Nimesulide is a drug of the NSAID group with a selective effect. The drug quickly relieves pain and inflammation, reduces the progression of negative changes in orthopedic pathologies. The active ingredient reduces the rate of degenerative processes in cartilage, prevents the development of severe forms of osteoarthritis.
Nimesulide tablets are often prescribed by doctors for the treatment of acute pain associated with rheumatic diseases, back and spinal lesions. The drug has less effect on the digestive tract than other names of NSAIDs. It is necessary to strictly adhere to the rules during treatment with Nimesulide. The instructions for use indicate all the information about an effective non-steroidal anti-inflammatory drug.
Composition and action
The drug Nimesulide contains the active ingredient of the same name and several auxiliary ingredients. The medicine belongs to the group of antirheumatic, anti-inflammatory drugs.
Nimesulide selectively affects COX - 2, to a small extent disrupts the production of COX - 1. The consequence is the suppression of the synthesis of prostaglandins, which are actively released during the inflammatory reaction. At the same time, regular prostaglandins, useful for the body, are produced in the usual way, which reduces the risk of possible complications, reduces the negative effect on the digestive organs.
The drug eliminates pain and inflammation, gives an antipyretic effect. Nimesulide reduces the release of histamine, reduces swelling in the affected area, inhibits metalloprotease and collagenase, which has a positive effect on the condition of the cartilage tissue.
Release form
Nimesulide comes in pill form in pharmacies. Each unit contains 100 mg of the active ingredient. Flat-cylindrical light yellow, with a line and a chamfer, tablets are placed on plates of 10 pieces. There are two or three cell packages in a cardboard box.
Nimesulide: analogues
According to the doctor's prescription, the patient can purchase another drug with a similar effect based on nimesulide:
- Nimesubel.
- Nimesan.
- Nisit.
- Nimesulide - Teva.
- Nise.
- Nimica.
- Nemulex.
Content
If you need an anti-inflammatory agent that will help reduce pain, fever, then pay attention to such a non-steroidal substance as nimesulide. It comes in various pharmacological forms. Detailed instructions for nimesulide for correct use are presented below.
The use of Nimesulide tablets
Nimesulide (in Latin - nimesulide) is a part of many medicines, as it has an instant anti-inflammatory and analgesic effect. In pharmacies, it can be found in the form of powders and ointments, which are inexpensive, but the most popular are tablets. The use of nimesulide is carried out only after consulting a doctor and according to instructions, because if used improperly, serious side effects are possible. The correct dosage will help relieve unpleasant symptoms.
From what tablets Nimesulide
A non-steroidal drug against inflammation is a great way to quickly get rid of pain, swelling inside the body. It is important to understand that medication with nimesulide will relieve you of the symptoms of the disease, but it will not eliminate the disease itself. According to the instructions for use, the substance has three main areas of work:
- elimination of heat;
- anti-inflammatory effect;
- anesthesia.
The medicine (see photo below) has received a large number of positive reviews and is actively used in medicine. If you don't know what nimesulide helps with, check out this list:
- rheumatism;
- Problems ;
- osteochondrosis;
- inflammation of the tendons;
- muscle pain.
Nimesulide - release form
Today, a large number of drugs are presented on the market, which include nimesulide. They differ not only in the brand of production and the price. The form of release plays an important role in the effectiveness of the action. To choose the right one for your case, you need to familiarize yourself with their full list and description:
- pills;
- powder;
- gel;
- ointment;
- syrup;
- ampoules (solutions for injections).
Composition of the drug Nimesulide
Experts attribute the substance to the group of sulfonamides. Non-steroidal anti-inflammatory drug quickly relieves fever, prevents the formation of edema. The composition of the drug allows for a short time to eliminate the violation in the tissues, while not exerting a harmful effect on the human body. Gels and ointments are based on thimerosal and alcohols. As for the pills, corn starch and aspartame predominate there.
