Nimesulide
- Atc Codes:M01AX17#M02AA26
- CAS Codes:51803-75-2
- PHARMGKB ID:51803-75-2
Table of contents
- Brand Names
- Drug Combinations
- Chemistry
- Pharmacologic Category
- Mechanism of Action
- Therapeutic Use
- Pregnancy and Lactation Implications
- Contraindications
- Warnings and Precautions
- Adverse Reactions
- Toxicological Effects
- Genes that may be involved
- Substrate of
- Inhibits
- Drug Interactions
- Dosage
- Pharmacokinetics and Pharmacodynamics
- Special Considerations
Brand Names
Europe
Austria: Aulin, Mesulid; Bulgaria: AllGone, Ameolin, Aulin, Biolin, Coxtral, Enetra, Nimed, Nimesil; Cyprus: Elinap, Flogostop, Nimelide, Specilid; Czech Republic: Aulin, Coxtral, Mesulid, Nimed, Nimesil; France: Nexen, Nimesulide; Germany: Zolan; Greece: Alencast, Algosulid, Algover, Amocetin, Aulin, Bioxidol, Chemisulide, Cliovyl, Discoric, Elinap, Fladalgin, Flogostop, Kartal, Lalide, Lemesilin, Lovirem, Melicat, Melimont, Mesilex, Mesulid, Mesupon, Min-A-Pon, Mosuolit, Multiformil, Myxina, Naofid, Niberan, Nimegel, Nimelide, Nimesul, Nimesulide, Ristolzit, Ritamine, Rolaket, Specilid, Tranzicalm, Ventor, Volonten; Hungary: Mesulid, Nidol, Nimelid, Winsulid, Xilox; Ireland: Aulin, Mesulid; Italy: Actalide, Algimesil, Algolider, Antalor, Areuma, Aulin, Dimesul, Domes, Efridol, Erreflog, Fansulide, Flolid, Isodol, Ledoren, Mesulid, Nerelid, Nimedex, Nimesulene, Nimesulide, Oronime, Pantames, Remov, Solving, Sulidamor; Latvia: Aponil, Coxtral, Mesulid, Nimesil; Lithuania: Aponil, Coxtral, Mesulid, Nimesil; Luxembourg: Mesulid; Poland: Aulin, Coxtral, Mesulid, Minesulin, Moxenil, Nimesil; Portugal: Aulin, Donulide, Nimalge, Nimartin, Nimed, Nimesulene, Nimesulida, Reumolide, Sulidor, Vitolide; Romania: Aponil, Aulin, Coxtral, Lemesil, Nimesil, Nimesulid, Sulidamor; Slovakia: Aulin, Coxtral, Mesulid, Nimed, Nimesil; Slovenia: Aulin.
Latin America
Argentina: Aldoron, Virobron; Brazil: Arflex Retard, Cimelide, Deflogen, Deltaflan, Fasulide, Inflalid, Neosulida, Nimesilam, Nimesubal, Nimesulida, Nimesulin, Nisoflan, Nisulid, Scaflam, Scalid, Sintalgin; Mexico: Apolide, Cargespril, Defam, Degorflan, Dexlin, Eskaflam, Fenoxil, Flamide, Flamozin, Igrexa, Inim, Lesiden, Lusemin, Medani, Meliden, Nidolin, Nilden, Nimepis, Nimesulida, Nizurin, Quidofril, Redaflam, Severin, Sidel, Sindel, Sulidek, Sulidol-GB, Sundir, Ul-Flam.
Drug combinations
Nimesulide and Azithromycin
Nimesulide and Orphenadrine
Chemistry
Nimesulide: C~13~H~12~N~2~O~5~S. Mw: 308.31. 4′-Nitro-2′-phenoxymethanesulfonanilide. CAS-51803-75-2.
Pharmacologic Category
Analgesics and Antipyretics; Other Nonsteroidal Anti-inflammatory Agents. Skin and Mucous Membrane Agents; Anti-inflammatory Agents. (ATC-Code: M01AX17; M02AA26).
