What You Need to Know About Your COVID-19 Risk if You Take Certain Medications

Your prescribed meds are supposed to improve your health, not imperil it. But since the onset of the novel coronavirus pandemic, the medical community has at times inquired whether certain drugs might have an adverse effect.

Experts thought that might happen for two reasons: Medications could potentially elevate your risk of getting infected with COVID-19, or meds could result in a more severe course of illness if you did get sick.

We took a close look at the research into the medications in question, which include proton pump inhibitors (PPIs) for heartburn, immunosuppressants and drugs to treat high blood pressure.

Here's the scoop on whether they actually do put you at risk, and steps you can take to stay healthy. (Spoiler alert: Continue taking your meds unless directed otherwise by your doctor!)

OK, this news sounds alarming, but medical experts caution people not to panic: A July 2020 study in the ​American Journal of Gastroenterology​, drawn from an online survey of more than 53,000 Americans, suggests that people who used PPI heartburn meds, like omeprazole and esomeprazole, daily had significantly increased odds of a positive test for COVID-19.

Researchers didn't find a positive COVID-19 association with people taking milder heartburn drugs, such as famotidine or cimetidine.

"I am not aware of any medications that increase the chances of contracting COVID-19."

PPIs function to neutralize your stomach acid — so why would they affect your coronavirus risk?

The researchers decided to explore the relationship between PPIs and COVID-19 early on in the pandemic, when they started to see an elevated number of digestive symptoms in patients. They learned that the coronavirus sheds into saliva and can then be swallowed into the stomach.

Under normal circumstances, stomach acid should be able to wipe out pathogens (including coronaviruses) with ease, before they enter your GI tract.

But PPI drugs make the pH of your gut less acidic, which reduces its ability to kill germs and makes it easier for viruses to take hold. For example, PPI users experience a higher incidence of intestinal infections like salmonella, per a July 2018 analysis in the ​Annals of Pharmacotherapy​.

Yet unlike salmonella, the novel coronavirus targets the lungs rather than your gut.

"The stomach is not an important part of the process of getting infected with COVID-19 or of recovering from this virus, so how it would be having an effect is unclear," says Michael Ison, MD, professor of medicine and surgery at Northwestern's Feinberg School of Medicine. "I am not aware of any medications that increase the chances of contracting COVID-19."

Also, keep in mind that this was a self-reported online survey, so the results need to be taken with a grain of salt.

People with compromised immune symptoms might be more likely to get seriously sick from the novel coronavirus, according to the Centers for Disease Control and Prevention (CDC).

"Medications that weaken the immune response — like chemotherapy agents, corticosteroids and immunosuppressants given to solid organ transplant patients — put you at risk of having a more severe course of illness," Dr. Ison says. (Although steroids have been shown to be effective for treating progressed stages of COVID-19 infection, they can have a harmful effect when you initially get sick.)

"Patients who contract COVID-19 while taking these drugs are more likely to be hospitalized, end up in the ICU and die," Dr. Ison says.

To understand why, let's look at how a healthy immune system operates to destroy pathogens.

"Lymphocytes, which are one type of white blood cells, identify infected cells and kill them so that the virus can't replicate in them," Dr. Ison says. "White blood cells also produce antibodies, which combine with antigens, preventing the virus from infecting new cells and enhancing disease clearance."

In addition, both lymphocytes and antibodies can trigger your body to churn out chemicals, such as interferons and cytokines, that help your immune system obliterate disease.

But when you're taking a medication that stifles your immune response, your body can't fight off pathogens as efficiently.

"For example, many of the agents used in cancer patients either have an adverse effect on lymphocytes or on the ability to make antibodies, so you have fewer cells to help fight off infection," Dr. Ison says. "As a result, you may have a higher viral load than someone with a fully functioning immune system."

You're in the clear with this one. In March of this year, the American College of Cardiology, American Heart Association and Heart Failure Society of America issued a joint statement expressing concerns that certain blood pressure meds might increase your risk of poor outcomes with COVID-19. This was later proven not to be the case.

"People focused on blood pressure medications because the coronavirus infects cells by binding to an enzyme called ACE2, which is responsible for blood pressure regulation," Dr. Ison says.

The medical community theorized that some blood pressure medications, called ACE inhibitors and angiotensin receptor blockers, might increase the amount of ACE2 on cellular surfaces, thus heightening the risk of infection and severity of illness.

But a July 2020 study in the ​Journal of the American Society of Nephrology​ revealed a decrease in ACE2 receptors, and zero change in lung membranes, in mice.

"This study supports the concept that there is no increased risk for COVID-19 infection by using ACE inhibitors and angiotensin receptor blockers," study author Daniel Batlle, MD, a professor of medicine at Northwestern University Feinberg School of Medicine, said in a Northwestern Now press release.

Further research indicates that taking ACE inhibitors and angiotensin receptor blockers is not associated with severe outcomes or increased mortality for patients with COVID-19, per an August 2020 meta-analysis in ​Current Atherosclerosis Reports​. In fact, people who took these meds experienced fewer critical events than those who did not take ACE inhibitors and angiotensin receptor blockers, per the analysis.

Most importantly, do not stop taking any prescription drugs unless your doc agrees.

"The medication you're taking has a benefit, otherwise you wouldn't be taking it," Dr. Ison says. "You may actually do yourself far more harm by stopping the medication without making a plan with your doctor."

If you have questions about the safety of your meds, reach out to your physician. Most now offer telemedicine visits, so there's a good chance you won't have to step foot in a clinic.

First, here's a refresher on what everyone should be doing to stay healthy, according to the CDC:

• Thoroughly and frequently wash your hands or use hand sanitizer with at least 60 percent alcohol when soap and water isn't available.
• Maintain a distance of at least six feet from people outside of your household.
• Wear a mask in public or when you're with people who don't live with you.

The CDC also issued enhanced infection prevention guidelines for vulnerable populations, including those on immunosuppressants, that go beyond the basic protocols:

• Limit interactions with people outside of your household.
• If you do venture out into public, avoid folks who are not wearing face coverings or ask them to put on a mask.
• Don't hang out with people who have been exposed to someone with COVID-19 in the past 14 days, or who are exhibiting symptoms of the virus.
• Ideally, stay outdoors when visiting friends or family; if that's not possible, stick to a well-ventilated indoor space with open windows and doors.

"Minimize large crowds and avoid going to grocery stores if possible," Dr. Ison adds. "And don't go to indoor restaurants if there is a large case of COVID-19 in your area."

As long as you're diligent about sticking to these guidelines and following your physician's advice, you'll minimize your risk of getting infected.

"There is constantly changing information about COVID-19, which is as frustrating to patients as it is to doctors," Dr. Ison says. "But when you consider that no one knew anything about this disease seven months ago, the fact that we understand as much as we do today is actually miraculous."