The drug Nimesulide - instructions for use
According to the observations of doctors, the substance, like its analogs, always gives a tangible effect, but it is better to keep it as a last resort. A large number of contraindications suggests that the instructions for nimesulide are very important for familiarization. There are certain rules of application that must not be forgotten:
- Pills... Take orally 1 piece 2 times a day. Dragee should be washed down with plenty of clean water. The maximum daily dose should not exceed 400 mg.
- Powder... Accepted in the same way as dragees, but its price is slightly more expensive. The daily dose should not exceed 400 mg.
- Creams and gels. Apply a small amount of ointment to the affected area 3-4 times. It is not recommended to use an overlay on top.
Nimesulide tablets
The most widespread form of release. Nimesulide tablets can be found in pharmacies under a variety of names. Depending on the country of the manufacturer, the price can vary significantly. The most popular commercial names are Nimesulide, Flolid, Ameolin. Dragee can dissolve with water. It is allowed to take 2 or a maximum of 4 pills per day. The total amount of the drug per day should not exceed 400 mg. The tablets are taken 2 times a day after meals.
Nimesulide powder - instructions for use
This form of drug release, like powder, is an excellent substitute for pills. Helps to dull toothaches, aching sensations in the lower abdomen during menstruation, fever during a cold. An adult patient needs to consume 100 mg of powder 2 times a day after meals. Dilute the granules in warm water. If this dose does not work, it can be doubled. The course of treatment lasts no more than 15 days.
The most famous powders in this category are Nemulex. They can be prescribed for gynecological diseases, toothaches, headaches and other ailments that require immediate elimination of discomfort and inflammation. For long-term use, it is better to act according to the doctor's prescription. If the patient has liver failure, then Nimesulide powder is allowed only in an amount of 100 mg.
Nimesulide gel - instructions
The gel is prescribed if there are problems with the musculoskeletal system. If the patient feels pain in the joints, then squeeze out a small amount of a creamy substance and massage it onto the affected area. It is necessary to rub in Nimesulide gel for several minutes. To obtain a quick result, the procedure must be repeated 3-4 times a day. Please note that you cannot apply the gel to open wounds and skin affected by various dermatological problems.
Nimesulide ointment - instructions for use
Here the situation is almost the same as with gels. It is necessary to use Nimesulide ointment for painful sensations in the joints according to the instructions. Regular rubbing of the creamy substance will get rid of the unpleasant feeling in just a few days. You need to carry out the procedure 3-4 times a day. The price of ointments is slightly lower than the cost of gels, especially when it comes to a domestic manufacturer.
Nimesulide suspension for children
The use of the substance by children under 12 years of age is prohibited, however, in practice, not a single case is known when the drug gave negative consequences. The child should be given a suspension or syrup. This pharmacological form of release is considered safe for children's health. The main indication for admission to young patients is a high temperature in ARVI. It should be remembered that such a suspension for children is given in cases where simple paracetamol does not give the desired effect.
The calculation of the dose for the child must be carried out very carefully, because the medicine is strong. The standard formula for determining the amount of the drug looks like this: 1.5-3 mg per 1 kg of the baby's weight. Given the activity of the substance, the dose received must be divided by 2. The volume found is the daily amount of the drug, which is taken in 2-3 approaches. If this dose of suspension or syrup per day does not give an effect for the child, it can be increased by 1/3.
Contraindications of nimesulide
The medicine has a strong effect, so you need to be especially careful during use. If you want to take nimesulide, you should know the instructions and the fact that it is prohibited for those who suffer from hypersensitivity, bronchial asthma, and intolerance to non-steroidal anti-inflammatory drugs. It is not worth using it for those who are addicted to drugs, drink alcohol, or have flu symptoms. In addition to the above, there are such contraindications to the use of nimesulide, indicated in the annotation:
- stomach ulcer and other gastrointestinal problems;
- hemophilia;
- heart, hepatic, or renal failure;
- pregnancy;
- lactation;
- children under 12 years old.
