Medial Epicondylitis Medication

Updated: Jan 24, 2019
  • Author: Craig C Young, MD; Chief Editor: Craig C Young, MD  more...
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Medication

Medication Summary

The goal of pharmacotherapy is to reduce patient morbidity and prevent complications.

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Nonsteroidal anti-inflammatory drugs

Class Summary

Anti-inflammatory agents may be helpful in cases of acute medial epicondylitis. However, most cases of medial epicondylitis are the result of chronic inflammatory changes for which the use of NSAIDs is somewhat controversial, [18] as these agents may or may not be beneficial to the physiologic processes of soft-tissue healing. NSAIDs have been found to be useful in controlling pain and allowing more rapid progress in physical therapy. Disadvantages of NSAIDs are many, including the risk of gastrointestinal (GI) bleeding, gastric pain, and renal damage. [47]

Ibuprofen (Ibuprin, Advil, Motrin)

Member of the propionic acid group of NSAIDs. Available in low-dose form as an over-the-counter medication. Highly protein bound, metabolized in the liver and eliminated primarily in urine. May reversibly inhibit platelet function.

Naproxen (Anaprox, Naprelan, Naprosyn)

Member of the propionic acid group of NSAIDs. Available in low-dose form as an over-the-counter medication. Highly protein bound, metabolized in the liver and eliminated primarily in urine. May reversibly inhibit platelet function.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. These agents modify the body's immune response to diverse stimuli and are strong anti-inflammatory agents. The general risks associated with corticosteroid use include skin atrophy, skin hypopigmentation, soft-tissue atrophy, infection, bleeding, and failure to work. Up to 50% of individuals who are administered corticosteroids experience a transient increase in pain for the first 24 hours. [48] However, a steroid flare that consists of increased pain up to several days may occur in up to 2% of individuals. [29]

Triamcinolone acetonide (Aristocort)

Injectable, intermediate-acting, steroid anti-inflammatory agent. Injectable corticosteroids are used to treat localized areas of inflammation. No good evidence exists to suggest that injected corticosteroids alter the long-term pathology of chronic inflammation. However, many patients have acute symptomatic improvement.

Betamethasone (Diprolene, Betatrex)

Injectable, long-acting steroid and potent anti-inflammatory agents. Injectable corticosteroids are used to treat localized areas of inflammation. No good evidence exists to suggest that injected corticosteroids alter the long-term pathology of chronic inflammation. However, many patients have acute symptomatic improvement.

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Nitric oxide modulators

Class Summary

Use of nitroglycerin transdermal patches as modulators of nitric oxide has been studied. The mechanism of action is not completely understood, but it is postulated that nitric oxide stimulates collagen production by fibroblasts. [43]

Nitroglycerin transdermal (NitroDur, Minitran)

Organic nitrate; nitric oxide released from nitroglycerin. Elicits muscle relaxation as a result of guanylate cyclase activation and resulting increased cyclic GMP in smooth muscle and other tissues, causing myosin dephosphorylation and, ultimately, vasodilatation. Limited off-label data suggest cutting transdermal nitroglycerin patch (5 mg/24 h) and applying one fourth of the patch to the affected area. Transdermal nitroglycerin patches are a matrix patch and, unlike reservoir patches, they do not leak or release product all at once when cut.

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