Medicines information

Why is taking vitamin D particularly important during Covid-19 pandemic?

Taking vitamin D would not prevent you from getting Covid-19; but avoiding deficiency is important to remain healthy whether you are worried about COVID-19 or not.

Vitamin D is also called colecalciferol. It controls calcium and phosphate levels in the body which helps maintain bones, teeth, muscles and general wellbeing. Normally people get enough vitamin D from sunlight between March and September in the UK. However, during Covid-19 lockdown you may not be getting enough sun exposure. Low levels of vitamin D is called “vitamin D deficiency”. The NHS recommends people take 400 units of vitamin D each day if we are at risk of deficiency. The main symptoms of vitamin D deficiency are bone pain or unexplained tiredness. Vitamin D is in some foods, and supplements can be bought from pharmacies, health food shops and many supermarkets, including on-line.

Who is most at risk of low levels of vitamin D?

National advice tells us there is a greater risk of vitamin D deficiency is people who:

• are over 65 years of age
• are overweight
• are pregnant or breastfeeding
• are spending a lot of time indoors
• have darker skin tones such as those of Mediterranean heritage or Black, Asian and Minority Ethnic (BAME) background including those of mixed-race

Food sources of vitamin D: It can be obtained from diet in fish (salmon), dairy products (milk/ cheese), and red meat. It can still be difficult to get enough vitamin D from food alone so check with your pharmacist or doctor before taking vitamin D supplements. You can increase your vitamin D levels by exposing your skin to sunlight, unless your doctor advises you against this.

I have dietary requirements; can I still take vitamins D supplements?

If buying supplements, you will need to check at the time if it is appropriate for you. If you have any illness e.g. kidney or liver impairment, pregnant or breastfeeding you need you will need to discuss with your healthcare team. Ask your pharmacist if you require vegan or vegetarian supplements.

Potential side effects from taking vitamins and minerals

Most people do not experience side-effects from taking them. However, like any treatment there is a possibility of experiencing side effects, so it is important to not exceed the recommended dose and to report any new symptoms to your pharmacist or GP.

Sources of Vitamin D

We can only make Vitamin D from sunlight between April to September. During the winter we will rely on vitamin D stores laid down during the summer months and from vitamin D containing foods. The government advise a small daily supplement of 10 micrograms per day for most of the population. Vitamin D is important for defence against all infections not just Covid, NICE made a rapid review of the evidence and states that the some parts of the population may be at higher risk of vitamin D deficiency due to staying indoors more during lock down, so the advice for a supplement throughout the winter is important, but there is no evidence of taking a dose greater than 10 micrograms is of any benefit and in fact supplements  more than 100 micrograms per day can be harmful.

More info:

• British Dietetic Association’s Food Facts leaflet 
• NICE

Paracetamol can be used to ease symptoms such as headache and fever if you become unwell with coronavirus, unless your doctor has said that it is not suitable for you.

Paracetamol is a common painkiller used to treat aches and pain. It can also be used to reduce a high temperature.

It is available to buy, and is sometimes combined with other painkillers and anti-sickness medicines. It is also the main ingredient in a wide range of cold and flu remedies.

Check with your doctor or pharmacist if you:

• have had an allergic reaction to paracetamol or any other medicines in the past
• have liver or kidney problems
• regularly drink more than the maximum recommended amount of alcohol (14 units a week)
• take medicine for epilepsy
• take medicine for tuberculosis (TB)
• weigh less than 50kg as you may need a lower dose
• take the blood-thinner warfarin.

Key facts

• Paracetamol takes up to an hour to work
• Paracetamol can be taken with or without food
• Adults can take a maximum of four doses (up to eight 500mg tablets in total) in 24 hours
• Always leave at least four hours between doses
• Do not take paracetamol with other medicines containing paracetamol. Check the label to see whether they contain paracetamol. – ask your healthcare professional if you are unsure
• Paracetamol is safe to take in pregnancy and while breastfeeding, at recommended doses. If you take paracetamol in pregnancy or while breastfeeding, take the lowest dose of paracetamol that works for you for the shortest possible time.
• Brand names for paracetamol includes Disprol, Hedex, Medinol and Panadol
• It's safe to take paracetamol with other types of painkiller that don't contain paracetamol, such as ibuprofen, aspirin and codeine.
• Most importantly overdosing on paracetamol can cause serious side effects. Do not be tempted to increase the dose or to take a double dose if your pain is very bad. Do not take an extra dose to make up for a missed one.

