C H A P T E R 1 6
Anti-inflammatory, antiarthritis and related agents
241
effects. Antihistamines (discussed in Chapter 54) are
used to block the release of histamine in the initiation
of the inflammatory response. In this chapter, discussion
of anti-inflammatory agents focuses on drugs that have
a direct effect on the inflammatory response, including
salicylates, non-steroidal anti-inflammatory and related
agents, and antiarthritis drugs.
Because many anti-inflammatory drugs are avail-
able over-the-counter (OTC), there is a potential for
abuse and overdosing. In addition, individuals may
take these drugs and block the signs and symptoms of
a present illness, thus potentially causing the misdiag-
nosis of a problem. In some situations, individuals may
combine these drugs and unknowingly induce toxicity.
All of these drugs have adverse effects that can be dan-
gerous if toxic levels of the drug circulate in the body.
See Box 16.1 for information on using these drugs with
various age groups.
SALICYLATES
Salicylates
(Table 16.1) are popular anti-inflammatory
agents not only because of their ability to block the inflam-
matory response, but also because of their
antipyretic
(fever-blocking) and
analgesic
(pain-blocking) properties.
T
he
inflammatory response
is designed to protect the
body from injury and pathogens. It employs a variety
of potent chemical mediators to produce the reaction
that helps to destroy pathogens and promote healing.
As the body reacts to these chemicals, it produces signs
and symptoms of disease, such as swelling, fever, aches
and pains. Occasionally, the inflammatory response
becomes a chronic condition and can result in damage
to the body, leading to increased inflammatory reac-
tions.
Anti-inflammatory agents
generally block or alter
the chemical reactions associated with the inflammatory
response to stop one or more of the signs and symptoms
of inflammation.
ANTI-INFLAMMATORY, ANTIARTHRITIS
AND RELATED AGENTS
Several different types of drugs are used as anti-inflam-
matory agents. Corticosteroids (discussed in Chapter 36)
are used systemically to block the inflammatory and
immune systems. Blocking these important protective
processes may produce many adverse effects, includ-
ing decreased resistance to infection and neoplasms.
Corticosteroids also are used topically to produce a
local anti-inflammatory effect without as many adverse
BOX 16.1
Drug therapy across the lifespan
Anti-inflammatory agents
CHILDREN
Children are more susceptible to the GI and CNS effects
of these drugs. Care must be taken to make sure that the
child receives the correct dose of any anti-inflammatory
agent.This can be a problem because many of these
drugs are available in OTC pain, cold, flu and combination
products. Parents need to be taught to read the label to
find out the ingredients and the dose they are giving the
child.
Aspirin is the only salicylate in Australia and New
Zealand recommended for children.The drug should not
be used when any risk of Reye’s syndrome exists.
Ibuprofen, naproxen, meloxicam and, in some cases,
indomethacin are the NSAIDs approved for use in
children.
Paracetamol is the most used anti-inflammatory drug
for children. Care must be taken to avoid overdose, which
can cause severe hepatotoxicity.
Children with arthritis may receive treatment with gold
salts or etanercept; they must be monitored very closely
for toxic effects.
ADULTS
Adults need to be cautioned about the presence of these
drugs in many OTC products and taught to be aware of
exactly what they are taking to avoid serious toxic effects.
They should also be cautioned to report OTC drug use
to their healthcare provider when they are receiving
any other prescription drug to avoid possible drug–drug
interactions and the masking of signs and symptoms of
disease.
PREGNANCY AND BREASTFEEDING
Pregnant and breastfeeding women should not use these
drugs unless the benefit clearly outweighs the potential
risk to the fetus or neonate.The salicylates, NSAIDs and
gold products have potentially severe adverse effects on
the neonate and possibly the mother. Paracetamol can
be used cautiously if a pain preparation or antipyretic is
needed. Non-drug measures should be taken when at
all possible to decrease the potential risk.These women
also need to be urged to avoid OTC drugs unless they are
suggested by their healthcare providers.
OLDER ADULTS
Older people may be more susceptible to the CNS and
GI effects of some of these drugs. Dose adjustment is not
needed for many of these agents.
Geriatric warnings have been associated with
naproxen, ketorolac and ketoprofen because of reports
of increased toxicity when they are used by older people.
These NSAIDs should be avoided if possible.
Gold salts, used to treat arthritis, which is more
common in older people, are particularly toxic for geriatric
people. Accumulations in tissues can lead to increased
renal, GI and even liver problems. If gold is used in
this group, the dose should be reduced and the person
monitored very closely for toxic effects.
