Lymphedema Medication

Updated: Jun 04, 2018
  • Author: Kathleen M Rossy, MD; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

As previously mentioned, few pharmacologic therapies have been found to be effective in the treatment of lymphedema. Case reports have suggested, however, that chronic lymphedematous changes (eg, elephantiasis nostra verrucosa [ENV]) can be treated with oral and topical retinoids. These therapies are thought to help normalize keratinization and decrease inflammatory and fibrotic changes. [64, 65]

Topical emollients and keratolytics, such as ammonium lactate, urea, and salicylic acid, have been recommended to improve secondary epidermal changes.

Patients experiencing recurrent lymphangitis or cellulitis may require long-term, prophylactic treatment with antimicrobial agents such as penicillin, cephalexin, or erythromycin. [61, 62]

Filariasis has been treated with the anthelmintic agents diethylcarbamazine and albendazole. [63]

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Retinoid-like Agents

Class Summary

These agents are thought to help normalize keratinization and decrease inflammatory and fibrotic changes.

Acitretin (Soriatane)

Acitretin, a metabolite of etretinate, is related to retinoic acid and retinol (vitamin A). Its mechanism of action is unknown; however, the drug is thought to exert its therapeutic effect by modulating keratinocyte differentiation, keratinocyte hyperproliferation, and tissue infiltration by inflammatory cells.

Tazarotene, topical (Tazorac)

Topical tazarotene (topical gel 0.1%) is a retinoid prodrug with an active metabolite that modulates the differentiation and proliferation of epithelial tissue. It may also have anti-inflammatory and immunomodulatory properties. Ensure that the skin is dry before the gel is applied.

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Anthelmintics

Class Summary

Filaria can cause lymphedema by obstruction.

Albendazole (Albenza)

Albendazole is a benzimidazole carbamate drug that inhibits tubulin polymerization, resulting in degeneration of cytoplasmic microtubules. It is converted in the liver to its primary metabolite, albendazole sulfoxide. Less than 1% of the primary metabolite is excreted in urine.

The plasma level is noted to rise significantly (as much as 5-fold) when albendazole is ingested after a high-fat meal. Experience with patients under age 6 years is limited.

To avoid an inflammatory response in the central nervous system (CNS), patients must also be started on anticonvulsants and high-dose glucocorticoids.

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Topical Skin Products

Class Summary

Topical emollients and keratolytics may improve secondary epidermal changes.

Ammonium lactate lotion (AmLactin, AmLactin XL, Lac-Hydrin, Gen-Hydrolac)

This agent is believed to act as a humectant when applied to skin. This may influence hydration of the stratum corneum. In addition, when applied to the skin, ammonium lactate lotion may decrease corneocyte cohesion. The mechanism by which this is accomplished is not yet known.

Found in a variety of topical emollient lotions, ammonium lactate is used to decrease scaling and pruritus. Ammonium lactate 5% lotion is available over the counter; lactic acid 12% cream and lotion are available by prescription.

Urea, topical (Carmol, Keralac, Ureacin)

Topical urea promotes hydration and removal of excess keratin in conditions of hyperkeratosis.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of this clinical setting.

Cefazolin

Cefazolin is a first-generation, semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. It is primarily active against skin flora, including Staphylococcus aureus. This agent is typically used alone for skin and skin-structure coverage. The intravenous and intramuscular dosing regimens are similar.

Clindamycin (Cleocin)

Clindamycin is a lincosamide used for the treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (but not enterococci). Clindamycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl transfer ribonucleic acid (t-RNA) from ribosomes, causing RNA-dependent protein synthesis to arrest.

Penicillin G benzathine (Bicillin L-A)

This agent interferes with the synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity. It is used to treat syphilis and for prophylaxis against recurrent streptococcal infections.

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