Anti-inflammatory

{{main|Nonsteroidal anti-inflammatory drug}}

Nonsteroidal anti-inflammatory drugs (NSAIDs) alleviate pain by counteracting the cyclooxygenase (COX) enzyme.{{cite journal|vauthors = Knights KM, Mangoni AA, Miners JO|title = Defining the COX inhibitor selectivity of NSAIDs: implications for understanding toxicity|journal = Expert Rev Clin Pharmacol|volume = 3|issue = 6|pages = 769–76|date = November 2010|pmid = 22111779|doi = 10.1586/ecp.10.120|s2cid = 207209534}} On its own, COX enzyme synthesizes prostaglandins, creating inflammation. In whole, the NSAIDs prevent the prostaglandins from ever being synthesized, reducing or eliminating the inflammation and resulting pain.{{cn|date=January 2024}}

Some common examples of NSAIDs are aspirin, ibuprofen, and naproxen. The newer specific COX-inhibitors are not classified together with the traditional NSAIDs, even though they presumably share the same mode of action.

On the other hand, there are analgesics that are commonly associated with anti-inflammatory drugs but that have no anti-inflammatory effects. An example is paracetamol (known as acetaminophen in the U.S). Contrary to NSAIDs, which reduce pain and inflammation by inhibiting COX enzymes, paracetamol has—as early as 2006—been shown to block the reuptake of endocannabinoids,{{cite journal|last=Ottani|first=Alessandra|author2=Leone, Sheila|author3= Sandrini, Maurizio|author4= Ferrari, Anna|author5= Bertolini, Alfio|title=The analgesic activity of paracetamol is prevented by the blockade of cannabinoid CB1 receptors|journal=European Journal of Pharmacology|date=February 15, 2006|volume=531|pages=280–281|doi=10.1016/j.ejphar.2005.12.015|pmid=16438952|issue=1–3|hdl=11380/613413}}{{cite journal|last=Dani|first=Mélina|author2=Guindon, Josée|author3= Lambert, Chantal|author4= Beaulieu, Pierre|title=The local antinociceptive effects of paracetamol in neuropathic pain are mediated by cannabinoid receptors|journal=European Journal of Pharmacology|date=November 14, 2007|volume=573|pages=214–215|doi=10.1016/j.ejphar.2007.07.012|pmid=17651722|issue=1–3}} which only reduces pain, likely explaining why it has minimal effect on inflammation; paracetamol is sometimes combined with an NSAID (in place of an opioid) in clinical practice to enhance the pain relief of the NSAID, while still receiving the injury/disease modulating effect of NSAID-induced inflammation reduction (which is not received from opioid/paracetamol combinations).{{cite journal|vauthors = Merry AF, Gibbs RD, Edwards J, Ting GS, Frampton C, Davies E, Anderson BJ|title = Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial|journal = British Journal of Anaesthesia|volume = 104|issue = 1|pages = 80–8|date = January 2010|pmid = 20007794|pmc = 2791549|doi = 10.1093/bja/aep338}}

Long-term use of NSAIDs can cause gastric erosions, which can become stomach ulcers and in extreme cases can cause severe haemorrhage, resulting in death. The risk of death as a result of GI bleeding caused by the use of NSAIDs is 1 in 12,000 for adults aged 16–45.{{cite web|title=Table 7|url=http://www.medicine.ox.ac.uk/bandolier/booth/painpag/nsae/nsae.html#Heading20|work=NSAIDs and adverse effects|publisher=Bandolier|access-date=December 20, 2012|archive-url=https://web.archive.org/web/20120218152243/http://www.medicine.ox.ac.uk/bandolier/booth/painpag/nsae/nsae.html#Heading20|archive-date=February 18, 2012|url-status=dead}} The risk increases almost twentyfold for those over 75. Other dangers of NSAIDs are exacerbating asthma and causing kidney damage. Apart from aspirin, prescription and over-the-counter NSAIDs also increase the risk of heart attack and stroke.{{cite journal|doi=10.1136/bmj.c7086|last=Trelle|first=Sven|author2=Reichenbach, Stephan|author3=Wandel, Simon|author4=Hildebrand, Pius|author5=Tschannen, Beatrice|author6=Villiger, Peter M.|author7=Egger, Matthias|author8= Jüni, Peter|title=Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis|journal=British Medical Journal (Clinical Research Ed.)|date=11 January 2011|volume=342|pages=c7086|pmid=21224324|pmc=3019238}}

Corticosteroids, specifically glucocorticoids or glucocorticoid receptor agonists, are powerful anti-inflammatory agents, but they are also powerful immunosuppressants and are associated with various toxicities, which constrains their use.{{cite journal | vauthors = Ingawale DK, Mandlik SK | title = New insights into the novel anti-inflammatory mode of action of glucocorticoids | journal = Immunopharmacol Immunotoxicol | volume = 42 | issue = 2 | pages = 59–73 | date = April 2020 | pmid = 32070175 | doi = 10.1080/08923973.2020.1728765 | url = }}{{cite journal | vauthors = Escoter-Torres L, Caratti G, Mechtidou A, Tuckermann J, Uhlenhaut NH, Vettorazzi S | title = Fighting the Fire: Mechanisms of Inflammatory Gene Regulation by the Glucocorticoid Receptor | journal = Front Immunol | volume = 10 | issue = | pages = 1859 | date = 2019 | pmid = 31440248 | pmc = 6693390 | doi = 10.3389/fimmu.2019.01859 | doi-access = free | url = }}

{{Main|Antileukotriene}}

Antileukotrienes are anti-inflammatory agents which function as leukotriene-related enzyme inhibitors (arachidonate 5-lipoxygenase) or leukotriene receptor antagonists (cysteinyl leukotriene receptors), and consequently oppose the function of these inflammatory mediators. Although they are not used for analgesic benefits, they are widely utilized in the treatment of diseases related to inflammation of the lungs, such as asthma and COPD, as well as sinus inflammation in allergic rhinitis.{{cite journal|vauthors = Dvorak J, Feddermann N, Grimm K|title = Glucocorticosteroids in football: use and misuse|journal = British Journal of Sports Medicine|volume = 40|pages = i48–54|date = July 2006| issue=Suppl 1 |pmid = 16799104|pmc = 2657490|doi = 10.1136/bjsm.2006.027599}}{{cite journal|vauthors=Scott JP, Peters-Golden M|title = Antileukotriene agents for the treatment of lung disease|journal = Am. J. Respir. Crit. Care Med.|volume = 188|issue = 5|pages = 538–544|date = September 2013|pmid = 23822826|doi = 10.1164/rccm.201301-0023PP}}

{{Reflist}}

{{Major Drug Groups}}

{{Anti-inflammatory products}}

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{{DEFAULTSORT:Anti-Inflammatory}}

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