Nimesulide tablets: instructions, reviews and prices. Nimesulide, a drug from the NSAID group with a selective effect: why it is prescribed and how to take the drug for orthopedic pathologies

Acute pain cannot be tolerated: measures must be taken immediately to eliminate it. Many people resort to the drug “Nimesulide” as an “ambulance”. How it affects the body, the properties of the active substance, features of use - this is discussed in the article.

The drug has one active component - N-(4-Nitro-2-phenoxyphenyl) methanesulfonamide or nimesulide, a substance from the group of non-steroidal anti-inflammatory drugs.

Different forms of medication can be used:

• granules for preparing a solution - 100 mg of nimesulide per sachet;
• tablets - 100 mg;
• suspension - 60 ml bottle;
• gel - 0.1%.

Each form of the drug has its own auxiliary components. They help to increase the shelf life of the medicine and improve its taste and texture characteristics.

Pharmacological action, pharmacodynamics and pharmacokinetics

A characteristic feature of sulfonamides, to which the drug belongs, is the ability to quickly block pain receptors. This effect is achieved by influencing the synthesis of prostaglandins through the enzyme cyclooxygenase.

The most pronounced anesthetic and anti-inflammatory effects of the drug. But nimesulide does not reduce fever as effectively as many other NSAIDs. Yes, and taking it during a fever of infectious origin or during a cold is prohibited.

Absorption of oral forms of the drug occurs very quickly: it begins immediately in the oral cavity through the mucous membrane. The maximum concentration in plasma is observed after one and a half to two hours. Duration of action is up to 6-7 hours.

The gel is quickly absorbed and almost instantly numbs the affected area. It almost never enters the bloodstream. The substance is excreted in the form of liver metabolites and unchanged by the kidneys.

Why is Nimesulide prescribed?

The drug does not treat the disease, but relieves acute pain symptoms, reducing signs of inflammation.

Most often, Nimesulide is used for pathologies of the musculoskeletal system that cause acute pain.

Among them:

• arthritis of various origins;
• osteoarthritis, arthrosis;
• osteochondrosis;
• rheumatism;
• radiculitis;
• bursitis.

The medicine is also used for other pathologies accompanied by acute pain.

• toothache (acute and after treatment);
• neuralgia;
• post-traumatic feelings;
• arthralgia;
• headache;
• myalgia;
• postoperative pain;
• stretching and inflammation of muscles, tendons;
• painful periods.

In addition, the gel is used for:

• tendinitis;
• lumbago;
• sprained ligaments, muscles;
• osteoarthritis;
• periarthritis.

Instructions for use and dosage

Any form of the drug is available only to patients over 12 years of age. Use at an earlier age is fraught with serious complications.

The dosage should be selected to be the smallest one that works effectively. The course of treatment does not need to be continued for more than 14 days.

Nimesulide tablets

The pills should be taken after meals so as not to irritate the mucous membranes. The recommended daily dose for adults is 200 mg of the drug. It must be divided into two doses. Maximum - 400 mg per day. Children over 12 years of age should take 50-100 mg of medication twice a day.

In powder form

Before use, the granules must be dissolved in half a glass of clean water (can be cold or slightly heated). You should drink it immediately, do not store the solution.

The dosage of Nimesulide in powder is the same as that of the tablet form: 1 sachet (100 mg of active substance) 2 times a day. For adult patients, if necessary, the dose can be increased to 400 mg per day, no more. For elderly patients, the doctor chooses the correct dosage, focusing on their well-being and clinical indicators.

Gel Nimesulide

The ointment structure of the drug is suitable for local pain relief. You need to squeeze out 5-6 cm of gel from the tube and gently rub it into the affected area until completely absorbed. The procedure can be carried out 3-4 times a day for no more than a month.

Do not use the drug on open wounds or in areas near the eyes and lips. If accidentally swallowed, rinse your mouth and take sorbents.

During pregnancy and lactation

Pregnant women are most at risk of contracting various diseases. After all, immunity in this state is often weakened.

Fever, body aches, pain of various origins are signs of the onset of the inflammatory process. Is it possible to eliminate them with Nimesulide?

Doctors do not advise starting this treatment, because the drug is too strong. Doctors recommend weaker means of the same effect.

In the first trimester, when all fetal systems develop, the drug can cause pathologies. It is possible to use the medicine in the second trimester, when the child’s organs have already formed, but only under the supervision of a doctor.

