Anti-inflammatory

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Anti-inflammatory refers to any drug, substance or mechanism that reduces inflammation by lessening the redness, swelling, fever, or pain and loss of function which are part of bodies inflammatory response. Anti-inflammatory drugs are agents that inhibit action or production of inflammatory mediators such as cytokines, histamines and prostaglandins. These drugs reduce pain by inhibiting mechanisms of inflammation, as opposed to opioids, which affect the central nervous system to block pain.[ not verified in body ]

Contents

Common anti-inflammatory drugs include nonsteroidal anti-inflammatory drugs (NSAIDs), [1] corticosteroids, antileukotrienes, and monoclonal antibodies.

Drugs

Clinically approved

Nonsteroidal anti-inflammatory drugs

NSAIDs alleviate pain by counteracting the cyclooxygenase (COX) enzyme involved in pain mechanisms. [1] [2]

Some common examples of NSAIDs are aspirin, ibuprofen, and naproxen. [1] Selective COX-2 inhibitors, such as celecoxib, block the enzymatic conversion of arachidonic acid into prostaglandin, inhibiting inflammation and pain. [3]

Analgesics commonly associated with anti-inflammatory drugs, such as paracetamol (acetaminophen), have no peripheral anti-inflammatory effects. [4] High, short-term doses of NSAIDs may become toxic, causing gastric erosions, stomach ulcers, internal bleeding, hepatotoxicity, or kidney disease. [4]

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. [5] The risk increases almost twentyfold for those over 75. [5] Apart from aspirin, frequent or high doses of prescription and over-the-counter NSAIDs may increase the risk of heart attack and stroke. [6]

Corticosteroids

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 constrain their use. [7] [8]

Antileukotrienes

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 used to manage diseases related to inflammation of the lungs, such as asthma, as well as being used for sinus inflammation in allergic rhinitis. [9] [10] Examples include montelukast and zileuton.[ medical citation needed ]

Monoclonal antibodies

Monoclonal antibodies, for instance against pro-inflammatory cytokines like interleukin-6 (anti-interleukin-6) and tumor necrosis factor α (TNFα) (TNF inhibitors), are approved and used in the treatment autoimmune diseases and other inflammatory conditions. [11] [12] [13]

Investigational and off-label

Omega-3 fatty acids

Omega-3 fatty acids may have anti-inflammatory effects, although clinical studies show that possible effects have been inconsistent, requiring further research. [14] A 2017 review indicated that omega-3 fatty acids may benefit rheumatoid arthritis, [15] although another analysis indicated no consistent effect. [14] There is no good evidence that use of omega-3 fatty acids provides relief in retinal inflammation or in dry eye syndrome. [14]

N-Acetylcysteine

N-Acetylcysteine (NAC) has been found to possess anti-inflammatory effects and has been clinically studied in the treatment of conditions involving inflammation. [16]

Melatonin

A 2021 review reported that melatonin has anti-inflammatory effects. [17] Found to reduce levels of several pro-inflammatory cytokines, it remains under preliminary research for its potential to treat inflammation. [17]

Serotonin 5-HT2A receptor agonists

Serotonin 5-HT2A receptor agonists, including serotonergic psychedelics, are under preliminary research as possible anti-inflammatory agents. [18] [19] The anti-inflammatory effects of some psychedelics, like DOI and psilocybin, have been found to occur at much lower doses than those at which they produce their hallucinogenic effects. [19] Serotonin 5-HT2A receptor agonists with anti-inflammatory properties are under clinical investigation as possible treatments for inflammatory disorders. [20]

Tetracyclic antibiotics

The tetracycline antibiotics minocycline and doxycycline have been found to have anti-inflammatory and immunomodulatory effects. [21] [22] Minocycline has been found to have some clinical benefit in people with treatment-resistant depression with inflammation but not in those without inflammation. [23]

Macrolide antibiotics

The macrolide antibiotic azithromycin is known to have anti-inflammatory and immunomodulatory properties. [24] It is said to be established and effective for certain inflammatory airway diseases such as asthma and chronic obstructive pulmonary disease (COPD). [24] [25] [26] [27] Azithromycin is also being assessed for potential treatment of other chronic inflammatory disorders. [28] [29]

Statins

Statins like atorvastatin and simvastatin are used to treat inflammatory conditions like rheumatoid arthritis and chronic kidney disease. [30] [31] [32] Statins may be useful for treating other inflammatory conditions, like uveitis, [32] depression, [33] [34] and possibly neuropsychiatric disorders. [35] [36] However, higher-quality evidence of statins for treatment of neuropsychiatric and other conditions is still needed. [37]

