In anticipation of everyday discomfort, some people take over-the-counter pain relievers such as ibuprofen or acetaminophen before attending their COVID-19 vaccination appointments. But that has raised concerns about inadvertently dampening the immune system and losing some vaccine protection.
The recent buzz may center around a study on the topic published Jan. 19, although the research only looked at immune responses in mice and human cells growing in Petri dishes. Additionally, as more and more people are getting their second dose of the COVID-19 vaccine, you may hear some mild side effects such as nausea, fatigue, and low-grade fever. These symptoms are more common after the second injection than the first, and doctors say this discomfort usually goes away within a day or two.
Until now, people rarely experience severe allergic reactions to the COVID-19 vaccines. A recent study from the Centers for Disease Control and Prevention found 10 cases of anaphylactic shock associated with the Moderna vaccine from more than 4 million doses administered in December and January. A previous study found 21 cases among the first 1.8 million doses of the Pfizer-BioNTech vaccine. Most of these side effects occurred shortly after people were vaccinated, so the standard protocol is to observe everyone for 15 minutes.
Gothamist asked Dr. Adam Berman, toxicologist and president of emergency medicine at Long Island Jewish Hospital in Northwell Health, to explain why self-medicating before an injection isn’t a good idea for most people – but probably not terrible either. His answers have been edited for brevity and clarity.
Some research suggests that common anti-inflammatory drugs can inhibit the immune response the body builds. Not much, but maybe a little. Is this something that worries you?
I’ve heard a lot about this – from my colleagues, my patients, and even my own family. I thought of it myself when I took the COVID-19 vaccine.
But I don’t think there is any good evidence in real people that they inhibit your immune response. There is only one study on this.
If there was good evidence that taking anti-inflammatory drugs was harmful to your immune response, we would have problems with all kinds of vaccines, which are taken throughout our lives without any problems with effectiveness. This applies to taking anti-inflammatory drugs before or after these shots. More research is needed, but I’m not too concerned about it right now.
Even if there is no evidence, there is the precautionary principle – the idea that we should play it safe. Isn’t that an argument against taking these drugs until we learn more about their potential impact on the immune system?
The truth is, if you feel like you can deal with the symptoms and you absolutely don’t need to take any medication, it is always best not to take any medication. If people are worried about weakening the vaccine response and wanting to avoid taking painkillers out of an excess of caution, then that’s all right. But there probably isn’t enough evidence to discourage the use of the medication if they have a sore arm from the vaccine.
So make sure the medications are on standby, wait to see if there are any bad symptoms, and then decide whether to take some Advil or Tylenol. But don’t take it in advance?
Exactly. When people know they have a history of vaccine reactions, that’s a different story. If someone says that they usually swell after taking an injection and are so concerned that it’s the difference between getting a vaccine, I would feel comfortable if they take a pain reliever before they get the vaccine. On the other hand, if they are so concerned, they may at least want to talk to their doctor before getting a vaccine.
Okay, so ‘wait and see’ and ‘less is more’. What should guide people’s decisions about taking these drugs?
We are talking about the same symptoms you would feel if you had a mild viral illness, such as a cold. And if people feel very uncomfortable after getting the vaccine, they should take a drug instead of breaking it up.
We hear these side effects are your body building an immune response. The public health folks say, “Your body is just doing what it’s supposed to do.” Is that true? Instead of the reaction coming from a sharp metal object, a syringe, entering muscle tissue?
The pain in the arm is more likely related to irritation from an amount of fluid injected into a muscle. That hurts. The whole-body symptoms that people experience a few hours after receiving a vaccine are likely a result of the actual immune response to the injection.
And those are the symptoms that respond well to anti-inflammatory drugs?
Generally speaking, yes. They can make you feel much better. After my second dose of the vaccine, I had a headache for a few days. At first I thought nothing of it. It wasn’t a bad headache. But after a few days I said to myself, “Maybe it’s the vaccine,” so I took some Aleve. After a few more days it went away.
It may of course have disappeared by itself at that point. Or maybe you had a small placebo effect?
That could be. I am all for the placebo effect!