Choice of non-steroidal anti-inflammatory drug for symptomatic treatment of rheumatic diseases: focus on nimesulide

Non-steroidal anti-inflammatory drugs are often used to relieve acute pain and eliminate symptoms of inflammation. Nimesil and its analogues are not first-line drugs and are recommended for use only if weaker drugs (paracetamol, diclofenac, ibuprofen) are ineffective.

According to the official instructions, Nimesil is a prescription medicine. Indications for use include moderate and severe pain of various origins (inflammatory, neurogenic, traumatic, postoperative), hyperthermia with chills, myalgia, dysmenorrhea.

Nimesil is sold in the form of a fast-dissolving granular powder, which before use must be dissolved in 150 ml of clean water to obtain an oral solution. This form of release provides the fastest possible therapeutic effect. Each sachet contains 100 mg of nimesulide, an NSAID that reduces the synthesis of inflammatory mediators such as prostaglandins, leukotrienes, and arachidonic acid. Thanks to this, it is possible to eliminate pain and reduce body temperature.

This powder is prohibited for use in the presence of such concomitant diseases as acute and chronic gastritis, duodenitis, duodenal and gastric ulcers, ulcerative colitis, aspirin-induced asthma, bleeding disorders, severe hepatic, hepatic and heart failure.

The official instructions for Nimesil provided by the manufacturer indicate that febrile fever and signs of influenza are contraindications to the use of this drug. Age limit – 12 years. The most common treatment regimen is 1 sachet as needed.

Cost of Nimesil and its analogues

Nimesil is an imported drug; it is produced by several pharmaceutical companies - Laboratorios Menarini (Italy) and Fine Foods & Pharmaceutical (Spain). This is one of the first nimesulide-based drugs registered in Europe. At the moment, a large number of generics have appeared on the market, which have the same clinical effect, but have a lower cost.

Similar means

The doctor may prescribe some other remedy that will act in much the same way as Nimesil. The composition in this case will also be similar to this medicine. A specialist can prescribe an analogue if the patient is allergic to one or another component of this drug. But usually in such a way that it does not cause any “side effects”. The main analogues of "Nimesil" are as follows:

• "Kokstral";
• "Nimesulide";
• "Remisid";
• "Nise";
• "Aponil";
• "Nimika";
• "Nimulid";
• "Nimegesic";
• "Nimid."

"Nimid"

Cheap analogues of Nimesil in tablets

Thanks to its special release form, Nimesil has the fastest possible analgesic effect. In cases where it is not possible to prepare a solution (for example, on the road), it is more convenient to use similar drugs in tablets. They cost a little less than the original drug, but are also effective.

Nimulid

The drug is made in India and is produced by Panacea Biotek. It is most often used for the treatment of inflammatory diseases of the musculoskeletal system (myositis, arthritis, arthrosis), helps to quickly eliminate pain of various origins, including after surgery and injuries. A special feature is the presence of not only tablets for oral administration, but also a sublingual form, which is intended for resorption in the oral cavity. For children over 6 years of age, Nimulid is used in the form of a suspension. The maximum daily dose for adults is 200 mg, that is, 2 tablets; for children it is calculated individually based on the formula 5 mg/kg body weight. The duration of action of the drug is 5-6 hours.

It is a second-line drug, since in addition to a good analgesic effect, it can cause adverse reactions, has a toxic effect on the liver, and can provoke bleeding or a hypertensive crisis.

Aponil

Tablets registered in our country as an antirheumatic and non-steroidal anti-inflammatory drug. Produced by the European company Mekodemi LTD (Cyprus) in the form of tablets with a single dosage - 0.1 g of nimesulide. Each cardboard package contains 2 plastic cellular blisters of 10 tablets. Lactose monohydrate, sodium docusate, hydrogenated vegetable oil (palm or coconut), corn and potato starch, and microcellulose are used as auxiliary components in the production of Aponil. According to the recommendations of specialized associations for stepwise pain therapy, Aponil is used for relieved acute pain syndrome when other analgesics are ineffective. This medicine helps to quickly eliminate myalgia, arthralgia, headache and toothache.

The drug should not be used by children, pregnant or lactating women. Contraindications include alcoholism, aspirin-induced asthma, impaired detoxification function of the liver, chronic kidney disease, exacerbation of inflammatory and ulcerative diseases of the gastrointestinal tract.

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Most often the drug is used symptomatically, but if long-term pain relief is needed, 1 tablet is prescribed 2 times a day after meals. The duration of treatment is determined individually, taking into account the indications.

