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• Antibiotics are prescribed for patients with lymphedema at the first sign of cellulitis. Cellulitis is an acute inflammation of the connective tissue of skin caused by a bacterial infection.

• Diuretics have long been prescribed for patients with lymphedema, however, their use is controversial because they can actually contribute to an increase in the degree of edema by increasing the high-protein concentration in the interstitial spaces. This leads to increased fibrosis and hardening of the skin. Most experts in the field agree that diuretics should not be used as a primary treatment for lymphedema.

• Benzopyrones (coumarin and flavonoids) - These drugs have been studied extensively in Australia and Europe for the treatment of lymphedema. Coumarin stimulates macrophages (white blood cells) which break down proteins and also stimulates other elements of the immune system that may promote absorption of protein. The smaller protein fragments pass more easily into functioning venous vessels which helps drain the fluid. Studies have suggested that coumarin is effective in reducing edema in arms, legs, and filarial elephantiasis with a reduction of fluid volume of up to 55%. Onset of positive results is slow and more recent research raises questions about its efficacy in general. Moreover, coumarin has been associated with acute liver toxicity and hepatitis. Coumarin is not approved for human use by the U.S. Food and Drug Administration for the treatment of lymphedema.

• Steroids - Although steroids are commonly used to treat inflammatory conditions, their use for the treatment of lymphedema is not recommended because they can cause fluid retention and suppress the immune system, thereby, increasing the risk of infections.

The ISL notes that:

• Diuretics may be of benefit under certain circumstances in the initial phases of Complete Decongestive Physiotherapy (CDP) treatment
• Benzopyrones, such as coumarin may be helpful as adjunct treatment but certainly not to replace CDP
• Antibiotics should be used for acute infection and should be considered prophylactically for prevention of recurrent infections
• Medications for lymphedema due to filariasis should include diethylcarbamazine, albendazole, and ivermectin