How Do Anti-Inflammatory Agents Work?

Anti-inflammatory agents are glucocorticoid medications used to control inflammation in many inflammatory diseases. Anti-inflammatory agents modulate the metabolism of carbohydrates, proteins, and fats and maintenance of fluid and electrolyte homeostasis (stable condition).

Anti-inflammatory agents work in multiple ways to prevent inflammation which include the following:

• Control the rate of protein synthesis.
• Prevent migration of polymorphonuclear leukocytes (PMN), types of white cells such as neutrophils, eosinophils, and basophils that release inflammatory substances and promote inflammation.
• Break up the aggregation of PMN.
• Prevent migration of fibroblasts, cells that form an extracellular matrix, the supportive structure that cells attach to, to form tissue.
• Reduce capillary permeability to prevent leakage of inflammatory cells and proteins (cytokines) from reaching the inflammation site.
• Inhibit the release of pro-inflammatory substances such as prostaglandin and cytokines.
• Suppress proliferation of lymphocytes.
• Inhibit mitosis, the process of cell division.
• Stabilize the membranes of cells, and lysosomes, the organelles inside cells that contain digestive enzymes.
• Increase the synthesis of surfactant, a natural substance in the lungs that lowers surface tension in the liquid/air interface in the air sacs (alveoli) and prevents them from collapsing.
• Improve pulmonary microcirculation.

Anti-inflammatory agents may be administered through the following routes:

• Oral tablets or concentrates
• Injections:
  • Intravenous (IV) into a vein
  • Intramuscular (IM) into the muscle
  • Intraarticular into a joint
  • Intralesional (into a lesion in the tissue)

The uses of anti-inflammatory agents include the following:

Adults

FDA-approved:

• Inflammation from any cause
• Acute exacerbations of multiple sclerosis
• Cerebral edema
• Shock
• Allergic conditions that include:
  • Asthma
  • Atopic dermatitis
  • Contact dermatitis
  • Drug hypersensitivity reactions
  • Perennial or seasonal allergic rhinitis
  • Serum sickness
• Multiple myeloma
• Dexamethasone suppression test

Off-label uses:

• COVID-19 disease
• Chemotherapy-induced nausea and vomiting
• Altitude sickness
• Spinal cord compression and injury
• Pneumocystis (carinii) jiroveci pneumonia (a fungal infection in AIDS patients)
• Severe lupus nephritis

Pediatric uses

FDA-approved:

• Airway edema
• Croup (upper airway infection)
• Inflammation
• Meningitis
• Cerebral edema associated with a brain tumor
• Spinal cord compression
• Adrenal cortical hyperfunction test
• Status asthmaticus (respiratory failure caused by acute severe asthma)

Off-label uses:

• Respiratory distress syndrome in premature infants
• Pneumocystis (carinii) jiroveci pneumonia (a fungal infection in AIDS patients)
• Severe lupus nephritis

Side effects of anti-inflammatory agents may include the following:

• Adrenal suppression
• Decreased carbohydrate and glucose tolerance
• Development of cushingoid state (Cushing syndrome features such as facial roundness and fat accumulation in the midsection and upper back)
• Growth suppression (children)
• Hyperglycemia (high blood glucose levels)
• Glycosuria (high glucose levels in urine)
• Diabetes mellitus
• Increase in medication requirement for diabetes mellitus
• Menstrual irregularities
• Amenorrhea (absence of menstruation)
• Hirsutism (male pattern hair growth in women)
• Hypertrichosis (abnormal, excessive hair growth anywhere in the body)
• Changes in motility and number of spermatozoa
• Delirium
• Emotional instability
• Psychosis
• Hallucinations
• Insomnia
• Depression
• Euphoria
• Mood swings
• Personality changes
• Psychic disorders
• Headache
• Malaise
• Vertigo
• Neuritis (inflammation of nerves)
• Neuropathy (damage to nerves)
• Paresthesia (abnormal skin sensations)
• Convulsions
• Seizure
• Pseudotumor cerebri (on withdrawal), a condition with an increase in intracranial pressure
• Hiccups
• Abdominal distention
• Nausea
• Increased appetite
• Weight gain
• Gastrointestinal (GI) perforation
• Ulcerative esophagitis (inflammation of the esophagus)
• Pancreatitis (inflammation of the pancreas)
• Peptic ulcer with possible perforation and hemorrhage
• Perianal pruritus (itching in the anal region)
• Hepatomegaly (liver enlargement)
• Hepatitis (liver inflammation)
• Increased transaminases (liver enzymes AST and ALT)
• Leukocytosis (increase in leukocytes in blood)
• Myopathy (muscle disease)
• Loss of muscle mass
• Muscle weakness
• Tendon rupture
• Osteoporosis (bone loss)
• Aseptic necrosis (tissue death) of femoral and humeral heads
• Long bone fractures
• Vertebral compression fractures
• Pituitary adrenal axis suppression, which impairs stress response and immune defense against infection
• Protein catabolism (breakdown)
• Fluid retention
• Edema
• Sodium and water retention
• Potassium loss
• Hypokalemic alkalosis (high alkalinity caused by low potassium in the blood)
• Tumor lysis syndrome (metabolic disturbance caused by the death of tumor cells and release of their contents into the bloodstream)
• Tachycardia (rapid heartbeat)
• Bradycardia (slow heartbeat)
• Cardiac arrhythmias (irregular heart rhythms)
• Cardiac arrest
• Cardiac enlargement
• Congestive heart failure
• Circulatory collapse
• Fat embolism (blood vessel block by fat globules)
• Hypertension (high blood pressure)
• Hypertrophic cardiomyopathy (abnormal thickening of heart muscles) in premature infants
• Myocardial infarction (heart attack) and rupture
• Pulmonary edema
• Syncope (fainting)
• Thromboembolism (blood vessel block by a blood clot)
• Thrombophlebitis (inflammation and block by a blood clot in the vein, often in the legs)
• Vasculitis (inflammation of blood vessel)
• Increased sweating
• Rash
• Acne
• Urticaria (hives)
• Allergic dermatitis
• Dry scaly skin
• Ecchymosis and petechiae (skin bruising and discoloration)
• Erythema (redness of the skin)
• Striae (stretch marks)
• Delayed/impaired wound healing
• Suppression of reactions to skin tests
• Thin, fragile skin
• Thinning scalp hair
• Angioedema (swelling in the tissue under the skin or mucous membranes)
• Anaphylaxis (serious allergic reaction)
• Anaphylactoid (anaphylaxis-like) reactions
• Blurred vision
• Exophthalmos (bulging eyeballs)
• Increase in intraocular pressure
• Glaucoma (a condition that damages optic nerves)
• Posterior subcapsular cataracts

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of anti-inflammatory agents include:

• DepoMedrol
• dexamethasone
• Dexamethasone Intensol
• Hemady
• Medrol
• Medrol Dosepak
• methylprednisolone
• SoluMedrol