Nimika

A non-narcotic analgesic with anti-inflammatory and analgesic properties. Indicated for toothache, lumbodynia, neuritis, injuries. Can be used to relieve pain during surgical procedures in dentistry, as well as after surgical interventions.

It is produced in India by the pharmaceutical company Ipka in tablet form with a dosage of 0.05 and 0.1 mg of nimesulide. According to the instructions, before taking, you need to dissolve 1 or 2 tablets in a spoon of water. For adults, Nimika is prescribed 100 mg 2 times a day. For children, an oral suspension is used (10 mg of nimesulide in 1 ml), a single dose is calculated taking into account weight and age, on average 2 mg/kg.

Contraindications: allergy to acetylsalicylic acid and other NSAIDs, increased bleeding, acute heart failure, renal and liver failure.

Nimesulid-Teva

A modern analgesic whose chemical structure is a sulfonanilide. Inhibits the synthesis of prostaglandins, arachidonic acid, leukotrienes, thereby eliminating signs of inflammation such as pain, swelling, and fever. Quickly normalizes well-being in infectious and inflammatory diseases that are accompanied by intoxication and fever, and also eliminates neurogenic and traumatic pain.

Nimesulide-Teva affects the pharmacodynamic properties of a large number of drugs and is therefore not recommended for routine use. The drug is prohibited for use by pregnant and lactating women and children under 12 years of age. To eliminate pain or hyperthermia, in most cases, a single dose of the tablet is sufficient.

Nimesan

Manufactured in India by Shreya. Packages of 20 tablets at a dosage of 100 mg are available for sale. Purified microcellulose, potato starch, sodium stearate, and lactose are used as auxiliary substances in production. Nimesan tablets are quickly absorbed from the gastrointestinal tract, the effect is noticeable 15-20 minutes after administration and lasts up to 6 hours. Indications for use: severe pain that cannot be relieved by other NSAIDs.

Nimesan is not recommended for long-term treatment. If the dosage is exceeded, as well as frequent use of this medicine, undesirable reactions may occur - dizziness, sleep disturbances, nausea, vomiting, stool upset, abdominal pain. The drug is hepatotoxic; in case of liver failure, dose adjustment is necessary. Age limit – 12 years.

During pregnancy and lactation, taking Nimesan can have negative effects on the fetus and child, so you should give preference to safer drugs.

Are pregnant women allowed to take the drug?

"Nimesil" is a drug belonging to the class of NSAIDs and inhibits the production of prostaglandins. This means that it can harm the fetus or its mother. Also, the drug may cause the ductus arteriosus to be blocked prematurely. The following pathologies sometimes develop because of it:

• hypertension in the pulmonary artery;
• renal dysfunction, as a result of which the appearance of renal failure, aggravated by oligodyramnia, cannot be excluded;
• bleeding;
• weakening of uterine contractility;
• peripheral edema.

Pregnant women should refrain from using Nimesil

So, it is clear: the drug is absolutely incompatible with a healthy pregnancy. Lactation is also a contraindication.

Inexpensive substitutes for Nimesil powder

If you need to quickly eliminate pain or fever, it is rational to use the drug in powder. This ensures high bioavailability of the drug and the fastest possible clinical effect. Sachets containing a single dose can be purchased individually at pharmacies.

Nise

Belongs to the group of non-steroidal anti-inflammatory drugs. The active ingredient is nimesulide. The chemical properties are sulfonanilide, and the mechanism is associated with blocking type 2 cyclooxygenase receptors. Indicated for the treatment of lumbago, gout attacks, arthritis of various etiologies. The drug has a fairly large number of side effects, which is associated with high hepatotoxicity, therefore it is not recommended in routine practice and is a second-line therapy.

Produced by the pharmaceutical company Dr. Reddis, India. A special feature is the presence of several forms of release:

• Sachets of granulated powder for preparing a solution, 2g;
• Enteric tablets;
• Oral suspension.

The drug can be used by children over 7 years of age with strict adherence to the instructions and constant medical supervision.

Nemulex

The drug is packaged in the Russian Federation by Sotex PharmFirma, which carries out control before sale. Raw materials based on nimesulide are produced in Romania at the Rompharm Company plant.

Release form: dry powder in the form of granules. After dissolution in water, a homogeneous suspension with a pleasant orange taste and smell is formed. The drug is used as symptomatic treatment of diseases that are accompanied by severe pain - osteochondrosis, arthrosis and arthritis, bursitis, myalgia, toothache and headache, radicular syndrome. It is prohibited to use the drug during pregnancy and breastfeeding.