Colchicine

Colchicine is an anti-inflammatory agent that disrupts the function of cytoskeletal by inhibiting microtubule polymerization, doing so prevents the activation, degranulation and migration of neutrophils. [38] Colchicine is mostly used in treatment of acute gout. It can also be used for treating familial Mediterranean fever and pericarditis. [39]

Curcumin

A 2019 systematic review and meta-analysis found that curcumin or turmeric did not significantly decrease several circulating inflammatory markers in people with various chronic inflammatory diseases. [40] Major problems of assessing curcumin in human studies are its unknown fate and properties after digestion, and its poor bioavailability. [41] [42] [43]

References

  1. 1 2 3 Ghlichloo I, Gerriets V (1 May 2023). "Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)". StatPearls, US National Library of Medicine. Retrieved 25 May 2025.
  2. ↑ Knights KM, Mangoni AA, Miners JO (November 2010). "Defining the COX inhibitor selectivity of NSAIDs: implications for understanding toxicity". Expert Rev Clin Pharmacol. 3 (6): 769–76. doi:10.1586/ecp.10.120. PMID   22111779. S2CID   207209534.
  3. ↑ Qureshi O, Dua A (28 February 2024). "COX inhibitors". StatPearls, US National Library of Medicine. Retrieved 25 May 2025.
  4. 1 2 Gerriets V, Anderson J, Patel P, Nappe TM (11 January 2024). "Acetaminophen". StatPearls, US National Library of Medicine. PMID   29493991 . Retrieved 25 May 2025.
  5. 1 2 "Table 7". NSAIDs and adverse effects. Bandolier. Archived from the original on 18 February 2012. Retrieved 20 December 2012.
  6. ↑ Trelle S, Reichenbach, Stephan, Wandel, Simon, Hildebrand, Pius, Tschannen, Beatrice, Villiger, Peter M., et al. (11 January 2011). "Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis". British Medical Journal. 342 c7086. doi:10.1136/bmj.c7086. PMC   3019238 . PMID   21224324.
  7. ↑ Ingawale DK, Mandlik SK (April 2020). "New insights into the novel anti-inflammatory mode of action of glucocorticoids". Immunopharmacol Immunotoxicol. 42 (2): 59–73. doi:10.1080/08923973.2020.1728765. PMID   32070175.
  8. ↑ Escoter-Torres L, Caratti G, Mechtidou A, Tuckermann J, Uhlenhaut NH, Vettorazzi S (2019). "Fighting the Fire: Mechanisms of Inflammatory Gene Regulation by the Glucocorticoid Receptor". Front Immunol. 10: 1859. doi: 10.3389/fimmu.2019.01859 . PMC   6693390 . PMID   31440248.
  9. ↑ Scott JP, Peters-Golden M (September 2013). "Antileukotriene agents for the treatment of lung disease". Am. J. Respir. Crit. Care Med. 188 (5): 538–544. doi:10.1164/rccm.201301-0023PP. PMID   23822826.
  10. ↑ Niwas H, Bansal P, Pentela B, Mazumder A (21 October 2025). "The Spectrum of Allergic Rhinitis: Risk Factors and their Clinical Relevance". Recent Advances in Inflammation & Allergy Drug Discovery. doi:10.2174/0127722708397912251001102439. ISSN   2772-2716. PMID   41126418.
  11. ↑ Lai Y, Dong C (April 2016). "Therapeutic antibodies that target inflammatory cytokines in autoimmune diseases". Int Immunol. 28 (4): 181–188. doi:10.1093/intimm/dxv063. PMC   4889878 . PMID   26545932.
  12. ↑ Li P, Zheng Y, Chen X (2017). "Drugs for Autoimmune Inflammatory Diseases: From Small Molecule Compounds to Anti-TNF Biologics". Front Pharmacol. 8: 460. doi: 10.3389/fphar.2017.00460 . PMC   5506195 . PMID   28785220.
  13. ↑ Yoo SM, Chung SH (April 2019). "Targets of monoclonal antibodies for immunological diseases". Arch Pharm Res. 42 (4): 293–304. doi:10.1007/s12272-018-1087-2. PMID   30426387.
  14. 1 2 3 "Omega-3 Fatty Acids: Fact Sheet for Health Professionals". Office of Dietary Supplements, US National Institutes of Health. 17 December 2024. Retrieved 25 May 2025.
  15. ↑ Calder PC (October 2017). "Omega-3 fatty acids and inflammatory processes: from molecules to man". Biochem Soc Trans. 45 (5): 1105–1115. doi:10.1042/BST20160474. PMID   28900017.