And taking the medication in the last trimester can lead to serious complications for the mother and fetus:

• pressure changes that threaten premature birth;
• renal failure;
• the likelihood of premature closure of the ductus arteriosus;
• reduction in the amount of water;
• stopping uterine contractions;
• bleeding;
• swelling.

During lactation, Nimesulide should also not be used for pain relief. The substance passes into milk and has a negative effect on infants.

Can I drink alcohol while taking the drug?

The drug does not interact directly with ethyl spit, so the manufacturer’s instructions do not say anything about the possibility of combining.

Medicine has a firm belief regarding this issue: the simultaneous intake of alcohol and a potent anti-inflammatory drug does not heal, but cripples the human body.

Why are doctors so categorical? Drinks containing ethyl alcohol have a detrimental effect on the cells and tissues of all organs, especially on the main filter - the liver. It is destroyed under the influence of alcohol. Nimesulide is a very toxic drug; it also significantly increases the load on the liver. And the cocktail that results from the combination causes severe disruptions in the liver, which can result in complete dysfunction and hepatitis.

Therefore, you should take the pill only when at least 10 hours have passed since your last glass of alcohol. Otherwise, there will be no expected effect, but only complications will appear.

Drug interactions

• Other NSAIDs when taken together with the drug cause worsening toxic effects. This should not be done!
• If you take glucocorticosteroids and antithrombotic drugs with the drugs discussed, the likelihood of internal bleeding in the gastrointestinal tract increases.
• Nimesulide reduces the effectiveness of diuretics and furasemide, together with the latter drug complicating the removal of potassium and sodium.
• Lithium-containing drugs increase the negative impact on the body if used together with drugs.
• The drug reduces the effectiveness of hypertensive and antiarrhythmic drugs.
• Nimesulide, together with ACE inhibitors, often provokes the development of renal failure.
• The drug with cyclsporine causes increased stress on the kidneys and liver, which causes their dysfunction.

The described combination refers to oral drugs that have a systemic effect on the body. The gel does not react with other medications when used correctly and in dosage.

Contraindications, side effects and overdose

The high effectiveness of medications is due to the fact that nimesulide is a powerful substance in its effect on the body.

That is why, while eliminating unwanted symptoms such as fever or acute pain, it at the same time affects other systems of the body. Side effects are periodically observed in patients taking the drug.

The list is impressive:

• urge to vomit;
• acute pain in the stomach area;
• diarrhea or constipation;
• myocardial rhythm disturbance;
• pulse surges;
• general weakness, fatigue;
• increased plasma potassium levels;
• swelling of the skin;
• frequent dizziness;
• a sharp increase and then a decrease in blood pressure;
• allergic skin rash, scabies;
• uncontrollable muscle spasms;
• hyperhidrosis;
• breathing problems, shortness of breath;
• spasms in the bronchi;
• increased gas formation;
• ulcerative pathologies, erosions, bleeding in the gastrointestinal tract;
• liver inflammation;
• urinary disorders;
• wounds in the mouth, gums;
• vision problems;
• panic syndrome;
• anxiety;
• renal failure;
• decrease in temperature indicators;
• excessive activity, aggressiveness.

Such symptoms are most often observed after taking tablets or suspensions. The gel does not penetrate the bloodstream when used correctly, so the risk of side effects is minimal. Allergic reactions are possible at the site of application of the ointment: redness, rash and peeling of the dermis.

To reduce the level of toxic effects on the body, you should take the drug in the smallest effective doses for a short course.

Failure to comply with the recommended dosage leads to serious consequences. In this case, the side effects are aggravated, and there is also a possibility of acute renal failure, respiratory arrest, anaphylactic shock, seizures and coma. In case of overdose, you should take sorbents and call a doctor immediately.

An overdose when using the gel can only occur if the dose of the drug is significantly higher (more than 50 g). Signs of the condition include nausea and vomiting.

The high toxicity of the drug causes a large number of contraindications.

• hypersensitivity to components (active and auxiliary), other NSAIDs;
• aspirin asthma - allergy to acetylsalicylic acid;
• children's age - up to 12 years;
• diseases with internal bleeding;
• decompensated heart failure;
• severe liver pathologies;
• decreased blood clotting;
• pregnancy (in the first and last trimester);
• ulcerative processes in the stomach;
• period after coronary bypass surgery;
• lactation;
• heat and fever due to viral diseases and acute respiratory infections;
• hyperkalemia;
• alcoholism and drug addiction.