Get help from 111 now if you take:

• more than two extra tablets of paracetamol
• more than eight tablets of paracetamol in 24 hours

Taking too much paracetamol can be dangerous and you may need treatment. Visit 111.nhs.uk or call 111.

We are aware there has been concern spreading about the use of ibuprofen and other non-steroidal anti-inflammatory medications (NSAIDs) in relation to COVID-19. The current advice from the Commission on Human Medicines’ Expert Working Group on coronavirus (COVID-19) has concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19.

Patients can take paracetamol or ibuprofen when self-medicating for symptoms of COVID-19, such as fever and headache, and should follow NHS advice if they have any questions or if symptoms get worse; unless your doctor has told you that either of one is not suitable for you.

What should I do?

• Currently there is no link between ibuprofen and the likelihood of contracting or worsening of coronavirus symptoms.
• If you have confirmed or believe they have COVID-19, should take paracetamol or Ibuprofen for the shortest duration necessary to control symptoms. This is unless your doctor advice against taking either one of them.
• Anyone who is currently advised to use ibuprofen or any other non-steroidal anti-inflammatory drugs (NSAIDs) for a long-term condition by their healthcare professional should not stop taking them . For example, for the treatment of arthritis, or if adults are taking low-dose 75 mg aspirin regularly for prevention of heart attacks or for vascular disease.

Remember to:

• Always take ibuprofen after food
• Not to exceed the prescribed dose or the one stated on the box when you buy it over the counter
• If you experience stomach pain that persists after taking it, discuss with your GP

Note that the evidence is being regularly reviewed on the government website.

It is always advisable to reduce or aim to stop smoking. Some people may also start to smoke excessively to relief some of the anxiety that we are going through with this pandemic. During self-isolation smoking may become an inconvenience due to having to leave the building or the house to smoke so your smoking pattern may change.

Either way if you smoke more or less than usual you may want to discuss with your local community pharmacist, GP, nurse or pharmacist prescriber at your GP. This is because smoking tobacco increases the activity of your liver making it break medications faster than it would in a non-smoker. If you stop smoking without a plan with a healthcare professional then the level of the medication may increase rapidly. This could be harmful in some instances.

Please note that not all medication are affected by smoking that’s why it is important to check with your community pharmacist at the first instance.  

These are some of the medications that may be affected by change in smoking pattern:

• Amitriptyline
• Aminophylline or theophylline
• Benzodiazepines e.g. diazepam
• Chlorpromazine
• Clozapine
• Haloperidol
• Insulin
• Methadone
• Olanzapine
• Propranolol
• Warfarin

For more information read the NICE guidelines on this page for smokers, especially those with COPD.

Chloroquine and hydroxychloroquine are being investigated but are not licensed to treat COVID-19 related symptoms or prevent infection. There have been many reports in the media about chloroquine and hydroxychloroquine being trialled to treat Covid-19. However, at this stage these are only trials and they have not finished. Please do not buy them to self-medicate as they could be harmful. Please note that they could interact with medications for example increase the level of digoxin which is a medicine taken for the heart and at a wrong dose it could be toxic. They can also affect your mood, eye sight and various other body functions. When prescribed, clinicians monitor it closely to make sure they are taken safely.

See more details on the Medicines and Healthcare products Regulatory Agency (MHRA) website.

Clozapine and blood testing during the Coronavirus Outbreak  - patient information leaflet

Taking Lithium during the Coronavirus outbreak

Throughout the Covid-19 pandemic, it is important to take measures to reduce the risk of infection by strengthening your immune system with a balanced diet.

Find out more about maintaining a balanced diet in our new leaflet.