Non-categorical contraindications are heart failure, diabetes mellitus, cigarette smoking. It is worth paying attention to the compatibility of the drug with antiplatelet agents. The use of a non-steroidal drug by elderly people is recommended with caution. In the presence of relative contraindications, a specialist consultation is required, otherwise serious side effects are possible: nausea, vomiting, bleeding in the stomach.
Nimesulide price
The non-steroidal drug has a very strong effect, so only the original drug should be chosen. It is best to buy it in a simple pharmacy. So you can be sure that you will not fall for a fake. If you want to save money and buy a medicine inexpensively, then there is always the opportunity to order it in an online pharmacy with delivery. The price of nimesulide will be slightly cheaper there, but you will have to wait. It is worth remembering that the cost of the drug depends on the form of release. See the table for more details.
"Nimesulide", what does this nonsteroidal anti-inflammatory drug help from? The drug has a slight antipyretic and moderate analgesic effect. The instructions for use recommend taking Nimesulide tablets for arthritis, headache and toothache.
Composition and form of release
The medicine is produced in the form of greenish tablets "Nimesulide", from which it helps many patients with pain in the joints, with a content of the active element of the same name in a volume of 100 mg. Also, the drug is sold in the form of a suspension for internal administration with the inclusion of nimesulide in the same amount. Excipients are: microcrystalline cellulose, povidone, lactose monohydrate, starch, magnesium stearate.
Nimesulide tablets are packaged in a blister of 10 pieces. The cardboard box contains 2 (20 tablets) or 3 (30 tablets) blisters, as well as instructions for use.
Pharmacological properties
Nimesulide tablets, from which a significant anti-inflammatory effect is observed, have a moderate analgesic and weak antipyretic effect, slow down the reproduction of prostaglandins. This is due to the inhibition of cyclooxygenase, which allows suppressing inflammation and the accompanying pain in the lesion.
In addition, the drug prevents the formation of free radicals without affecting phagocytosis and hemostasis. The medication counteracts the release of myeloperoxidase, which also contributes to the anti-inflammatory effect.
The effect develops within 1-2 hours after taking the pill or suspension. The medication is excreted from the body completely within a day. With prolonged use, the effect of cumulation does not occur.
Tablets "Nimesulide": what helps the drug
The medication has no effect on the development of the disease. It is used to relieve pain, reduce inflammation, and for symptomatic treatment. The indications for taking the pills are as follows: 
- bursitis;
- arthritis of various origins;
- osteoarthritis;
- tendinitis;
- rheumatoid arthritis.
From what tablets "Nimesulide" still help? The tool is used to relieve pain when:
- arthralgia;
- myalgia;
- algodismenorrhea;
- after surgery;
- headache and toothache.
The drug "Nimesulide": instructions for use
The tablets must be taken after meals with a large volume of liquid. Adult patients are prescribed 1 tablet 2 times a day. An increase in dosage is possible, but the intake should contain no more than 4 capsules per day. The duration of treatment is up to 2 weeks. For children after 12 years of age, the volume of the drug is calculated based on the weight:
- more than 40 kg - 100 mg twice a day;
- up to 40 kg - 1.5 mg / kg.
Nimesulide tablets are given to children 2 times a day.
Contraindications
The instructions for use prohibit taking the drug "Nimesulide" when:
- exacerbations of stomach or intestinal ulcers;
- hypersensitivity to the components of the drug "nimesulide" (from which allergies can develop);
- blood clotting disorders;
- dysfunction of the liver and kidneys;
- heart failure;
- internal bleeding;
- alcoholism;
- the aspirin triad and asthma;
- together with hepatotoxic medicines;
- children under 12 years old;
- pregnant women;
- breastfeeding mothers;
- cerebrovascular hemorrhage.
Caution when taking pills should be observed in patients with diseases (including in the past) of the stomach or intestines, high blood pressure, diabetes, metabolic disorders, heart failure, in old age.
