Definition of Anti-inflammatory Medications

What are the Anti-inflammatory Medications?

Inflammation is a natural response of the body to different stimuli like injury or infection. Although it is an essential process for healing, excessive or chronic inflammation can lead to discomfort and various health conditions.

Anti-inflammatory medications are used in medicine to alleviate the effects of inflammation in some tissues and alleviate uncomfortable symptoms.

There are two popular types of anti-inflammatory medication, non-steroidal and steroidal anti-inflammatory drugs.

This article will review the different types of anti-inflammatory drugs, their uses and side effects, and other natural anti-inflammatory substances we can add to our daily lives.

Non-steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are a drug class approved by the FDA to be used as antipyretic, anti-inflammatory, and analgesic agents. These make these drugs helpful in treating pain and arthritis, menstrual cramps, and migraine, and they are used as opioid-sparing agents in certain trauma cases. Another use of NSAIDs is as fever reducers.

NSAIDs block two cyclooxygenase enzyme (COX) forms, COX-1 and COX-2. COX-1 protects the stomach lining of the digestive acids and helps maintain kidney function. At the same time, COX-2 is generated in joints when they are injured or inflamed. This knowledge will help choose the different medications depending on the goal of the treatment and to prevent the side effects they may produce.

Classification of NSAIDs

NSAIDs that inhibit COX-1

• Fenoprofen
• Flurbiprofen
• Ketoprofen
• Oxaprozin

Non-selective NSAIDs

• Ibuprofen
• Indomethacin
• Ketorolac
• Nabumetone
• Naproxen
• Piroxicam
• Sulindac

NSAIDs that inhibit COX-2

Lower COX-2 selectivity

• Celecoxib
• Diclofenac
• Etodolac
• Mefenamic acid
• Meloxicam
• Salsalate

Higher COX-2 selectivity

• These drugs have been withdrawn worldwide. Some examples are valdecoxib and rofecoxib.

Administration

NSAIDs are commonly available in oral tablets. Topical NSAIDs are also available for treating pain due to soft tissue injuries and osteoarthritis. Parenteral administration is available for some specific NSAIDs, like ibuprofen or ketorolac, to manage pain or fever.

Side Effects of NSAIDs

• Gastric adverse effects: Due to the inhibition of COX-1. More likely in patients with a history of peptic ulcers.
• Renal adverse effects: Because of the facilitation of the production of prostaglandins from COX-1 and COX-2. Complications in patients with renal dysfunction are acute renal dysfunction, fluid and electrolyte disorders, renal papillary necrosis, and nephrotic syndrome.
• Cardiovascular adverse effects: These include myocardial infarction, thromboembolic events, atrial fibrillation, and hypertension. Diclofenac is reported to be the NSAID with the highest reports of cardiovascular adverse events.
• Hepatic adverse effects: These are less common. Diclofenac has the highest rate of hepatotoxic effects.
• Hematologic adverse effects: Frequently produced when nonselective NSAIDs are taken due to their antiplatelet activity.
• Other minor effects: These include skin rashes and reactions in the pulmonary system.

Interactions of NSAIDs

• Lithium
• Methotrexate
• Hypertensive drugs
• Cyclosporine
• Alcohol

When not to use NSAIDs

• If you have experienced an allergic reaction after taking NSAIDs
• If you have undergone coronary bypass graft surgery
• During pregnancy
• If you have a history of Peptic Ulcer Disease

Corticosteroids

Corticosteroids are steroid hormones and are used as a type of anti-inflammatory medication. This drug mimics the effects of the hormones naturally produced by the adrenal glands. They are used to manage severe inflammation and conditions like asthma, rheumatoid arthritis, and inflammatory bowel disease. They are available in many forms, such as oral tablets, injections, creams, and inhalers.

They can be used in the short term to provide rapid relief and in the long term to aid in chronic treatments. In the last case, it requires careful monitoring due to the potential side effects.

Classification of Corticosteroids

Corticosteroids can be divided into two major groups.

Glucocorticoids

This type of steroid suppresses inflammation and immunity. They also assist in the breakdown of fats, carbohydrates, and proteins.

• Hydrocortisone
• Cortisone
• Betamethasone
• Prednisone
• Prednisolone
• Triamcinolone
• Methylprednisolone
• Dexamethasone

Mineralocorticoid

This type of steroid regulates the body’s balance of salt and water.

