Inflammation And Voltaren
Inflammation and Voltaren
When body’s tissues are damaged by harmful stimuli, the body’s tissues naturally try to eliminate the cause of the damage and repair the damaged tissues.1 This defensive response to the stimuli that body immune system shows is called inflammation.1 In addition, the common signs and symptoms of inflammation include redness, heat, swelling, pain and occasionally accompanied by loss of function.2 For inflammation treatment, Voltaren is one of the widely used drugs. In this essay, the process of inflammation will be explained as well as the action of Voltaren in relieving inflammation.
The process of inflammation is initiated by damage to body’s tissues.3:479 The damage can be caused by microbial infection or injury.1 For example, inflammation can be initiated by the invasion of the bacteria.1 When bacteria enter and stimulate the body’s tissues, the body’s tissues release several inflammatory chemical messengers that alter the entire environment of the damaged tissue area. 4:751
First of all, one of the major chemical messengers is histamine. The function of this substance is significant for initiation of inflammatory response. When mast cells in the damaged tissues are stimulated, the mast cells secrete histamines to the surrounding.3:480-481 Histamines then increase diameter of blood vessels around the damaged tissues.3:480 The dilated blood vessels promote increase of blood flow in the damaged area, resulting in characteristic of inflammation such as redness and heat.5 Besides, histamines make the blood vessels permeable to proteins such as phagocytes by opening pores in the blood vessel endothelia.5 The phagocytes can then penetrate the blood vessels and move into the damaged tissue spaces.5 Interestingly, chemical substances that are produced by the phagocytes also induce the mast cells to release histamines.6:468
Another chemical is leukotriene. Leukotrienes are synthesized from arachidonic acid by an enzyme called lipoxygenase and released by mast cells and basophils.6:469 Similar to histamines, leukotrienes B4 increase the permeability of the local blood vessels to phagocytes and help phagocytes pass through the blood vessels.4:757
Prostaglandins are another class of inflammatory chemicals. Prostaglandins are also released by the damaged tissues and have various biological effects, indeed.7 As an inflammatory chemical, prostaglandins affect production of pain and heat, permeability of blood vessels, regulation of vascular smooth muscle contraction, and aggregation of platelets.3:339 Moreover, prostaglandins are synthesized by cyclooxygenase. Cyclooxygenase is an enzyme that catalyzes the conversion of arachidonic acid into PGG2. PGG2 is then changed into PGH2 by peroxidase.4:755 Thereafter, PGH2 is converted to other prostaglandins by other enzymes.4:755
Figure 1. The formation of prostaglandins and leukotrienes1:339
When phagocytes move into the site of inflammation by the aid of various inflammatory chemicals, the phagocytes, such as neutrophils and macrophages, start to engulf and destroy the causes of the tissue damage such as bacteria and damaged tissues in attempt to minimize the tissue damage.6:469-470 This ingestion process is called phagocytosis.6:469 Furthermore, when phagocytes engulf many bacteria or damaged tissues, the phagocytes die.8:80-81 The dead phagocytes in turn mix with interstitial fluids living phagocytes, and other cell debris, forming pus in the infected area.8:84
Figure 2. Phagocytes and phagocytosis1:476
Effect of Voltaren
Voltaren is a nonsteroidal anti-inflammatory drug which exhibiting anti-inflammatory, analgesic, anti-pyretic and anti-rheumatic properties.9 Voltaren’s main anti-inflammatory action is interfering cyclooxygenase pathway and lipoxygenase pathway.4:768
The inhibition of prostagladins formation can be initiated by simply blocking the entrance of arachidoic acid to the active site of cyclooxygenase.7 In fact, Voltaren inhibits two different forms of cyclooxygenase.4:768, 7 These are cyclooxygenase-1 and cyclooxygenase-2, and each type of cyclooxygenase synthesizes different types of prostaglandins.3:340
Cyclooxygenase-1 is responsible for the constant production of prostagladins which are essential for all different types of normal body chemistry.7 For example, PGE1 protects gastroduodenal mucosa.4:776 However, when patients use Voltaren for long-term treatment, the patients may develop gastrointestinal irritation due to reduced production of PGE1.4:756
On the other hand, cyclooxygenase-2 produces prostagladins in response to the inflammatory stimuli.3:340 The cyclooxygenase-2 prostagladins are in turn the causes of inflammatory response.7 Voltaren induces less production of the prostagladins by cyclooxygenase-2 interference.4:768 Therefore, Voltaren alleviates inflammation. While Voltaren works effectively on inflammation most of the time, Voltaren may increase the risk of cardiovascular disease by less production of PGI2 by cyclooxygenase-2 inhabitation.3:340, 4:768
Another anti-inflammatory effect of Voltaren is blocking leukotrienes production by inhibition of lipoxygenase.4:768 Thereby, Voltaren reduces leukotrienses production.
As indicated before, inflammation is body’s defensive response to harmful stimuli by the aid of a variety of inflammatory chemicals such as histamines, leukotrienes and prostaglandins. Voltaren can relieve inflammation by inhibition of prostaglandin and leukotriene production. However, since Voltaren may cause the undesirable side effect such as gastrointestinal irritation and cardiovascular disease, patients who use Voltaren for long-term needed to be informed about the side effect.9
1.Widmaier EP, Raff H, Strang KT, editors. Vander, Sherman, Luciano’s human physiology: the mechanisms of body function. 9th ed. Boston: McGraw-Hill Higher Education; 2004. p.699-698.
2. Harris P, Nagy S, Vardaxis N, editors. Mosby’s dictionary of medicine, nursing & health professions. Sydney: Elsevier Australia; 2006. Inflammation; p.902.
3. Fox SI. Human physiology. 10th ed. Boston: McGraw-Hill Higer Education ; 2008. p.339-340, 479-481.
4. Williams DA, Lemke TL, editors. Foye’s principles of medicinal chemistry. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p.751, 755-757, 768.
5. Silverthorn DU. Human physiology: an integrated approach. 4th ed. San Francisco: Pearson Education; 2007. p.787.
6. Tortora GJ, Funke BR, Case CL. Microbiology: an introduction. 8th ed. San Francisco: Pearson Education; 2004. p.468-470.
7. Bettelheim FA, Brown WH, March J. Introduction to general, organic, and biochemistry. 7th ed. Australia: Brooks/cole-Thomson Learning; 2004. p.518-519.
8. Dziarski R. Innate immunity. In: Engleberg NC, Dirita V, Dermody TS. Schaechter’s mechanisms of microbial disease. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p.80-81, 84.
9. Mims Online [Online]. 2007 [cited 2008 April 12]. Available from:
1. Fox SI. Human physiology. 10th ed. Boston: McGraw-Hill Higer Education ; 2008. p.339, 476.