Side effects
When using the drug "Nimesulide", reviews and instructions confirm this, there may be negative reactions from the nervous, urinary, digestive, respiratory, hematopoietic, cardiac and vascular systems. After using the drug, you may experience: 
- headache, itching, interstitial nephritis;
- cholestasis, hemorrhage, bronchospasm;
- Hot flashes, Reye's syndrome, increased sweating;
- renal failure, gastritis, purpura;
- shortness of breath, palpitations, general weakness;
- fear, dermatitis, hematuria, vomiting, or nausea;
- pancytopenia, exacerbation of bronchial asthma;
- blurred vision, hypothermia, anxiety;
- erythema, dysuria, flatulence, thrombocytopenia;
- dizziness, angioedema, rash;
- urinary retention, jaundice, anemia;
- oliguria, abdominal pain, diarrhea.
Interaction
The drug "Nimesulide", when used simultaneously with anticoagulants, increases their effectiveness. A decrease in the diuretic result was noticed when used with the drug "Furosemide". The agent increases the toxicity of the drugs Methotrekat and Cyclosporin.
Price and analogues
"Nimesulide" can be replaced by such drugs as: "", "", "Ameolin", "Nimid", "", "Remesulide", "Nimesin", "Nigan". You can buy Nimesulide tablets at a price of 90 rubles for 20 pieces.
Conditions of release and storage
In the pharmacy network, Nimesulide tablets are dispensed with a doctor's prescription. Their independent use is not recommended, as this can cause unpleasant and serious complications or health consequences in the future.
The shelf life of Nimesulide tablets is 3 years from the date of manufacture. The medication should be stored in a place protected from light, moisture, out of reach of children, at an air temperature not exceeding + 25 ° C.
Patient opinions
Reviews of the drug "Nimesulide" are mostly positive. Many people use the medication for pain, inflammation, lowering the temperature. Patients praise the remedy for the speed and duration of action. Reviews of side effects are rare.
Nimesulide is a non-steroidal anti-inflammatory drug (hereinafter referred to as NSAIDs), a selective inhibitor of cyclooxygenase-2 (COX-2). It has a powerful anti-inflammatory, analgesic and, to a lesser extent, antipyretic (antipyretic) effect. It is one of the most popular NSAIDs in Russia. It is an effective remedy for the relief of acute pain syndrome of various etiologies. According to the WHO recommendations, NSAIDs and, in particular, nimesulide, are second-line drugs for the treatment of acute pain, after paracetamol. The mechanism of action of the drug is based on its ability to influence the metabolism of arachidonic acid, reducing the synthesis of pain and inflammation mediators by suppressing COX. Due to the selective effect on COX-2, the biosynthesis of cytoprotective prostaglandins in the gastric mucosa is not disturbed, which reduces the risk of developing gastrointestinal side effects. In addition to this, nimesulide reduces the activity of neutrophilic granulocytes in the production of superoxide anions, resulting in a decrease in the number of aggressive free radicals that aggravate the course of the inflammatory process. To date, the drug is used in the symptomatic treatment of osteoarthritis during the period of exacerbation of pain, with painful menstruation, for relief of postoperative pain, as well as for pain relief in dental practice. Nimesulide has an extensive evidence base for its effectiveness, including in comparison with other drugs. Thus, one of the randomized clinical trials compared the efficacy and safety of nimesulide and diclofenac. After a two-week course of medication, both drugs showed comparable efficacy with a slight advantage of nimesulide. In terms of portability, the superiority of the latter was more pronounced. In another study, nimesulide had to pass the naproxen test. The efficacy indicator in this study was the absence or significant reduction of pain during movement in patients with acute bursitis (inflammation of the periarticular bursa) and tendinitis (inflammation of the ligaments).