Also, when prescribing the drug, it is necessary to take into account the presence of the following diseases that require dose adjustment and careful monitoring by a doctor:

• problems with kidney function;
• arterial hypertension;
• type 2 diabetes mellitus;
• ischemia.

Treatment of elderly patients requires regular monitoring, visual and clinical, and, if necessary, dose reduction or drug withdrawal.

Nimesulide's analogs

Full synonyms of the drug are represented in pharmacology by various medications containing nimesulide.

Among them:

• "Nemulex" in granules for medicinal solution;
• "Flolid" in tablets, suspensions and granules;
• "Nimesan" in tablet form;
• "Actasulide" in capsules;
• "Prolide" - absorbable tablets;
• "Nise" in the form of tablets, gel and suspension;
• "Nimesil" granules;
• "Aponil" in pills;
• "Nimulid" - granules, tablets, ointment.

Other NSAIDs have a similar effect on the body, eliminating pain, fever and blocking the development of inflammation. The range of medications is wide, since there are many synonymous series of medications with the same active substance.

If you need a remedy that has an anti-inflammatory effect that will help reduce pain and fever, then pay attention to a non-steroidal substance such as nimesulide. It is produced in different pharmacological forms. Detailed instructions for nimesulide for proper use are presented below.

Application of Nimesulide tablets

Nimesulide (in Latin -nimesulide) is included in many medications, as it has an immediate 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. Nimesulide is used only after consultation with a doctor and according to the instructions, because if used incorrectly, serious side effects are possible. The appropriate dosage will help get rid of unpleasant symptoms.

What are Nimesulide tablets for?

A non-steroidal anti-inflammatory drug is an excellent way to quickly get rid of pain and swelling inside the body. It is important to understand that medicine with nimesulide will relieve you of the symptoms of the disease, but will not eliminate the disease itself. According to the instructions for use, the substance has three main areas of work:

• elimination of fever;
• 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 ;
• tendon inflammation;
• muscle pain.

Nimesulide – release form

Today there are a large number of drugs on the market that contain nimesulide. They differ not only in brand of production and price. The form of release plays a big role in the effectiveness of 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 classify the substance as a group of sulfonamides. A nonsteroidal anti-inflammatory drug quickly relieves fever and prevents the formation of edema. The composition of the drug allows you to eliminate tissue disorders in a short time, without causing any harmful effects on the human body. Gels and ointments are based on thimerosal and alcohols. As for dragees, corn starch and aspartame predominate.

The drug Nimesulide - instructions for use

According to the observations of doctors, the substance, like its analogues, always gives a noticeable 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 to read. There are certain rules of application that should not be forgotten:

• Pills. Take 1 piece orally 2 times a day. Dragees should be washed down with plenty of clean water. The maximum daily dose should not exceed 400 mg.
• Powder. It is accepted in the same way as pills, but its price is a little 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. Using an overlay overlay is not recommended.

Nimesulide tablets

The most widely used form of release. Nimesulide tablets can be found in pharmacies under different names. Depending on the country of origin, the price may vary significantly. The most popular commercial names are Nimesulide, Flolid, Ameolin. Dragees can dissolve with water. You are allowed to take 2 or a maximum of 4 tablets per day. The total amount of the drug per day should not exceed 400 mg. Take tablets 2 times a day after meals.

Nimesulide powder - instructions for use

This form of drug release, such as powder, is an excellent replacement for dragees. Helps dull toothache, 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. The granules need to be diluted in warm water. If this dose does not produce results, it can be doubled. The course of treatment lasts no more than 15 days.

Nemulex is also considered the most famous powder in this category. They can be prescribed for gynecological diseases, dental pain, 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 for problems with the musculoskeletal system. If the patient feels pain in the joints, then squeeze out a small amount of a creamy substance and apply it to the affected area with massage movements. It takes several minutes to rub in Nimesulide gel. To get quick results, the procedure should be repeated 3-4 times a day. Please note that the gel cannot be applied 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 pain in the joints according to the instructions. Regular rubbing of the creamy substance will help you get rid of the unpleasant feeling in just a few days. The procedure needs to be carried out 3-4 times a day. The price of ointments is slightly lower than the cost of gels, especially if we are talking about a domestic manufacturer.

Nimesulide suspension for children

The use of the substance by children under 12 years of age is prohibited, but in practice there is not a single case where the medicine has had 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 use in young patients is high fever during ARVI. It must be remembered that such a suspension for children is given in cases where downtime does not give the desired effect.

