Frequently Asked Questions About Anti-Inflammatory Medications

Formulations from the group of anti-inflammatories are used for a variety of diseases that are accompanied by inflammation. They reduce the inflammation and usually also render a painkiller effect.

There are multiple conditions for which anti-inflammatory medicines can be prescribed.

The conditions for which nonsteroidal anti-inflammatory drugs (NSAIDs) are used:
– Inflammatory diseases of joints, bones, etc.;
– Gout;
– Dysmenorrhea (painful period);
– Bone metastases;
– Headache and migraine;
– Post-surgery pain syndrome;
– Pain syndrome of weak or moderate severity in inflammatory processes or injury;
– Fever;
– Renal colic.

Steroid anti-inflammatories are used for:
– Allergy;
– Bronchial asthma;
– Bronchospasms associated with different health conditions;
– Joints inflammation;
– Osteochondrosis;
– Sciatica and pinched nerves;
– Colitis;
– Crohn's disease.
Besides, for colitis and other inflammatory intestinal diseases, the formulations from the class of aminosalicylates are used.

The choice of a formulation greatly depends on the nature of the disease. For instance, you cannot use NSAIDs for the therapy of ulcerative colitis or Crohn’s disease because they can only aggravate these diseases. For other diseases listed above, NSAIDs are the first choice medications because they do not influence hormones and cannot change any hormonal imbalances. They can also be used for more extended periods of time than corticosteroid anti-inflammatories. However, if you use NSAIDs, you should remember that it’s still preferable not to use them for long periods of time as they negatively affect the digestive tract and can cause colitis and ulceration.

By the strength of the anti-inflammatory action of medium doses (from maximum to minimum):
– Indomethacin;
– Flurbiprofen;
– Diclofenac sodium;
– Piroxicam;
– Ketoprofen;
– Naproxen;
– Ibuprofen;
– Amidopyrine;
– Aspirin.

By the painkiller effect of medium doses (from maximum to minimum):
– Ketorolac;
– Ketoprofen;
– Diclofenac sodium;
– Indomethacin;
– Flurbiprofen
– Amidopyrine;
– Piroxicam;
– Naproxen;
– Ibuprofen;
– Aspirin.

The main differences between the two groups of medicines in the therapy of diseases are the following:
1. Unlike NSAIDs, steroid medications have not only local but also systemic effects. Their influence is stronger and multifaceted.
2. The range of use of nonsteroidal medicines use is broader; they are used not only in the treatment of inflammatory pathologies (arthritis), but also in pain syndrome associated with osteochondrosis of any localization, menstrual pains, post-surgery pains, and so on.
3. The spectrum of adverse events is much wider in steroid hormonal drugs. This is due to the fact that they have an affinity with endogenous compounds of the body.
4. Contraindications. Steroids affect virtually all systems of the human body. It is not possible to achieve selectivity of action using adrenal hormones. Therefore, many conditions exclude the use of this group of medicines. Selective NSAIDs (COX-2 inhibitors), on the contrary, can only affect the inflammatory site, which greatly expands the therapeutic potential of this group of medicines. On the other hand, steroids have a weaker negative effect on the mucous membrane of the stomach and intestines. This factor is often decisive when choosing medicine.
5. Features of treatment. Usually, the first-line formulations for the treatment of joints inflammation are NSAIDs. If the treatment is chosen correctly, it can be used for a long time. Only in the case of insufficient efficacy, steroid medications are prescribed. They are not used for a long time as it’s always preferable to stick to NSAIDs for long-term therapy. It is important to remember that the cessation of steroids use can be detrimental to the state of the body as a withdrawal syndrome can develop. In the use of NSAIDs, there is no withdrawal syndrome.
6. Forms of release. Steroid and non-steroid medications are produced in the form of ointments, solutions for intramuscular, intravenous, intra-joints administration, gels, suppositories, and tablets for oral administration.
Steroid and nonsteroidal formulations are necessary for the most effective course of treatment for rheumatic diseases. But you cannot use them without prior consulting a specialist. Only strict adherence to the proposed treatment regimen can provide persistent relief from articular manifestations and avoid undesirable effects.

The prohibitions for NSAIDs use are:
– Intolerance of the formulation’s components;
– History of allergic reactions (bronchospasm, skin rash, etc.) in the use of aspirin or any NSAIDs;
– History of liver changes in the use of NSAIDs;
– Simultaneous use with other liver-damaging formulations;
– Alcoholism or drug addiction;
– Active stomach or duodenum ulcer, recurrence of peptic ulcer or digestive tract bleeding in history, or bleeding associated with other diseases, perforation in history;
– Severe bleeding disorder;
– Severe heart failure;
– Severe renal failure;
– Liver failure;
– Suspected acute surgery-requiring pathology;
– A history of cerebrovascular bleeding or other hemorrhages.
– Pregnancy and breastfeeding.