Possible adverse reactions include allergies, urticaria, dizziness, drowsiness, depressed emotional state, nausea, abdominal pain.

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Nimid

An anesthetic drug based on nimesulide, which is available in sachets containing 2 g of instant powder. It belongs to non-narcotic analgesics of category B, sold by prescription.

Recommended as a second-line anti-inflammatory and analgesic agent. Effectively eliminates pain of any etiology, helps reduce signs of inflammation during infection or injury.

Produced in India by the pharmaceutical company Kusum in several dosage forms that can be combined to achieve maximum effect:

• powder for suspension;
• pills;
• gel for external use.

When is the drug prescribed?

Doctors prescribe this medication when the patient feels acute pain. The indications are as follows:

• pain caused by injuries;
• tendinitis;
• pain from menstruation (in women);
• tooth pain;
• osteoarthrosis, osteochondrosis;
• myalgia;
• bursitis;
• arthritis;
• rheumatoid arthritis;
• arthralgia.

The drug is prescribed for pain caused by both diseases of the spine and pathologies of internal organs

For quite a long time, this medicine was prescribed for common colds and other pathologies that increase body temperature. However, this is now a dubious indication: Nimesil is now prescribed only if none of the other NSAIDs helps. It is especially often used for back pain caused by pathologies of the locomotor system, in particular osteochondrosis.

Analogues with a minimum of side effects

When choosing an NSAID, you need to take into account a large number of factors - the severity of pathological symptoms, age, and the presence of concomitant diseases. There are no medications without side effects, so it is very important to follow the instructions, choose the safest medications and use the minimum effective doses. You can replace Nimesil with over-the-counter analgesics, which have fewer unwanted effects and contraindications.

Ibuprofen

The international nonproprietary name is similar to the active ingredient - Ibuprofenum. According to its chemical structure, it is a derivative of propionic acid, which has a blocking effect on the COX enzyme and reduces the production of inflammatory mediators. The drug also helps eliminate fever and chills. Can be used during pregnancy and lactation as prescribed by a doctor. Special forms of ibuprofen have been developed in the form of syrup and suspension, which allows it to be prescribed to children after 3 months.

The most popular tablets from these manufacturers:

• Darnitsa, Ukraine;
• Borisov ZMP, Belarus;
• Borshchagovsky Chemical Plant, Ukraine;
• Akrikhin, Russian Federation;
• Hemofarm, Serbia;
• Tatchimpharmpreparaty, Russia.

Tablets contain 100, 200 or 400 mg of ibuprofen. The drug can be used for 2-3 weeks. Dosage regimen: 1 tablet 2 times a day, depending on the clinical situation.

Nalgesin

A modern analgesic-antipyretic containing 275 mg of naproxen in the form of sodium salt. The mechanism of action is associated with inhibition of the activity of enzymes involved in the synthesis of inflammatory mediators (prostaglandins and leukotrienes). This medicine also has antithrombotic properties. The drug has high bioavailability and is well tolerated by most patients.

According to the instructions, Naproxen is indicated for the treatment of radiculitis, ischalgia, radicular neuralgia, headache, muscle, joint and menstrual pain.

Contraindications:

• pregnancy and lactation;
• acute inflammatory diseases of the gastrointestinal tract (gastritis, duodenitis, peptic ulcer);
• intolerance to one of the components;
• bleeding disorders.

Undesirable effects when taking Nalgesin are associated with the individual characteristics of the body or an incorrectly selected dosage. They may manifest as a feeling of drowsiness and depression, abdominal discomfort, and dizziness.

The drug is produced in Slovenia by the company KRKA. A prescription is not required to purchase Nalgesin tablets.

Ketonal

The main active ingredient is ketoprofen. It is a representative of the latest generation of NSAIDs. In addition to blocking the action of all types of COX, it has the ability to inhibit the enzyme lipoxygenase. As a result, the concentration of bradykinin, prostaglandin and other inflammatory mediators decreases.

Indications for use:

• hyperthermia;
• infectious and inflammatory diseases of various localizations;
• acute and chronic pain.

The drug is contraindicated in cases of aspirin intolerance, bronchial asthma, gastric and duodenal ulcers, and increased bleeding.

Ketonal is available in capsules and tablets of 25, 150 and 200 mg. The presence of an injection form and a variety of dosages allows you to select the minimum effective dose, method and frequency of use of the drug. Ketonal can be used either as symptomatic therapy once or in a course of 2-3 weeks. Manufacturer: Lek DD, Slovenia.

How does Nimesil interact with other medications?