The dose calculation for a child must be done 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 baby’s weight. Taking into account the activity of the substance, the dose received must be divided by 2. The found volume is the daily amount of medication, which is taken in 2-3 approaches. If this dose of suspension or syrup per day does not provide an effect for the child, it can be increased by 1/3.

Nimesulide contraindications

The medicine has a strong effect, so you need to be especially careful during use. If you want to take nimesulide, it is worth knowing 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 should not be used by those who are addicted to drugs, drink alcohol, or have flu-like symptoms. In addition to the above, there are the following contraindications to the use of nimesulide, indicated in the annotation:

• and other gastrointestinal problems;
• hemophilia;
• cardiac, hepatic or

Compound

each tablet contains: active substance nimesulide - 100 mg;

auxiliary components: microcrystalline cellulose, croscarmellose sodium, povidone, polysorbate 80, hydrochloric acid, calcium stearate, lactose monohydrate.

Description

tablets from light yellow to yellow, flat-cylindrical, with a chamfer and a score on one side. Blotches are allowed on the surface of the tablets.

pharmachologic effect

Pharmacotherapeutic group: Other non-steroidal anti-inflammatory drugs.

pharmachologic effect

A nonsteroidal anti-inflammatory drug (NSAID) has anti-inflammatory, analgesic, antipyretic and antiplatelet effects.

Indications for use

Treatment of acute pain. Symptomatic treatment of pain in osteoarthritis. Primary dysmenorrhea.

Contraindications

Hypersensitivity, complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose or paranasal sinuses and intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (including a history), erosive and ulcerative lesions of the mucous membrane of the stomach or duodenum, active gastrointestinal tract intestinal bleeding, cerebrovascular or other bleeding, inflammatory bowel disease (Crohn's disease, ulcerative colitis) in the acute phase, hemophilia and other bleeding disorders, decompensated chronic heart failure, liver failure or any active liver disease, history of hepatotoxic reactions with the use of nimesulide , alcoholism, drug dependence, drug addiction, severe chronic renal failure (creatinine clearance less than 30 ml/min), progressive kidney disease, confirmed hyperkalemia, the period after coronary artery bypass surgery, simultaneous administration with other potentially hepatotoxic drugs, increased body temperature and/or flu-like symptoms, pregnancy, lactation, children under 12 years of age.

Carefully: coronary heart disease, cerebrovascular diseases, chronic heart failure, dyslipidemia/hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, renal failure (creatinine clearance less than 60 ml/min), anamnestic data on the development of ulcerative lesions of the gastrointestinal tract, infection Helicobacterpylori, old age, long-term use of non-steroidal anti-inflammatory drugs, alcoholism, severe somatic diseases, simultaneous use of anticoagulants (including warfarin), antiplatelet agents (including acetylsalicylic acid, clopidogrel), oral glucocorticosteroids, selective serotonin reuptake inhibitors (including including citalopram, fluoxetine, paroxetine, sertraline).

Pregnancy and lactation

Use during pregnancy and lactation is contraindicated. Like other NSAIDs that are known to inhibit prostaglandin synthesis, nimesulide may cause premature closure of the ductus arteriosus, pulmonary hypertension, oliguria, oligoamnion, increased risk of bleeding, weakness of labor and the development of peripheral edema. There have been isolated cases of renal failure in children and women taking nimesulide in late pregnancy.

Directions for use and doses

Inside, after eating. 1 tablet (100 mg) 2 times a day. The minimum effective dose should be administered for the shortest possible period of time in order to minimize the risk of adverse reactions. The maximum duration of taking nimesulide should not exceed 15 days. Patients with renal failure with a creatinine clearance of 30-80 ml/minute, as well as elderly patients, do not require a dose reduction.

Side effect

From the gastrointestinal tract: heartburn, nausea, vomiting, diarrhea, constipation, flatulence, gastralgia, ulceration of the gastrointestinal mucosa, gastritis, abdominal pain, dyspepsia, stomatitis, melena, gastrointestinal bleeding and perforation.

From the central nervous system: dizziness, encephalopathy, drowsiness, headache (Reye's syndrome).

Mental disorders: nervousness, anxiety, nightmares.

From the eyes: visual impairment.

From the kidneys and urinary system: fluid retention, hematuria, dysuria, urinary retention, oliguria, interstitial nephritis.

