While there are many forms of anti-inflammatories (steroids, herbs,
certain foods, etc.), the most common type are NSAIDs, Non-Steroidal
Anti-Inflammatory Drugs. Their main purpose is to not only reduce inflammation
but to also decrease fevers and pain.
The type most people have heard of and taken are the form you can buy
over the counter. Aspirin, ibuprofen (such as Advil or Motrin), and naproxen
(Aleve) are all familiar household names. They block or inhibit enzymes and
proteins in the body, specifically prostaglandins (PGs). PGs promote inflammation, pain, and blood
clotting, which are good for the body but can cause us ache after injury. Thus NSAIDs
are also used to treat pain in disorders such as rheumatoid arthritis or kidney
stones. For such disorders or for post-operational patients, doctors generally prescribe
such drugs or variants (depending on the disease or recent surgery) in much
high quantities.
Aspirin is an unusual NSAID. While most NSAIDs can increase your chance
of cardiovascular disease, an aspirin a day has been shown to reduce risk of
CVD. In addition, aspirin is a cox-1 inhibitor, while most NSAIDs partially
inhibit both cox-1 and cox-2.
Cox-2 is the cox isoform that deals with inflammation, directly being
affected by such cytokines as TNF and IL-1. Cox-1 is the isoform found on
almost every type of cell in the body and involved in homeostasis of things
such as GI tract, kidneys, and blood content. It is also the isoform that
promotes PG proliferation. Ibuprofen and naproxen are nonselective, meaning
that they partially inhibit both isoforms, meaning that they promote a decrease
of PG as well as stopping the body’s overall message to become inflamed. At
minor over-the-counter doses, cox-1 is not affected much and swelling decreases.
Overdoses of such medications result due to inhibition of natural homeostasis.
Gastrointestinal complications, ranging from indigestion to stomach ulcers, are
3 times higher in frequent NSAID users. Renal complications are also common
side effects.
Because of these side effects, research has gone into creating an inhibitor
of cox-2 only. While many versions are on the market and a couple of them are
FDA approved (Celecoxib, aka Celebrex or Celebra), most are either still in
trial phases or have been pulled from the market due to statistically higher
rates of cardiac issues. Research is still being performed to find a healthier
balance of cox-inhibitions by the NSAIDs available.
Gotlieb, David, MBChB. “Non Steroidal Anti-Inflammatory Drugs: NSAIDs.”
August 2011. http://www.arthritis.co.za/nsaids.html
“NSAIDs for Arthritis Pain.” AstraZeneca, 2012. http://www.vimovo.com/nsaid-therapy.aspx
“Nonsteroidal Anti-Inflammatory
Drugs (NSAIDs).” Pain Management Health Center, WebMD, 4 August 2011. http://www.webmd.com/pain-management/nonsteroidal-anti-inflammatory-drugs-nsaids
While discussing in a class, topic about while doctors prescribe us anti-inflammatory they never tell us about its side effect. They prescribe the dose of the medicine according to the pain we describe them to. We should be careful about what we put in our body, and i think it would be helpful before prescribing the prescription doctor should also tell us about the side effects of it.
ReplyDeleteEven research has gone into creating an inhibitor of cox-2 only, there is still possibility of mild to severe side effects like serious skin allergy and cardiovascular side effect; blood clot, stroke. So one of the way to make sure of our safety while taking a anti-inflammatory is to follow up with your doctor.
I think it's interesting how you mentioned that researchers are in the process of developing selective COX-2 inhibitors. There are a few already that includes Vioxx (Rofecoxib), Bextra (Valdecoxib), and Celebrex (Celecoxib) like mentioned. However, I don't see selective COX-2 inhibitors as a breakthrough NSAIDs as the cardiovascular related risks are dangerous. By inhibiting COX-2, Prostacyclin (PGI2) is suppressed and cannot inhibit platelet aggregation. At the same time, COX-1 is not inhibited and platelet production by Thromboxane (TXA2) is still present. Therefore, I feel that COX-2 inhibitors carry greater risks over anti-inflammatory benefits.
ReplyDeleteI like the overview of your post, but one needs to take in account that inflammation has positive effects. Maileen makes a good point, it's problematic to just inhibit COX-2 because of clot formations. Furthermore, I think that a positive balance of inhibition between both COX-1 and COX-2 would provide decreased swelling but not leave the body open for other foreign attacks. (easier said then done)
ReplyDeleteNick raises a good point that inflammation is important for defense against foreign attacks. However, I will say that in the cases of particular pathogens, inflammatory activation of cells can be to the advantage of the virus or bacteria. For instance, HIV-1 replicates with much better efficiency in activated T cells than in resting T cells. Also, latent M. Tuberculosis survives in the granulomas formed by macrophages, and there is some research suggesting that M. Tb purposely attracts activated macrophages to wall themselves off to avoid complete annihilation by other components of the immune system.
ReplyDeleteThe above comments get at all the parts of any type of medication where relief and side effects must be weighed. Dr. Cohen has mentioned through the semester about changing the way we treat immunological problems. Where therapies can be directed at the culprits rather than mitigating responses because there will always be unwanted side affects a patient must account for but it is the health care providers and researchers job to be two steps ahead of any disease or injury. As mentioned in the post if an anti-inflammatory drugs are causing severe GI bleeding or cardiac distress we need to further understand pathways and decipher the interconnectedness of the human body. Obviously very easy so I expect the next person to read this to make millions.
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