• Fludrocortisone

Interactions of Corticosteroids

• Troleandomycin.
• Erythromycin.
• Clarithromycin.
• Ketoconazole.
• Phenobarbital.
• Ephedrine.
• Phenytoin.
• Rifampin.
• Estrogens.
• Warfarin.
• Drugs that reduce potassium in the blood, like diuretics or amphotericin B.
• Anticholinesterase drugs in patients with myasthenia gravis.
• Diabetes medications for their effect in increasing blood glucose.

Side Effects of Corticosteroids

• Gastric adverse effects: Diarrhea, black or tarry stools, nausea, vomiting, heartburn, and abdominal pain or discomfort.
• Musculoskeletal effects: Joint/muscle pain, weakness.
• Reproductive system adverse effects: Irregular or absent menstrual periods.
• Neurological adverse effects: Headaches, dizziness, restlessness, insomnia.
• Psychological adverse effects: Depression and anxiety.
• Cushing syndrome: Weight gain in the trunk, with thin arms and legs, weight gain in the face, fatty lump on the back between the shoulders, pink or purple stretch marks on the abdomen, hips, breasts, and underarms. Thin, frail skin that bruises easily, slow wound healing, and acne.
• Dermatological adverse effects: Increased sweating, folliculitis, increased hair growth, thinning, and skin bruising.
• Cardiovascular adverse effects: Hypertension.

Other Anti-inflammatory Medications

Disease-Modifying Antirheumatic Drugs (DMARDs)

DMARDs are medications used for autoimmune diseases like rheumatoid arthritis and psoriatic arthritis. The DMARDs work as immune system suppressors and inflammation reducers. It helps to reduce pain, swelling, and joint damage. Its long-term use can enhance overall quality of life and improve disease outcomes in patients with these conditions.

Some examples of DMARDs are:

• Methotrexate
• Sulfasalazine
• Hydroxychloroquine
• Leflunomide
• Azathioprine

Biological Response Modifiers

This is a newer class of medications that target specific immune system components involved in inflammation. They are used for conditions like rheumatoid arthritis, psoriasis, and inflammatory bowel disease. This type of medication is administered through injections or intravenous infusions and is effective in reducing disease progression.

Some examples of biological response modifiers are:

• Monoclonal antibodies
• Interferons
• Interleukins
• Tumor necrosis factor
• Colony stimulating factors

Natural Anti-inflammatories

In addition to conventional medication, they are natural substances that possess anti-inflammatory properties and can be used for mild inflammation or as a complement to manage inflammation in chronic disease.

• Omega-3 fatty acids: Found in different foods like fatty fish, flaxseeds, and chia seeds.
• Turmeric: Found in curcumin, commonly used in traditional medicine to alleviate pain and reduce inflammation.
• Ginger: Ginger contains anti-inflammatory properties and has been used for centuries to relieve pain and inflammation.

Which conditions can be treated by anti-inflammatory medications?

Generally speaking, pain, inflammation, and fever can be treated with non-steroidal anti-inflammatory medications. Some of the conditions for which NSAIDs are used include

• Muscle pain,
• Menstrual pain,
• Fever,
• Pain and inflammation caused by injuries,
• Some types of headaches,
• Gout, and
• Conditions that affect the joints, such as arthritis or arthrosis.

Corticosteroids are helpful in the treatment of many conditions in which the immune system is not working correctly, producing excess inflammation and damage. These include the following (this list is not extensive)

• Asthma,
• Allergic reactions,
• COPD,
• Contact dermatitis,
• Adrenal insufficiency,
• Inflammatory bowel disease (Chron’s disease and ulcerative colitis),
• Leukemia,
• Lymphoma,
• Idiopathic thrombocytopenic purpura,
• Rheumatoid arthritis,
• Lupus,
• Polymyalgia rheumatica,
• Uveitis, and
• Cerebral edema, among others.

Conclusions

Anti-inflammatory medications play a crucial role in managing inflammation and alleviating associated symptoms. NSAIDs and corticosteroids are the most commonly used medication that relieves inflammation and suppresses the immune response.

Topical anti-inflammatories and natural substances with anti-inflammatory properties also offer additional relief and are used as a complementary approach.

It is essential to use these types of medication considering specific conditions, individual factors, and the severity of inflammation. There must be awareness of potential side effects and treatment monitoring to ensure safe and effective medication use. Always consult your doctor before using any medication to ensure you get the best results possible.

In addition to anti-inflammatory medication, lifestyle modifications, like a healthy diet, regular exercise, and stress management, can help inflammation management.

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