Anti-inflammatory drugs – types, action, indications and side effects

Proven content

Anti-inflammatory drugs can be found in every household and in every first aid kit. Immediately after antibiotics, they are the most commonly used preparations. Their popularity is due to the universality and availability of many of them without the need for a prescription, which is issued by a doctor. They are used to relieve pain, fever and inflammation, bringing quick relief. What types of anti-inflammatory drugs are there? How do anti-inflammatory drugs work? What are the side effects of taking these drugs? When to use anti-inflammatory drugs and in what situations are they contraindicated?

What are anti-inflammatory drugs?

Anti-inflammatory drugs are one of the most popular medications in the world and are found in every household. The anti-inflammatory drug is most often used in the event of inflammation accompanied by pain or fever, and its popularity is due to its general availability and a wide spectrum of activity.

Most anti-inflammatory drugs are available over the counter and you can buy them not only at a pharmacy, but also at a grocery store, drugstore or petrol station. According to estimates, about 30 million people worldwide use anti-inflammatory drugs every day, and the income from their sale reaches about 14 trillion annually.

Among the most commonly used anti-inflammatory drugs there are drugs in which the main composition is paracetamol, although it does not have an anti-inflammatory effect. Research shows that almost 63% of patients are taking medications that contain this substance. Less popular, because taken by about 31% of patients, are anti-inflammatory drugs that contain ibuprofen, naproxen and indomethacin, while only 9% of people use salicylic acid when inflammation occurs.

Anti-inflammatory drugs also owe their popularity to the World Health Organization (WHO), which considers them the basic preparation recommended for the treatment of mild and moderate pain of various origins. The vast majority of anti-inflammatory drugs are classified as non-steroidal anti-inflammatory drugs. They constitute a wide group of drugs, among which the most commonly used and popular ones can be mentioned, they are, among others, acetylsalicylic acid, ibuprofen, naproxen, ketoprofen and diclofenac. Although these drugs are derived from several different chemicals, they all work in the same way.

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Can back pain be dealt with without medication? Check: How To Overcome Back Pain Without Medication?

Classification of anti-inflammatory drugs – chemical structure

There are many available on the market types of anti-inflammatory drugs differing in chemical structure, potency and heterogeneous application. However, there are also three important characteristics that are common to all anti-inflammatory drugs. Among them, we distinguish identical pharmacological properties, a twin basic mechanism of action and similar side effects.

Anti-inflammatory drugs can be classified according to their chemical structure. The first group of anti-inflammatory drugs are salicylates, the active substances of which are acetylsalicylic acid and salicylamide. Examples of preparations in this group are: Acard, Aspirin, Polopyrine, Cholinex, Sachol, Scorbolamid or Lecard, showing analgesic and antipyretic properties.

Another group of anti-inflammatory drugs are phenylpropionic acid derivatives, the active substances of which are ibuprofen, naproxen, fenbufen, fenoprofen, ketoprofen. Among the preparations available for sale in this group, we can distinguish, among others: Ibum, Ibuprofen, Nurofen, Ketonal, Fastum, Kidofer or Ultrafastin, characterized by analgesic and anti-inflammatory effects.

Another distinguished group of anti-inflammatory drugs are indole acetic acid derivatives, in which the active substances are: indomethacin, acematacin, tolmetin. Drugs belonging to this group are Metindol and Indocollyre that have analgesic, antipyretic and anti-inflammatory properties.

Another group includes derivatives of phenylacetic acid with the active substances aceclofenac, diclofenac and fenclofenac. Drugs in this group include: Diclac, Akis, Majamil, Dicloziaja, Itami, Biofenac, characterized by analgesic, anti-inflammatory and antipyretic properties.

The group of anti-inflammatory drugs derived from fenamic acid, the active substances of which are mefenamic acid and meclofenamic acid, are characterized by analgesic, antipyretic and anti-inflammatory properties. One of the most commonly used preparations from this group is Mefacit.