Effectively relieving pain, both drugs have proven themselves to be the best without any significant advantage to one of the competing parties. Negative adverse reactions were noted, for the most part, from the digestive tract. Their severity and frequency were higher in the naproxen group. It is important that nimesulide has been especially scrupulously studied by domestic specialists. So, since 1995, more than 20 large studies have been carried out in Russia, according to which nimesulide either surpassed in all respects, or not one iota was inferior to the recognized "masters" among NSAIDs: a significant improvement in the condition against the background of nimesulide therapy was achieved on average in 70 % of patients. The safety of the drug was also at an acceptable level: the number of patients with dyspeptic symptoms was 9.1%, ulcers of the gastrointestinal tract developed in 1.6% of patients, drug withdrawal was required in 1.4% of patients (comparison drugs in all these cases showed the worst results). This does not mean that nimesulide is ideally tolerated. However, its safety profile was significantly more favorable than that of diclofenac, which was used as an active control drug in most of the studies.
Nimesulide is available in tablet form. The recommended dose for adults is 100-200 mg 2 times a day, for children - 1.5 mg per 1 kg of body weight 2-3 times a day. In addition to direct contraindications, the drug has a number of other limitations. So, special care should be taken when prescribing nimesulide to patients suffering from arterial hypertension, renal and heart failure, and visual impairments. The use of nimesulide in pediatric practice in patients under 6 years of age should be carried out under close medical supervision.
Pharmacology
NSAIDs, in the structure of which there is a sulfonylide group. It is believed that nimesulide belongs to selective COX-2 inhibitors. It has a pronounced anti-inflammatory, as well as analgesic and, to a lesser extent, antipyretic effect. The mechanism of action is associated with inhibition of prostaglandin synthesis. Suppresses the synthesis of prostaglandins in the area of inflammation to a greater extent than in the gastric mucosa or kidneys, which is due to the inhibition of mainly COX-2.
In addition, in the mechanism of the anti-inflammatory action of nimesulide, its ability to suppress the formation of free oxygen radicals (without affecting hemostasis and phagocytosis) and inhibit the release of the enzyme myeloperoxidase is important.
Pharmacokinetics
After oral administration, nimesulide is well absorbed from the gastrointestinal tract, C max in blood plasma is achieved after 1-2 hours.
Protein binding is 99%. After oral administration of a single dose of 100 mg, nimesulide is present in the tissues of the female genital organs at a concentration of 40% of the plasma concentration.
It is metabolized in the liver, the main metabolite, hydroxynimesulide, has pharmacological activity.
T 1/2 from plasma is 2-3 hours.
It is excreted from the body mainly in the urine, about 98% of the dose is excreted within 24 hours. With prolonged therapy, no cumulation of nimesulide is observed.
Release form
The tablets are cylindrical, biconvex, light yellow.
Excipients: lactose monohydrate 115 mg, sodium carboxymethyl starch 28 mg, povidone 16 mg, magnesium stearate 3.2 mg, microcrystalline cellulose 52.2 mg, colloidal silicon dioxide 2 mg, water 3.6 mg.
10 pieces. - contour cell packaging (1) - cardboard packs.
10 pieces. - contour cell packaging (2) - cardboard packs.
10 pieces. - contour cell packaging (3) - cardboard packs.
10 pieces. - contour cell packaging (4) - cardboard packs.
10 pieces. - contour cell packaging (5) - cardboard packs.
10 pieces. - contour cell packaging (6) - cardboard packs.
10 pieces. - contour cell packaging (8) - cardboard packs.
10 pieces. - contour cell packs (10) - cardboard packs.
20 pcs. - contour cell packaging (1) - cardboard packs.
20 pcs. - contour cell packaging (2) - cardboard packs.
20 pcs. - contour cell packaging (3) - cardboard packs.
20 pcs. - contour cell packaging (4) - cardboard packs.
20 pcs. - contour cell packaging (5) - cardboard packs.
20 pcs. - contour cell packaging (6) - cardboard packs.
20 pcs. - contour cell packaging (8) - cardboard packs.
20 pcs. - contour cell packs (10) - cardboard packs.
30 pcs. - contour cell packaging (1) - cardboard packs.
30 pcs. - contour cell packaging (2) - cardboard packs.
30 pcs. - contour cell packaging (3) - cardboard packs.
30 pcs. - contour cell packaging (4) - cardboard packs.