  16. ↑ Santus P, Signorello JC, Danzo F, Lazzaroni G, Saad M, Radovanovic D (July 2024). "Anti-Inflammatory and Anti-Oxidant Properties of N-Acetylcysteine: A Fresh Perspective". J Clin Med. 13 (14): 4127. doi: 10.3390/jcm13144127 . PMC   11278452 . PMID   39064168.
  17. 1 2 Cho JH, Bhutani S, Kim CH, Irwin MR (March 2021). "Anti-inflammatory effects of melatonin: A systematic review and meta-analysis of clinical trials". Brain Behav Immun. 93: 245–253. doi:10.1016/j.bbi.2021.01.034. PMC   7979486 . PMID   33581247.
  18. ↑ Nichols DE, Johnson MW, Nichols CD (February 2017). "Psychedelics as Medicines: An Emerging New Paradigm". Clin Pharmacol Ther. 101 (2): 209–219. doi:10.1002/cpt.557. PMID   28019026.
  19. 1 2 Nichols CD (November 2022). "Psychedelics as potent anti-inflammatory therapeutics". Neuropharmacology. 219 109232. doi: 10.1016/j.neuropharm.2022.109232 . PMID   36007854.
  20. ↑ Kozlowska U, Nichols C, Wiatr K, Figiel M (July 2022). "From psychiatry to neurology: Psychedelics as prospective therapeutics for neurodegenerative disorders". J Neurochem. 162 (1): 89–108. doi:10.1111/jnc.15509. PMID   34519052.
  21. ↑ Park CS, Kim SH, Lee CK (December 2020). "Immunotherapy of Autoimmune Diseases with Nonantibiotic Properties of Tetracyclines". Immune Netw. 20 (6) e47. doi:10.4110/in.2020.20.e47. PMC   7779869 . PMID   33425432.
  22. ↑ Singh S, Khanna D, Kalra S (2021). "Minocycline and Doxycycline: More Than Antibiotics". Curr Mol Pharmacol. 14 (6): 1046–1065. doi:10.2174/1874467214666210210122628. PMID   33568043.
  23. ↑ Al Jumaili W, Vora D, Trivedi C, Jain S (September 2023). "Role of Minocycline as an Adjunct Neuroinflammatory Modulator in Treatment-Resistant Depression: A Systematic Review of Randomized Controlled Trials". Prim Care Companion CNS Disord. 25 (5). doi:10.4088/PCC.22r03467. PMID   37713730. Results: Minocycline as an adjunct immunomodulator shows inconsistent benefit in TRD. Minocycline has some beneficial effect on depression scale scores and inflammatory markers in TRD patients with inflammatory disequilibrium (C-reactive protein elevation exceeds 3 mg/L). However, minocycline showed an inconclusive effect in TRD with no clear immunologic dysregulation.
  24. 1 2 Firth A, Prathapan P (December 2020). "Azithromycin: The First Broad-spectrum Therapeutic". Eur J Med Chem. 207 112739. doi:10.1016/j.ejmech.2020.112739. PMC   7434625 . PMID   32871342.
  25. ↑ Pollock J, Chalmers JD (December 2021). "The immunomodulatory effects of macrolide antibiotics in respiratory disease". Pulm Pharmacol Ther. 71 102095. doi:10.1016/j.pupt.2021.102095. PMC   8563091 . PMID   34740749.
  26. ↑ Hiles SA, McDonald VM, Guilhermino M, Brusselle GG, Gibson PG (November 2019). "Does maintenance azithromycin reduce asthma exacerbations? An individual participant data meta-analysis". Eur Respir J. 54 (5). doi:10.1183/13993003.01381-2019. hdl: 1765/122222 . PMID   31515407.
  27. ↑ Mackay AJ, Hurst JR (July 2012). "COPD exacerbations: causes, prevention, and treatment". Med Clin North Am. 96 (4): 789–809. doi:10.1016/j.mcna.2012.02.008. PMID   22793945.
  28. ↑ Parnham MJ, Erakovic Haber V, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R (August 2014). "Azithromycin: mechanisms of action and their relevance for clinical applications". Pharmacol Ther. 143 (2): 225–45. doi:10.1016/j.pharmthera.2014.03.003. PMID   24631273.
  29. ↑ Hirsch R, Deng H, Laohachai MN (April 2012). "Azithromycin in periodontal treatment: more than an antibiotic". J Periodontal Res. 47 (2): 137–148. doi:10.1111/j.1600-0765.2011.01418.x. PMID   22050485.