Mechanism of action
Targets a number of key mediators of inflammatory process such as COX-2/PTGS2-mediated prostaglandins, free radicals, proteolytic enzymes, histamine and substance P. Nimesulide has anti-inflammatory, antipyretic, and analgesic properties. Nimesulide differs from other NSAIDs by having a sulfonanilide as its functional acidic group. Nimesulide inhibits prostaglandin synthetase (cyclooxygenase), which in turn limits prostaglandin production. Its cyclooxygenase-inhibiting potency is considered to be intermediate when compared with other NSAIDs. It appears that positive anti-inflammatory activity of NSAIDs can be attributed to their ability to inhibit COX-2/PTGS2 while their associated side-effects are due to their ability to inhibit COX-1/PTGS1. Studies have shown that nimesulide is relatively selective for COX-2/PTGS2. In addition, nimesulide acts as free radical scavenger and interferes with production of oxygen radicals by leukocytes without inhibiting leukocyte chemotaxis and phagocytosis. Since products of free radicals directly and indirectly damage host tissue and contribute to maintenance of inflammatory process, nimesulide helps protect against tissue damage that occurs during inflammation and short-circuits inflammatory process. Nimesulide exerts potent anti-inflammatory effect in vivo even greater than its anti-prostaglandin effect.
Therapeutic use
Acute pain. Symptomatic treatment of painful osteoarthritis. Primary dysmenorrhea. Nimesulide has especially proved useful in patients who do not respond adequately to other NSAIDs, and patients who are NSAID-intolerant due to hypersensitivity (e.g. asthmatics) or gastric intolerance.
Pregnancy and lactiation implications
Irreversible end-stage renal failure reported in a neonate born to a mother who received nimesulide as tocolytic from 26^th^ to 32^nd^ week of pregnancy. Others reported neonatal renal failure associated with nimesulide. Not recommended in pregnancy. Contraindicated in 3^rd^ trimester. Contraindicated in breastfeeding.
Unlabeled use
Contraindications
Contraindicated in children <12 years. Hypersensitivity to nimesulide or to any excipient of the products. History of hypersensitivity reactions (e.g. bronchospasm, rhinitis, urticaria) in response to acetylsalicylic acid or other NSAIDs. History of hepatotoxic reactions to nimesulide. Concomitant exposure to other potentially hepatotoxic substances. Alcoholism, drug addiction. Active gastric or duodenal ulcer, history of recurrent ulceration or GI bleeding, cerebrovascular bleeding or other active bleeding or bleeding disorders. Severe coagulation disorders. Severe heart failure. Severe renal impairment. Hepatic impairment. Fever and/or flu-like symptoms. Pregnancy (3^rd^ trimester) and breastfeeding.
Warnings and precautions
Increases risk of liver toxicity (use should be limited to maximum of 15 days). Treatment should be discontinued if no benefit seen. Concomitant administration with known hepatotoxic drugs, and alcohol abuse must be avoided, since either may increase risk of hepatic reactions. During therapy with nimesulide, patients should be advised to refrain from other analgesics. Simultaneous use of different NSAIDs not recommended. Patients receiving nimesulide who develop fever and/or flu-like symptoms should discontinue treatment. GI bleeding or ulceration/perforation can occur at any time during treatment with or without warning symptoms or previous history of GI events. If GI bleeding or ulceration occurs, nimesulide should be discontinued. In renal or cardiac impairment, caution required since use of nimesulide may result in deterioration of renal function. In the event of deterioration, treatment should be discontinued. Contraindicated in severe renal impairment (CrCl <30 mL/minute). Contraindicated in hepatic impairment. Elderly patients are particularly susceptible to adverse effects of NSAIDs, including GI hemorrhage and perforation, impaired renal, cardiac and hepatic function. As nimesulide can interfere with platelet function, it should be used with caution in bleeding diathesis. Nimesulide not a substitute for acetylsalicylic acid for cardiovascular prophylaxis. NSAIDs may mask fever related to underlying bacterial infection. Use of nimesulide may impair female fertility and is not recommended in women attempting to conceive. Nimesulide should not be used concurrently or within 8 weeks of administration of amoxycillin/clavulanic acid.