help to transmit pain signals. There, they trigger chemical changes within the cells that stop them firing signals, so reducing the perception of pain.
However, some patients taking the drugs for weeks or months can experience an increase in their agony. This is due to something called opioid-induced hyperalgesia, an abnormally increased sensitivity to pain.
Over time, the body reacts to the drugs’ effects by increasing the number of receptors on the surface of the cells in a bid to get pain signals through to the brain. As a result, the drug dose is spread more thinly.
Dr Cathy Stannard, a consultant in complex pain at NHS Gloucestershire clinical commissioning group, says: ‘It’s a very different sort of pain — not just the existing problem getting worse.
‘It can be very severe and affect the whole body.’ However, it is very rare, she adds.
Anti-fever drugs prolong infection
Taking paracetamol or ibuprofen to bring down a high temperature might actually prolong a viral infection and increase the amount of virus we can pass on to others.
‘Fever is part of the body’s response to infection,’ says Dr Andrew Easton, a virologist at the University of Warwick.
Laboratory studies show that when you elevate the temperature, the virus doesn’t replicate well. In practice, this means that lowering your temperature by taking medicines such as paracetamol may help the virus survive inside the body for longer.
‘The theory is [taking paracetamol or ibuprofen] prolongs infection,’ says Dr Easton.
Ear wax drops block ears
Over-the-counter ear drops are the main recommended remedy when ears become blocked with wax that is impairing hearing or causing infections.
Most drops contain sodium bicarbonate, which is alkaline. Ear wax is high in acid. When the two come into contact, there is a chemical reaction that starts to dissolve hardened wax.
But during the early stages of the softening process, the wax expands as it breaks down. This worsens the blockage and disrupts hearing at least for a few days.
ENT surgeon Mr Narula says: ‘You need to persevere as this effect only lasts for a few days.’
Over-the-counter ear drops are the main recommended remedy when ears become blocked with wax that is impairing hearing or causing infections [File photo]