From the hematopoietic system: thrombocytopenia, leukopenia, anemia, agranulocytosis; prolongation of bleeding time.

From the respiratory system, chest and mediastinum: shortness of breath, bronchospasm.

From the cardiovascular system: tachycardia, arterial hypertension, blood pressure fluctuations.

From the liver: increased activity of “liver” transaminases, hepatitis, fulminant hepatitis (including fatal ones), cholestatic jaundice.

For the skin and subcutaneous tissues: itching, skin rash, increased sweating, erythema, dermatitis, urticaria, angioedema, erythema multiforme, Stevens-Johnson syndrome or toxic epidermal necrolysis.

Allergic reactions: skin rash, anaphylactic shock.

Overdose

Symptoms: apathy, drowsiness, nausea, vomiting. They are usually reversible when the drug is discontinued. Gastrointestinal bleeding may occur. Arterial hypertension, acute renal failure, and respiratory depression may occur, but are very rare.

Treatment: consult a doctor; Symptomatic treatment of the patient and supportive care are required. There is no specific antidote. If an overdose has occurred within the last 4 hours, it is necessary to induce vomiting, take activated carbon (60-100 g per adult), and osmotic laxatives. Forced diuresis and hemodialysis are ineffective due to the high binding of the drug to proteins.

Interaction with other drugs

When nimesulide is used simultaneously with the following drugs, the drugs compete for binding to plasma proteins: with digoxin; phenytoin and lithium preparations; diuretics and antihypertensive drugs; other NSAIDs; cyclosporine; methotrexate and antidiabetic agents.

The effect of medications that reduce blood clotting is enhanced when used simultaneously with nimesulide. In patients taking warfarin and acetylsalicylic acid, the risk of bleeding increases, so this combination is not recommended. If the prescription cannot be avoided, then the dose of warfarin should be under strict medical supervision.

Nimesulide may reduce the effect of furosemide on sodium excretion and, to a lesser extent, on potassium excretion and diuretic action. Co-administration of furosemide and nimesulide leads to a decrease (by approximately 20%) in the excretion of furosemide without reducing renal clearance.

The use of nimesulide within 24 hours before or after may increase the likelihood of side effects when taking methotrexate.

Plasma lithium levels increase when lithium and nimesulide are taken concomitantly, so serum lithium concentrations should be monitored more carefully.

Due to the high degree of binding of nimesulide to plasma proteins, patients who are simultaneously treated with hydantoin and sulfonamides should be under medical supervision, undergoing examinations at short intervals.

Nimesulide may enhance the nephrotoxic effect of cyclosporine.

Features of application

With long-term use, systematic monitoring of renal function is necessary.

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Characteristics of the substance Nimesulide

NSAIDs from the sulfonamide class.

Pharmacology

pharmachologic effect- anti-inflammatory, antipyretic, analgesic.

Pharmacodynamics

Inhibits the COX enzyme responsible for the synthesis of PGs, mainly COX-2 - an enzyme involved in the synthesis of PGs - mediators of edema, inflammation and pain at the site of inflammation.

Reversibly inhibits the formation of PGE 2, both at the site of inflammation and in the ascending pathways of the nociceptive system, including the pathways of pain impulses in the spinal cord. Reduces the concentration of short-lived PGN 2, from which PGE 2 is formed under the action of prostaglandin isomerase. A decrease in the concentration of PGE 2 leads to a decrease in the degree of activation of EP-type prostanoid receptors, which is expressed in analgesic and anti-inflammatory effects. Inhibits the release of TNF-α, which causes the formation of cytokinins.

Suppresses the release of histamine, inhibits the synthesis of IL-6 and urokinase, thereby preventing the destruction of cartilage tissue. Inhibits the synthesis of metalloproteases (elastase, collagenase), preventing the destruction of proteoglycans and collagen of cartilage tissue. Interacts with glucocorticoid receptors, activating them by phosphorylation, which also enhances its anti-inflammatory effect. Suppresses platelet aggregation.

When applied topically, it causes a weakening or disappearance of pain at the site of application of the gel, incl. pain in the joints at rest and during movement, reduces morning stiffness and swelling of the joints. Helps increase range of motion.

Pharmacokinetics

Suction. After oral administration, nimesulide is well absorbed from the gastrointestinal tract, reaching C max in the blood plasma after 2-3 hours.