The last group distinguished among anti-inflammatory drugs due to their chemical structure are drugs derived from enolic acids, the active substances of which are: oxicams (piroxicam, isoxicam, tenoxicam) and pyrazolidinediones (phenylbutazone, oxyphenbutazone). The main preparations in this group include: Piroxicam, Jelfa, Celomix, Aglan, Butapirazole with anti-inflammatory, analgesic and antipyretic properties.

If you want to know the best ways to fight a fever, check out: How to beat a fever? Here are some home remedies

Classification of anti-inflammatory drugs – strength and duration of action

Another used division that is useful from a practical point of view is classification of anti-inflammatory drugs according to the strength and duration of their action. The classification is based on five groups:

1.  “Weak” anti-inflammatory drugswhich include ibuprofen and acetylsalicylic acid, among others. They are characterized by a short half-life and their primary indication is the occurrence of acute inflammatory pain of moderate intensity, including chronic rheumatoid arthritis.
2.  “Moderate” anti-inflammatory drugs such as naproxen are used for moderate to severe pain intensity as they are moderate in potency with an intermediate half-life. They are most often used for menstrual pain or migraine.
3. “Strong” anti-inflammatory drugs with a short half-life, among which are diclofenac, indomethacin, ketoprofen and lornoxicam. Preparations from this group, especially diclofenac, which has the lowest effect on the occurrence of adverse effects in the gastrointestinal tract, are used as the basic drug in pains caused by rheumatoid arthritis and in osteoarthritis. Due to the high effectiveness of anti-inflammatory drugs from this group, the risk of side effects increases, mainly in the upper gastrointestinal tract and kidneys.
4.  “Strong” anti-inflammatory drugs with a long half-lifewhich are mainly all oxicans. Preparations from this group are used in chronic inflammatory pain and cancer-related pain. Medicines from this group are not recommended for the elderly as they may cause side effects.
5.  “Selective / selective inhibitors of ”COX-2which are characterized by a strong anti-inflammatory and analgesic effect with a low risk of damage to the upper gastrointestinal tract. They are used in clinical treatment and include parecoxib administered by the intravenous route, valdecoxib and celecoxib.

There are many types of anti-inflammatory drugs on the market with different strengths and duration of action. The most popular anti-inflammatory drugs are ibuprofen, acetylsalicylic acid, ketoprofen, metamizole sodium, and naproxen. Thanks to the classification and knowledge of their properties, the average person who does not know what drug to choose in the event of pain can prevent the occurrence of undesirable effects and use these drugs safely and without harming their own health.

Can drugs be replaced with herbs? Check: Herbal medicine – for whom and how to do it?

Characteristics of popular anti-inflammatory drugs – acetylsalicylic acid

One of the most popular anti-inflammatory drugs is acetylsalicylic acid, commonly known as Aspirin or Polopyrin. This preparation is available over the counter and is mainly used as an anti-inflammatory, analgesic and fever-reducing agent. This drug in low doses also has an anticoagulant effect, inhibiting the aggregation of platelets and can also be used in the prevention of cardiovascular diseases.

Like most anti-inflammatory drugs, acetylsalicylic acid inhibits the activity of cyclooxygenase, which is a messenger that stimulates pain receptors and the formation of prostacyclins. This reduces the symptoms of inflammation, fever and pain.

Acetylsalicylic acid works quite quickly, because you can notice an improvement in your health within 30 minutes of taking it. This drug is available in pharmacies in the form of tablets, granules for dissolving, gastro-resistant tablets and effervescent tablets. Acetylsalicylic acid is recommended by the World Health Organization and has been used for over 100 years.

However, like other anti-inflammatory drugs, acetylsalicylic acid can damage the gastric mucosa, so it is contraindicated in people with gastric and duodenal ulcers. This medicine should also not be used in children and adolescents under 12 years of age, as it can lead to Reye’s syndrome, which can cause fatal damage to the brain and liver.