Pharmacodynamics

If you use Nimesil with glucocorticosteroids, you can get a gastrointestinal ulcer/bleeding.

Combining it with antiplatelet drugs and SSRIs, say fluoxetine, can increase the likelihood of GI bleeding.

The effects of anticoagulants such as warfarin may be increased by taking NSAIDs. But the increased likelihood of bleeding makes this combination much less useful. For those who have serious problems with coagulation, this is even more contraindicated. If it is impossible to do without this combination, you should carefully monitor how well the blood clots.

Interaction with diuretics

"Nimesil", like any other NSAID drug, can make the effect of diuretics weaker. If the patient is not sick with anything else, nimesulide slows down the excretion of sodium for some time due to the effect of furosemide, somewhat less - the excretion of potassium, and indeed the result of using a diuretic. If the drug nimesulide and furosemide are used simultaneously, the result is a 1/5 decrease in the area under the concentration-time curve, and also a decrease in the cumulative excretion of furosemide without distorting the renal clearance of the same drug. So if kidney/heart pathologies are detected, this combination should be used with extreme caution.

You should be careful with the combination of Nimesil and diuretics

ACE inhibitors and angiotensin-2 receptor antagonists in combination with Nimesil

If you use these two types of drugs together with NSAIDs, it is possible that the effect of the former will be weaker. If there is even mild renal failure, this sometimes spoils the functioning of the kidneys and provokes their acute failure. It is already irreversible. All this must be taken into account if a person uses Nimesil with ACE inhibitors or angiotensin-2 receptor antagonists. So great caution is required from a specialist if he prescribes such a combination of medications. Especially if the patient has reached old age. The patient needs to drink a lot of water, and the functioning of his kidneys must be kept under very close control throughout the entire duration of such therapy.

How does Nimesil interact pharmacokinetically with other medications?

NSAIDs are known to impair the elimination of lithium from the human body, thereby increasing its toxicity and blood levels. When prescribing nimesulide to someone who is taking lithium drugs, the doctor is obliged to monitor how much lithium accumulates in the patient’s blood.

No significant problems have been identified caused by the combination of Nimesil with any of the following drugs:

• glibenclamide;
• digoxin;
• cimetidine;
• antacids.

“Nimesil” can be combined with some drugs without problems

When prescribing a patient to take nimesulide with a time interval between it and methotrexate of less than a day, the doctor must be careful: this can increase the level of methotrexate in the blood, and the harm from it too.

Due to their effect on renal prostaglandins, nimesulide and other inhibitors of this substance sometimes increase the nephrotoxicity of cyclosporines.

How do other medications interact with nimesulide?

According to research, the following medications displace nimesulide from binding zones:

• tolbutamide;
• salicylic acid;
• valproic acid.

Although this was found in blood plasma, nothing similar was seen in clinical use.

Reviews from doctors and patients

1. Andrey Viktorovich, dentist: “After opening the gumboil and removing a tooth, I always recommend that my patients take Nimesil, in addition to the antibiotic. After the anesthesia wears off, it effectively eliminates discomfort and swelling of the gums.”
2. Marina: “After cauterization of the cervical erosion, terrible pain appeared in the lower abdomen. The doctor advised me to drink a packet of Nise powder and then take these pills for a few days. It helped very quickly and well.”
3. Stepan: “Previously, at the first symptoms of colds and flu, I took Nimid in powder, but then problems with the liver began, I had to choose a more gentle drug. I switched to regular ibuprofen in domestically produced capsules. It relieves fever just as quickly and costs much less.”

When choosing a fast-acting analgesic, you should pay attention to the drug Nimesil; however, when using it, you need to familiarize yourself with the contraindications. This powder can be replaced by safer drugs, so the risks need to be assessed and compared with the expected benefits of its use.

The nuances of using this medicine

If you read the instructions for Nimesil, you can find out how to minimize the likelihood of side effects from the drug. Here you just need to follow some rules of application:

• By taking the product after meals, you can reduce the likelihood of getting gastrointestinal pathologies;
• until the course ends, you cannot drink a drop of alcohol;
• It is best to use just enough of the drug to help, but no more. For example, if you have a cold, you can take just a couple of sachets twice a day instead of the three recommended for the flu and its symptoms;
• when the symptoms are reduced, and inflammation, temperature and pain are relieved, Nimesil should be stopped;
• a possible increase in body temperature during the Nimesil course is a sign that the active component of the medicine is not suitable for the patient, and the use of this drug should be immediately interrupted.

Video - How to properly dilute Nimesil?