30 pcs. - contour cell packaging (5) - cardboard packs.
30 pcs. - contour cell packaging (6) - cardboard packs.
30 pcs. - contour cell packaging (8) - cardboard packs.
30 pcs. - contour cell packs (10) - cardboard packs.
10 pieces. - polymer cans (1) - cardboard packs.
20 pcs. - polymer cans (1) - cardboard packs.
30 pcs. - polymer cans (1) - cardboard packs.
40 pcs. - polymer cans (1) - cardboard packs.
50 pcs. - polymer cans (1) - cardboard packs.
100 pieces. - polymer cans (1) - cardboard packs.
Dosage
Inside for adults, 100-200 mg 2 times / day, for children - 1.5 mg / kg 2-3 times / day.
The maximum dose for children is 5 mg / kg / day in 2-3 doses.
Interaction
Possible manifestations of drug interactions while taking nimesulide orally with digoxin, phenytoin, lithium preparations, diuretics, antihypertensive drugs, other NSAIDs, anticoagulants, cyclosporine, methotrexate, oral hypoglycemic agents.
Side effects
From the digestive system: heartburn, nausea, stomach pain; in some cases - tarry stools, melena (associated with bleeding and erosive and ulcerative lesions of the gastrointestinal tract).
From the side of the central nervous system: rarely - headaches, dizziness, drowsiness.
Allergic reactions: skin rash, erythema, urticaria.
Others: rarely - oliguria, fluid retention in the body, local or systemic edema; in some cases - thrombocytopenic purpura.
Indications
Osteoarthritis, extra-articular rheumatic diseases, pain and inflammation after surgery, pain and fever in acute inflammatory processes in the upper respiratory tract, pain associated with dysmenorrhea.
There are no direct indications of the embryotoxic and tocolytic effect of nimesulide.
Application for violations of liver function
Contraindicated in moderate to severe hepatic impairment.Application for impaired renal function
Contraindicated in renal failure (CC less than 30 ml / min).Application in children
special instructions
It should be used with caution by mouth in patients with impaired renal function, with arterial hypertension, with impaired heart function, visual impairment.
When applied externally, a doctor's control over the condition of elderly patients with impaired renal function, liver function, and congestive heart failure is required.
When used in pediatrics, dosage forms intended for children should be used. In children under 6 years of age, when using nimesulide externally, a doctor's supervision is required.
Influence on the ability to drive vehicles and control mechanisms
Due to the fact that nimesulide, when taken orally, can cause dizziness and drowsiness, it should be used with caution in patients engaged in potentially hazardous activities that require increased concentration of attention and rapid psychomotor reactions.
NSAIDs. Selective COX-2 inhibitor
Active substance
Nimesulide
Release form, composition and packaging
1000 pcs. - plastic bags (1) - plastic containers.
pharmachologic effect
NSAIDs, has anti-inflammatory, analgesic, antipyretic and antiplatelet effects. Unlike other NSAIDs, it selectively inhibits cyclooxygenase-2 (COX-2), inhibits the synthesis of prostaglandins (Pg) in the inflammation focus; has a less pronounced inhibitory effect on cyclooxygenase-1 (COX-1) (less often causes side effects associated with inhibition of Pg synthesis in healthy tissues).
Pharmacokinetics
Oral absorption is high (food intake reduces the rate of absorption without affecting its degree). Time to reach C max - 1.5-2.5 hours. Protein binding - 95%, with erythrocytes - 2%, with lipoproteins - 1%, with acid alpha1-glycoprotein - 1%. Dose variation does not affect the degree of binding. C max - 3.5-6.5 mg / l. V d - 0.19-0.35 l / kg. It penetrates well into the acidic environment of the focus of inflammation (40%), synovial fluid (43%). Easily penetrates histohematogenous barriers. It is metabolized in the liver by tissue monooxygenases. The main metabolite -4-hydroxynimesulide (25%), has a similar pharmacological activity, but due to a decrease in the size of the molecules, it is able to quickly diffuse along the hydrophobic channel of COX-2 to the active binding site of the methyl group. 4-hydroxynimesulide is a water-soluble compound that does not require glutathione and phase II metabolism conjugation reactions (sulfation, glucuronidation, etc.) to be eliminated. T 1/2 of nimesulide - 1.56-4.95 hours, 4-hydroxynimesulide - 2.89-4.78 hours. 4 - Hydroxynimesulide is excreted by the kidneys (65%) and with bile (35%), undergoes enterohepatic recirculation.