Distribution. Communication with plasma proteins - 95%, erythrocytes - 2%, lipoproteins - 1%, acid alpha 1 -glycoproteins - 1%. Penetrates into the tissues of the female genital organs, where after a single dose its concentration is about 40% of the plasma concentration. Penetrates well into the acidic environment of the inflammation site (40%) and synovial fluid (43%). Easily penetrates the BBB.

Metabolism. Metabolized in the liver using the cytochrome P450 isoenzyme CYP2C 9. The main metabolite is the pharmacologically active parahydroxy derivative of nimesulide - hydroxynimesulide.

Excretion. T1/2 of nimesulide is 1.56-4.95 hours, hydroxynimesulide - 2.89-4.78 hours. Nimesulide is excreted from the body mainly by the kidneys (about 50% of the dose taken). Hydroxynimesulide is excreted by the kidneys (65%) and bile (35%) and undergoes enterohepatic recirculation.

The pharmacokinetic profile of nimesulide in elderly people does not change when administered single and multiple/repeated doses.

According to an experimental study conducted in patients with mild to moderate renal failure (Cl creatinine 30-80 ml/min) and healthy volunteers, the C max of nimesulide and its metabolite in the plasma of patients did not exceed the concentration of nimesulide in healthy volunteers. AUC and T1/2 in patients with renal failure were 50% higher, but within the pharmacokinetic range. When nimesulide is taken repeatedly, no accumulation is observed.

Pills

Suction. After oral administration, nimesulide is well absorbed from the gastrointestinal tract. Eating reduces the rate of absorption without affecting its extent. Tmax - 1.5-2.5 hours. Maximum concentration of nimesulide in blood plasma reaches 3.5-6.5 mg/l.

Distribution. Communication with plasma proteins is 95%, erythrocytes - 2%, lipoproteins - 1%, acid alpha 1 -glycoproteins - 1%. The dose does not affect the degree of binding to blood proteins. V d - 0.19-0.35 l/kg. Penetrates into the tissues of the female genital organs, where after a single dose the concentration is about 40% of the plasma concentration. Penetrates well into the acidic environment of the inflammation site (40%) and synovial fluid (43%). Easily penetrates the BBB.

Metabolism. Metabolized in the liver by tissue monooxygenases. The main metabolite (25%) - 4-hydroxynimesulide - has similar pharmacological activity.

Excretion. T1/2 nimesulide is 1.56-4.95 hours, 4-hydroxynimesulide - 2.89-4.78 hours. 4-Hydroxynimesulide is excreted by the kidneys (65%) and bile (35%), and undergoes enterohepatic recirculation.

Pharmacokinetics in special clinical cases. In patients with mild to moderate renal impairment (creatinine clearance 1.8-4.8 l/h or 30-80 ml/min), as well as in children and the elderly, the pharmacokinetic profile of nimesulide does not change significantly.

Gel for external use

When applying the gel, the concentration of the active substance in the systemic circulation is extremely low. Cmax of nimesulide in blood plasma after a single application is observed at the end of the first day; its value is more than 300 times lower than that for oral dosage forms of nimesulide. No traces of the main metabolite of nimesulide (4-hydroxynimesulide) are found in the blood.

Application of the substance Nimesulide

Granules for preparation of suspension for oral administration

Acute pain (back pain, lower back pain; pain syndrome due to pathology of the musculoskeletal system, including injuries, sprains and dislocations of joints; tendonitis, bursitis; toothache), symptomatic treatment of osteoarthritis with pain syndrome, algomenorrhea.

Pills

Rheumatoid arthritis, articular syndrome during exacerbation of gout, psoriatic arthritis, ankylosing spondylitis, osteochondrosis with radicular syndrome, osteoarthritis, myalgia of rheumatic and non-rheumatic origin, inflammation of ligaments, tendons, bursitis, incl. post-traumatic inflammation of soft tissues, pain syndrome of various origins (including in the postoperative period, with injuries, algodismenorrhea, toothache, headache, arthralgia, lumbar ischialgia).

Gel for external use

Acute and chronic inflammatory diseases of the musculoskeletal system (articular syndrome with exacerbation of gout, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, osteoarthritis, osteochondrosis with radicular syndrome, radiculitis, inflammatory damage to ligaments and tendons, bursitis, sciatica, lumbago), rheumatic muscle pain and non-rheumatic origin, post-traumatic inflammation of soft tissues and the musculoskeletal system (damage and rupture of ligaments, bruises).