Contraindications for steroidal anti-inflammatory formulations:
– Hypersensitivity to the formulation;
– Severe infections (except tuberculous meningitis and septic shock);
– Chickenpox;
– Immunization with a live vaccine.

The medications can be used but with caution in:
– Diabetes mellitus;
– Hypothyroidism;
– Gastric ulcer and duodenal ulcer;
– Ulcerative colitis;
– Hypertension;
– Liver cirrhosis;
– Cardiovascular failure;
– Increased thrombogenesis (formation of blood clots);
– Tuberculosis;
– Cataracts and glaucoma;
– Mental disorders.

It is not recommended to use NSAIDs throughout pregnancy especially during the last three months of gestation. Although no direct teratogenic effects (negative effects on the fetus) have been identified, it is considered that NSAIDs can induce kidney complications in the fetus. There is also information about preterm labor. Despite this, aspirin in combination with heparin has been used successfully in pregnant women with antiphospholipid syndrome.
According to the latest data from Canadian researchers, the use of NSAIDs at periods up to 20 weeks of pregnancy was related to an increased risk of miscarriage. The outcome of the study shows that the danger of miscarriage rose by 2.4 times regardless of the dose of the medication taken.
Steroid anti-inflammatory formulations during pregnancy can be used only if the potential benefit is greater than the risks.

For instance, they can be appointed in:
1. The threat of premature birth (a short course of hormones improves the readiness of the premature fetus for birth);
2. Rheumatism and autoimmune diseases in the active phase.
3. Hereditary (intrauterine) hyperplasia in the fetus of the cortical layer of the adrenal glands.

NSAIDs can be used in children but usually, special formulations are used, for instance, syrups. Consult a pediatrician to find out what anti-inflammatory medication you can use for your child.
Steroidal anti-inflammatory medications can influence a child’s growth so a very responsible approach is needed.
Only a qualified pediatrician can decide whether your kid needs these medications or not.

The most common adverse effects caused by NSAIDs are:
– Sickness;
– Indigestion;
– Gastric and duodenal ulcer;
– Gastrointestinal bleeding;
– Diarrhea;
– Interstitial nephritis;
– Nephrotic syndrome;
– Acute renal failure;
– Increased liver enzymes;
– Headache;
– Lightheadedness.

Corticosteroids can cause a wide variety of side effects. When using weakly active or moderately active agents, adverse reactions are less pronounced and rarely occur. High doses of the formulations and the use of highly active corticosteroids, as well as their prolonged use, can cause the following negative reactions:
– The appearance of edema due to the retention of sodium and water in the body;
– Increased blood pressure;
– Increased blood sugar levels (possibly even the onset of diabetes);
– Osteoporosis due to enhanced calcium excretion;
– Aseptic bone necrosis;
– Exacerbation or the occurrence of the gastric ulcer;
– Gastrointestinal bleeding; increased thrombosis;
– Weight gain;
– The occurrence of bacterial and fungal infections due to lowered immunity (secondary immunodeficiency);
– Violation of the menstrual cycle; neurological disorders;
– Glaucoma and cataracts; skin atrophy;
– Increased sweating;
– The appearance of acne;
– Suppression of the tissue regeneration process (slow wound healing);
– Excessive growth of facial hair;
– Adrenal suppression;
– Instability of mood, depression.

Long courses of corticosteroids use can lead to a change in the patient's appearance (Cushing syndrome). It is manifested in the excessive deposition of fat in certain parts of the body: on the face (the so-called "moon-shaped face"), on the neck ("bull neck"), chest, on the abdomen; limb muscles atrophied; bruises on the skin and stria (stretch marks) on the abdomen. In this syndrome, there is also growth retardation, impaired formation of sex hormones (menstrual disorders and male type of hair growth in women, and signs of feminization in men). To diminish the risk of adverse reactions, it is important to respond promptly to their occurrence, adjust doses (use small doses whenever possible), control body weight and calorie intake, and limit salt and fluid intake.

We have already pointed out that NSAIDs are not suitable for inflammatory disease of the intestines. Therefore, steroid anti-inflammatories and aminosalicylates are used. The most frequently used medications for inflammatory diseases of the bowel are aminosalicylates. For instance, you can opt for Asacol (Mesalamine) by Sun Pharma or Azulfidine (Sulfasalazine) by IPCA. These are modern anti-inflammatories with maximum effect and minimum adverse reactions that can be used by people of all ages. However, if you want to get it without having a prescription from your physician, we advise you to discuss their use with your health provider first.