Indications
- rheumatoid arthritis;
- osteoarthritis;
- arthritis of various etiologies;
- arthralgia;
- myalgia;
- postoperative and post-traumatic pain;
- bursitis;
- tendinitis;
- algodismenorrhea;
- toothache and headache.
The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, does not affect the progression of the disease.
Contraindications
- complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose or paranasal sinuses and intolerance (ASA) and other NSAIDs (including in history);
- erosive and ulcerative lesions of the mucous membrane of the stomach and duodenum;
- active gastrointestinal bleeding;
- cerebrovascular or other bleeding;
- inflammatory bowel diseases (Crohn's disease, ulcerative colitis) in the acute phase;
- hemophilia and other blood clotting disorders;
- decompensated chronic insufficiency (CHF);
- liver failure or any active liver disease;
- hepatotoxic reactions when using nimesulide in history;
- alcoholism;
- drug addiction;
- severe chronic renal failure (CRF) (CC less than 30 ml / min);
- progressive kidney disease;
- confirmed hyperkalemia;
- the period after coronary artery bypass grafting;
- concomitant use of other hepatotoxic drugs;
- children under 12 years old;
- pregnancy;
- lactation period;
- increased sensitivity.
WITH caution: Ischemic heart disease, cerebrovascular diseases, CHF, dyslipidemia / hyperlilidemia, diabetes mellitus, peripheral arterial disease, smoking, renal failure (CC less than 30-60 ml / min), anamnestic data on the development of gastrointestinal ulcers, the presence of Helicobacter pylori infection, old age, long-term use of NSAIDs, severe somatic diseases, concomitant use (including warfarin), antiplatelet agents (including ASA, clopidogrel), oral corticosteroids, selective serotonin reuptake inhibitors (including fluoxetine, paroxetine, sertraline ).
Dosage
The content of 1 sachet of granulate is dissolved in 80-100 ml of water. The recommended dose for is 100 mg (1 sachet) 2 times / day after meals. The maximum daily dose for adults and adolescents aged 12-18 is 200 mg.
No dose reduction required for elderly patients.
Patients with chronic renal insufficiency a decrease in the daily dose to 100 mg is required.
The minimum effective dose should be administered for as short a period of time as possible in order to minimize the risk of adverse reactions. The maximum duration of taking the drug should not exceed 15 days.
Side effects
Allergic reactions: hypersensitivity reactions, anaphylactoid reactions.
From the side of the central nervous system: dizziness, fear, nervousness, nightmares, headache, drowsiness, encephalopathy (Reye's syndrome).
From the side of the skin: itching, skin rash, increased sweating, erythema, dermatitis, urticaria, angioedema, facial swelling, exudative erythema multiforme, incl. Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome).
From the urinary system: edema, dysuria, hematuria, urinary retention, hyperkalemia, renal failure, oliguria, interstitial nephritis.
From the digestive system: diarrhea, nausea, vomiting, constipation, flatulence, gastritis, abdominal pain, stomatitis, tarry stools, gastrointestinal bleeding, ulcer and / or perforation of the stomach or duodenum.
From the liver and biliary system: increased hepatic transaminases, hepatitis, fulminant hepatitis, jaundice, cholestasis.
From the hematopoietic system: anemia, eosinophilia, thrombocytopenia, pancytopenia, purpura, prolonged bleeding time.
From the respiratory system: shortness of breath, exacerbation of bronchial asthma, bronchospasm.
From the senses: blurred vision.