Do you know which drugs should never be mixed with each other? Read: Dangerous interactions

Characteristics of popular anti-inflammatory drugs – ibuprofen

Another commonly known and used anti-inflammatory drug is ibuprofen. It is an organic chemical compound derived from propionic acid. As with acetylsalicylic acid, ibuprofen inhibits prostaglandin synthesis.

Ibuprofen is a powerful anti-inflammatory and analgesic drug, but it slightly reduces fever. Its effect begins to be visible within 60 minutes of taking it and is less burdensome than acetylsalicylic acid, therefore it can be used in children under 12 years of age.

Ibuprofen, as an anti-inflammatory drug, is perfect for colds and flu and related complications. It can also be used for headaches, sinus, muscle and joint pain, menstrual pain, toothache, muscle pain, back pain, post-traumatic pain and neuralgia.

Due to its popularity, it is available in many forms, such as traditional capsules or tablets, but also in the form of suppositories, suspensions, ointments and even patches.

Only people with renal or hepatic insufficiency should be cautious in the use of ibuprofen, as there is a risk of gastric and duodenal ulcers. Despite this, ibuprofen is the best-tolerated anti-inflammatory drug by the body and is therefore recommended by the World Health Organization and the European Anti-Rheumatic Union.

Do you have doubts whether it is the flu or a cold? Read: Flu or cold? Find out which one caught you

Characteristics of popular anti-inflammatory drugs – naproxen and dicoflenac

One of the most powerful anti-inflammatory drugs is naproxen. This drug is used to combat not only low and medium intensity pain, but also reduces fever and brings great results in the treatment of inflammation.

Naproxen is recommended for people with degenerative joint diseases, as well as in rheumatic diseases. This substance has a long-lasting effect, so it is enough to take it twice a day.

It is not recommended to administer this anti-inflammatory drug to people with gastric ulcer, duodenal ulcer, people with blood coagulation disorders and people allergic to piroxene.

The last powerful anti-inflammatory drug is diclofenac, a derivative of aminophenylacetic acid. This substance is an active ingredient in many anti-inflammatory and analgesic agents for external use. They are most often recommended for people suffering from stiffening arthritis of the spine, patients with degeneration of the spine, and in the case of rheumatoid arthritis and with overload of tendons, ligaments or muscles.

What does muscle pain indicate and how to deal with it? Check: Muscle pain

The mechanism of action of anti-inflammatory drugs

The mechanism of action of anti-inflammatory drugs is related to the inhibition of the activity of cyclooxygenase (COX) enzymes. These enzymes are involved in the synthesis of prostoglandin, which is a neurotransmitter that stimulates pain receptors and contributes to the typical symptoms of inflammation, i.e. fever and swelling.

There are two types of this enzyme, ie COX-1 (constitutive cyclooxygenase) and COX-2 (induced cyclooxygenase). The first of the COX-1 enzymes synthesizes prostaglandins that perform physiological functions. This enzyme, in addition to its positive effect on the functioning of the digestive system, is also responsible for stimulating pain receptors. On the other hand, the second COX-2 enzyme is responsible for the synthesis of inflammatory prostagglans at the site of inflammation.

The mechanism of action of anti-inflammatory drugs is to inhibit COX-1 and COX- 2. Drugs that inhibit COX-1 may cause side effects such as disturbances in blood flow, damage to the gastric mucosa, deregulation of thrombocyte function. In contrast, by blocking the second type of COX-2 enzyme by anti-inflammatory drugs, it reduces pain, lowers fever, and inhibits inflammation in the body.

Classic anti-inflammatory drugs, which are widely available for sale, block the activity of COX-1 and COX-2 in a similar way. preventively and equally inhibiting. The second group includes second-generation anti-inflammatory drugs that mainly inhibit COX-1 and to a small extent the COX-2 enzyme, and third-generation inflammatory drugs that inhibit only COX-1.