  30. ↑ Li GM, Zhao J, Li B, Zhang XF, Ma JX, Ma XL, et al. (March 2018). "The anti-inflammatory effects of statins on patients with rheumatoid arthritis: A systemic review and meta-analysis of 15 randomized controlled trials". Autoimmun Rev. 17 (3): 215–225. doi:10.1016/j.autrev.2017.10.013. PMID   29353098.
  31. ↑ Wang J, Chen Z, Qiu Y, Wu L, Wang H, Wu L, et al. (2022). "Statins Have an Anti-Inflammation in CKD Patients: A Meta-Analysis of Randomized Trials". Biomed Res Int. 2022 4842699. doi: 10.1155/2022/4842699 . PMC   9617709 . PMID   36317110.
  32. 1 2 Gilbert R, Al-Janabi A, Tomkins-Netzer O, Lightman S (2017). "Statins as anti-inflammatory agents: A potential therapeutic role in sight-threatening non-infectious uveitis". Porto Biomed J. 2 (2): 33–39. doi:10.1016/j.pbj.2017.01.006. PMC   6806973 . PMID   32258583. In addition to the known lipid-lowering effects, statins are now widely accepted to have anti-inflammatory and immunomodulatory effects. Adjunctive use of statins has proven beneficial in the context of a wide range of inflammatory diseases, including rheumatoid arthritis.
  33. ↑ De Giorgi R, De Crescenzo F, Rizzo Pesci N, Martens M, Howard W, Cowen PJ, et al. (2021). "Statins for major depressive disorder: A systematic review and meta-analysis of randomized controlled trials". PLOS ONE. 16 (3) e0249409. Bibcode:2021PLoSO..1649409D. doi: 10.1371/journal.pone.0249409 . PMC   8009386 . PMID   33784356.
  34. ↑ Bai S, Guo W, Feng Y, Deng H, Li G, Nie H, et al. (January 2020). "Efficacy and safety of anti-inflammatory agents for the treatment of major depressive disorder: a systematic review and meta-analysis of randomised controlled trials". J Neurol Neurosurg Psychiatry. 91 (1): 21–32. doi:10.1136/jnnp-2019-320912. PMID   31658959.
  35. ↑ Avan R, Sahebnasagh A, Hashemi J, Monajati M, Faramarzi F, Henney NC, et al. (December 2021). "Update on Statin Treatment in Patients with Neuropsychiatric Disorders". Life. 11 (12): 1365. Bibcode:2021Life...11.1365A. doi: 10.3390/life11121365 . PMC   8703562 . PMID   34947895.
  36. ↑ Fitton R, Sweetman J, Heseltine-Carp W, van der Feltz-Cornelis C (December 2022). "Anti-inflammatory medications for the treatment of mental disorders: A scoping review". Brain Behav Immun Health. 26 100518. doi:10.1016/j.bbih.2022.100518. PMC   9547233 . PMID   36217374.
  37. ↑ Köhler-Forsberg O, Otte C, Gold SM, Østergaard SD (November 2020). "Statins in the treatment of depression: Hype or hope?". Pharmacol Ther. 215 107625. doi:10.1016/j.pharmthera.2020.107625. PMID   32652185.
  38. ↑ Shekelle PG, FitzGerald J, Newberry SJ, Motala A, O'Hanlon CE, Okunogbe A, et al. (March 2016), "Methods", Management of Gout [Internet], Agency for Healthcare Research and Quality (US), retrieved 4 November 2025
  39. ↑ "Clinical Review", Colchicine (Myinfla): CADTH Reimbursement Review: Therapeutic area: Atherothrombotic events in coronary artery disease [Internet], Canadian Agency for Drugs and Technologies in Health, April 2022, retrieved 4 November 2025
  40. ↑ White CM, Pasupuleti V, Roman YM, Li Y, Hernandez AV (August 2019). "Oral turmeric/curcumin effects on inflammatory markers in chronic inflammatory diseases: A systematic review and meta-analysis of randomized controlled trials". Pharmacol Res. 146 104280. doi:10.1016/j.phrs.2019.104280. PMID   31121255.
  41. ↑ Liu W, Zhai Y, Heng X, Che FY, Chen W, Sun D, et al. (September 2016). "Oral bioavailability of curcumin: problems and advancements". J Drug Target. 24 (8): 694–702. doi:10.3109/1061186X.2016.1157883. PMID   26942997.
  42. ↑ Hegde M, Girisa S, BharathwajChetty B, Vishwa R, Kunnumakkara AB (March 2023). "Curcumin Formulations for Better Bioavailability: What We Learned from Clinical Trials Thus Far?". ACS Omega. 8 (12): 10713–10746. doi:10.1021/acsomega.2c07326. PMC   10061533 . PMID   37008131.
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