On the part of the cardiovascular system: arterial hypertension, tachycardia, hemorrhages, hot flashes.
Others: general weakness, hypothermia.
Overdose
Symptoms: nausea, vomiting, drowsiness, apathy, gastrointestinal bleeding, increased blood pressure, acute renal failure, respiratory depression;
Treatment: symptomatic and supportive treatment is recommended. There is no specific antidote for Nimesulide. Patients admitted to the hospital with symptoms of an overdose of the drug (within 4 hours after taking it or after taking a high dose) are recommended to wash the stomach, take activated carbon (for adults - 60-100 mg) and / or an osmotic-type laxative. Regular monitoring of liver and kidney function is required. There are no data on the possibility of removing nimesulide by hemodialysis. Formed diuresis, hemodialysis are ineffective due to the high connection of the drug with proteins.
Drug interactions
There is evidence that nimesulide can reduce the bioavailability of furosemide, compete in the binding of plasma proteins with fenofibrate, tolbutamide.
Nimelide can replace salicylic acid and furosemide (but not warfarin) in plasma proteins.
It has no effect on drugs affecting blood glucose concentration and glucose tolerance in diabetic patients treated with various drugs containing sulfonylurea derivatives.
Physiological concentrations of unsaturated fatty acids do not affect the binding of nimesulide to serum albumin.
At therapeutic concentrations, the binding of nimesulide was not affected by warfarin, furosemide, glibenclamide, digitoxin.
In the presence of nimesulide, the free fractions of methotrexate can increase significantly.
Taking nimesulide in therapeutic doses by mouth for a short period does not alter the serum profile of digoxin in patients with mild heart failure.
The concentration of lithium in plasma increases with the simultaneous administration of lithium and nimesulide preparations. Nimesulide may increase the effect of cyclosporine on the kidneys.
Use with corticosteroids, serotonin reuptake inhibitors, increases the risk of gastrointestinal bleeding.
special instructions
To reduce the risk of side effects, it is necessary to use the drug in the minimum effective dose with the shortest duration. If the patient's condition does not improve, treatment must be discontinued.
It is necessary to stop taking the drug if the temperature rises or develops against the background of taking flu-like symptoms.
Gastrointestinal bleeding or ulcer / perforation of the stomach or duodenum may develop at any time during the use of the drug, which may not be accompanied by clinically pronounced symptoms (including pain syndrome). If gastrointestinal bleeding or ulcers occur, the drug should be discontinued.
If the drug is used for more than 2 weeks, it is necessary to monitor liver function indicators.
In patients with cirrhosis of the liver or with renal failure with hypoalbuminemia or hyperbilirubinemia, the binding of nimesulide is reduced.
Elderly patients most often develop side effects when taking the drug, including gastrointestinal bleeding, perforation, dysfunction of the heart, kidneys and liver. Therefore, regular clinical monitoring of the patient's condition is recommended.
The use of nimesulide may adversely affect female fertility and is not recommended for women planning a pregnancy.
Influence on the ability to drive vehicles and control mechanisms
If, when using the drug, there are undesirable effects on the part of the central nervous system and sensory organs, it is necessary to refrain from driving vehicles and engaging in activities that require increased concentration of attention and speed of psychomotor reactions.
Pregnancy and lactation
Contraindicated during pregnancy and lactation.
Childhood use
Contraindicated in children under 12 years of age.
With impaired renal function
Contraindicated in severe chronic renal failure (CRF) (CC less than 30 ml / min); with progressive kidney disease.
With care: renal failure (CC less than 30-60 ml / min).
Patients with chronic renal failure require a daily dose reduction of up to 100 mg.
In case of deterioration of renal function, the drug should be canceled.
For violations of liver function
Contraindicated in liver failure or any active liver disease.
If patients taking Nimesulide develop symptoms indicating liver damage (eg, anorexia, nausea, vomiting, abdominal pain, fatigue, dark urine), or an increase in hepatic transaminases, the drug should be discontinued. Such patients are not recommended to prescribe Nimesulide in the future.