What should you know about the effects of painkillers? Check: Self-healing traps – what’s the difference between painkillers?

Indications for the use of anti-inflammatory drugs

As the name suggests, anti-inflammatory drugs are mainly used when inflammation occurs in the body. Anti-inflammatory drugs are characterized by a wide spectrum of action and the basic indication for their use may be:

• headache, migraine headaches;

• toothache, pain after tooth extraction;

• muscle aches;

• menstrual cramps;

• bone and joint pain;

• joint degeneration (ibuprofen, nabumetone, diclofenac coxby are used);

• rheumatoid arthritis;

• acute gout;

• rheumatic fever;

• thrombotic and stroke prophylaxis;

• myocardial infarction;

• increased body temperature;

• inflammation in the oropharynx;

• nervousness;

• cancer pain associated with bone metastases.

In addition to acting on pain and diseases of various origins and severity, anti-inflammatory drugs are also used to relieve chronic pain.

What drugs should not be used to treat chronic pain? Read: Paracetamol, ibuprofen, and aspirin are not suitable for the treatment of chronic pain. They can do “more harm than good”

Contraindications to the use of anti-inflammatory drugs

Despite the fact that anti-inflammatory drugs are very popular preparations and generally available to everyone, there are contraindications to their use. There are cases where a physician should decide on the use and dosage of this medication. The main contraindications for the use of anti-inflammatory drugs are:

• allergy – hypersensitivity to any of the ingredients of the drug;

• gastric or duodenal ulcer;

• severe renal, heart and liver failure;

• people who have undergone surgery;

• dehydrated people;

• children under 12 years of age.

In addition, people with a coagulation disorder, people with hemorrhagic diathesis, people suffering from lupus erythematosus, pregnant women (especially in the first and third trimesters) and breastfeeding women, and people taking other drugs should exercise particular caution in the use of anti-inflammatory drugs.

If you want to know the history of pain medications, read on: From Opium to Ibuprofen – The History of Painkillers

The method of using anti-inflammatory drugs

The first medication we use when we experience inflammation, which may be accompanied by elevated temperature or pain, is anti-inflammatory drugs. These are the most widespread and widely available preparations, most often used due to their wide spectrum of activity. Although you can get them not only at a pharmacy, but also at a store or petrol station, and many of them are available without a prescription, their improper use can have many undesirable effects.

Therefore, it is worth consulting a doctor before buying an anti-inflammatory drug, and if this is not possible, ask a pharmacist for advice or read the package leaflet carefully.

The general principles of using anti-inflammatory drugs are similar. An important thing to keep in mind after taking these medications is to drink a dose of the preparation with plenty of water. Do not use them more often than every 4-6 hours. They should be taken with a meal, never on an empty stomach, thanks to which we will reduce the risk of irritation of the gastric mucosa.

If there are contraindications or concerns about taking an anti-inflammatory drug, consult a doctor who, after a medical history, will recommend the safest drug in a given situation.

An important issue when using an anti-inflammatory drug is the fact that these drugs have so-called ceiling effect, which means that after exceeding a given dose of the drug, it does not increase its anti-inflammatory or analgesic effectiveness, but carries the risk of side effects. Thus, a given anti-inflammatory drug cannot be used concurrently with another drug belonging to this group.

In the case of severe pain, anti-inflammatory drugs can be combined with paracetamol, metamizole or opioids. It is very important not to give anti-inflammatory drugs to children under the age of 12, any deviation from this rule must be consulted with a primary care physician. In case of high temperature, it makes best sense to give the child ibuprofen, which according to the WHO is the drug best tolerated by the body.

What is worth knowing about taking your medications effectively? Check: How to take medications effectively?

Side effects from the use of anti-inflammatory drugs

Misuse or abuse of anti-inflammatory drugs can have many side effects. Also, when taking the recommended doses for diagnostic purposes, anti-inflammatory drugs can have an undesirable effect, i.e. any unintended and unfavorable to our health, or even life-threatening.

