Anti Inflammatory Medications
Inflammation is the primary defensive response of the body against a pathogen when it seeks to search and destroy it. It is mediated through the vascular system and is characterized by five specific signs: heat, redness, swelling, pain and loss of function.
Inflammation is a protective response, however it may need to be moderated in order for efficient healing to occur. Inflammation may need to be moderated:
If triggered against the body’s own tissues (as in autoimmune diseases)
At specific sites; severe swelling in the throat may cause choking
When it becomes chronic
To prevent associated pain, fever and swelling
Anti-inflammatory drugs:
There are two main types of anti-inflammatory drugs:
1. Non Steroidal Anti-Inflammatory Drugs (NSAIDs)
2. Anti-Inflammatory Steroids (Corticosteroids)
NSAIDs:
Examples: Aspirin, Diclofenac, Naproxen, Ibuprofen
Prostaglandins are the inflammatory mediators that are involved in the onset of pain and fever. These drugs inhibit the action of cycloxygenase enzyme (COX), which synthesizes prostaglandins, thereby reducing pain and inflammation.
The main side effect of NSAIDs is damage to the stomach mucosa. Along with the fact that many NSAIDs are acidic in nature, these drugs inhibit both types of COX enzymes, thus also preventing the formation of those prostaglandins that protect the gastrointestinal mucosa and thromboxane that help in blood clotting. The result is damage to the gastric mucosa, ulceration and bleeding.
To overcome this, a new class of NSAIDs has been introduced recently, called Selective COX Inhibitors or COX 2 Inhibitors; examples include Celecoxib and Etoricoxib. These inhibit only the COX 2 enzyme, thus preventing inflammation without damaging the gastric mucosa. However, these drugs have an increased risk of causing heart attack and stroke. Due to selective inhibition of prostaglandins, the amount of thromboxane increases, increasing the risk of blood clot formation.
Paracetamol (acetaminophen) is not an NSAID (a common misconception). It has a different mechanism of action and only reduces pain, but not inflammation.
Steroids:
Examples: Betamethasone, Budesonide, Dexamethasone, Fluticasone, Prednisone
Steroids, specifically glucocorticoids, are very potent anti-inflammatory agents. Steroids prevent the anti-inflammatory actions of white blood cells and also inhibit the formation of prostaglandins by blocking the action of COX enzymes in a similar way to NSAIDs.
Their main drawback is immunosuppression, which increases the risk of acquiring a new infection and/or aggravating a pre-existing infection.
Immune Selective Anti-Inflammatory Derivatives:
Recently introduced imSAIDs act by preventing the release of chemicals from white blood cells that start the inflammatory process. These drugs act differently than both steroidal and non-steroidal anti-inflammatories and do not suppress the immune system.
Herbs
Many herbs also contain anti-inflammatory properties such as ginger, turmeric, hyssop, arnica montana, which contain helenalin, a potent anti-inflammatory agent, while willow bark contains salicylic acid (aspirin).