The list of side effects and complications from anti-inflammatory drugs is very diverse. The most common complications are related to the digestive system, liver and cardiovascular system, but may also affect the respiratory and nervous systems.

Pharmaco-epidemiological data show that 30% of patients taking anti-inflammatory drugs experience gastrointestinal side effects. Acids contained in anti-inflammatory drugs, although in low concentrations, can damage the gastric mucosa. Inhibition of the production of prostaglandins that protect the digestive system and impaired blood flow to the mucosa cause erosions and ulcerations in the gastric and duodenal mucosa.

Anti-inflammatory drugs, mainly those that inhibit COX-1 activity (e.g. ketoprofen, indomethacin, cementation agent, acetylsalicylic acid and pirocicam), can cause lower GI bleeding, posing a health and life hazard.

Another digestive organ that can suffer from anti-inflammatory drugs is the liver. In the case of high levels of anti-inflammatory drugs in the liver and bile ducts, e.g. after taking nimezulide for a long time, damage to hepatocytes may occur, mainly by inducing apoptosis of hepatic cells and inducing oxidative stress.

Further side effects from the use of anti-inflammatory drugs may affect the blood system. The use of anti-inflammatory drugs increases the risk of cardiovascular diseases, thromboembolic complications and congestive heart failure. People diagnosed with hypertension should be especially careful, as taking drugs from this group may lead to a heart attack or stroke.

With the use of all anti-inflammatory drugs, hematological complications may occur, the risk of bleeding increases and the problem with blood blockage increases, as they reduce blood clotting. The use of anti-inflammatory drugs may increase the risk of renal impairment in elderly patients with renal insufficiency due to hypovolaemia, pharmacotherapy or in elderly patients with renal insufficiency. Additionally, the use of anti-inflammatory drugs can cause dizziness, tinnitus, mood changes, nausea and diarrhea.

What is worth knowing about the side effects of the medications used? Read: Adverse drug reactions

Influence of anti-inflammatory drugs on pregnancy

Studies show that 92,6% of pregnant women take over-the-counter anti-inflammatory drugs, usually to relieve headache or back pain. Before we reach for an anti-inflammatory drug, it is worth knowing what side effects they may have not only for pregnant women, but also for those who are planning pregnancy. The effects of anti-inflammatory drugs that may make pregnancy difficult are:

• decreased fertility;

• ovulation disorders;

• increased risk of miscarriage;

• inhibition of the maturation of the egg, which may cause temporary infertility.

Women in the first trimester of pregnancy should avoid taking any anti-inflammatory drugs as they may increase the risk of miscarriage, especially between the 3rd and 8th week of pregnancy.

However, in the third trimester of pregnancy, drugs from this group may increase the risk of malformations, increase the risk of cardiovascular disorders, increase the child’s pulmonary pressure and decrease kidney function.

Relatively safe anti-inflammatory drug that can be administered in case of absolute necessity in the second trimester of pregnancy is ibuprofen or diclofenac. However, it should be remembered that all anti-inflammatory drugs cross the placenta-blood barrier and can pass into breast milk and may disrupt the functioning of the developed organs or affect the proper development of the fetus.

Apart from medications, dietary supplements or herbal teas are also anti-inflammatory, such as Lime Mint Bio Yogi Tea – lime tea with mint or Positive Energy Bio Yogi Tea – black tea for better well-being, which at the same time adds energy and strengthens.

Can the painkiller Apap be used during pregnancy? Check: Apap in pregnancy – is it safe to use?

Before use, read the leaflet, which contains indications, contraindications, data on side effects and dosage as well as information on the use of the medicinal product, or consult your doctor or pharmacist, as each drug used improperly is a threat to your life or health. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home. Now you can use e-consultation also free of charge under the National Health Fund.