In all dosage forms, nimesulide is intended for symptomatic therapy, reducing pain and inflammation at the time of use, and does not affect the progression of the disease.

Contraindications

Granules for the preparation of suspension for oral administration, tablets

Hypersensitivity, complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose or paranasal sinuses and intolerance to acetylsalicylic acid and other NSAIDs (including a history), erosive and ulcerative changes in the mucous membrane of the stomach and duodenum, active gastrointestinal bleeding, cerebrovascular or other bleeding, inflammatory bowel disease (Crohn's disease, ulcerative colitis) in the acute phase, hemophilia and other bleeding disorders, decompensated heart failure, liver failure or any active liver disease, anamnestic data on the development of hepatotoxic reactions when using nimesulide, alcoholism, drug addiction , severe renal failure (Cl creatinine<30 мл/мин), прогрессирующие заболевания почек, подтвержденная гиперкалиемия, период после проведения аортокоронарного шунтирования, одновременный прием других гепатотоксических ЛС , беременность и период грудного вскармливания, детский возраст до 12 лет.

Gel for external use

Hypersensitivity, incl. to other NSAIDs, complete or incomplete combination of bronchial asthma, recurrent nasal polyposis and paranasal sinuses and intolerance to acetylsalicylic acid or other NSAIDs (history), erosive and ulcerative lesions of the gastrointestinal tract in the acute stage, dermatoses, damage to the epidermis and skin infections in the area of ​​application, severe renal failure (Cl creatinine<30 мл/мин), печеночная недостаточность тяжелой степени, беременность и период грудного вскармливания, детский возраст до 12 лет.

Restrictions on use

Granules for the preparation of suspension for oral administration, tablets

Arterial hypertension; diabetes; compensated heart failure; IHD; cerebrovascular diseases; dyslipidemia/hyperlipidemia; peripheral arterial disease; smoking; renal failure (creatinine Cl 30-60 ml/min); anamnestic data on the presence of ulcerative lesions of the gastrointestinal tract, infection caused by Helicobacter pylori; elderly age; long-term previous use of NSAIDs; severe somatic diseases; concomitant therapy with anticoagulants (for example, warfarin), antiplatelet agents (for example, acetylsalicylic acid, clopidogrel), oral corticosteroids (for example, prednisolone), SSRIs (for example, citalopram, fluoxetine, paroxetine, sertraline).

The decision to prescribe oral nimesulide should be based on an individual risk-benefit assessment.

Gel for external use

History of erosive and ulcerative lesions of the gastrointestinal tract (including peptic ulcer of the stomach and duodenum); liver and kidney failure of mild to moderate severity; severe heart failure; arterial hypertension; elderly age; children over 12 years of age; diabetes; bleeding disorders (including hemophilia, prolongation of bleeding time, bleeding tendency).

Use during pregnancy and breastfeeding

The use of nimesulide is contraindicated during pregnancy and breastfeeding. If use is necessary during breastfeeding, breastfeeding should be discontinued.

The use of nimesulide may adversely affect fertility in women and is not recommended for women planning pregnancy.

Side effects of the substance Nimesulide

The frequency of occurrence of adverse reactions is classified as follows: very often (>1/10); often (≥1/100,<1/10); нечасто (≥1/1000, <1/100); редко (≥1/10000, <1/1000); очень редко (<1/10000); частота неизвестна (частота не может быть подсчитана по доступным данным).

Granules for the preparation of suspension for oral administration, tablets

From the blood and lymphatic system: rarely - anemia, eosinophilia; very rarely - thrombocytopenia, agranulocytosis, pancytopenia, thrombocytopenic purpura.

Allergic reactions: rarely - hypersensitivity reactions; very rarely - anaphylactoid reactions.

uncommon - itching, rash, increased sweating; rarely - erythema, dermatitis; very rarely - urticaria, angioedema, facial swelling, exudative erythema multiforme, incl. Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome).

From the side of the central nervous system: infrequently - dizziness; rarely - a feeling of fear, nervousness, nightmares; very rarely - headache, drowsiness, encephalopathy (Reye's syndrome).

From the senses: rarely - blurred vision.

From the SSS side: infrequently - increased blood pressure; rarely - tachycardia, blood pressure lability, hot flashes, palpitations.

From the respiratory system: infrequently - shortness of breath; very rarely - exacerbation of bronchial asthma, bronchospasm.

From the gastrointestinal tract: often - diarrhea, nausea, vomiting; infrequently - constipation, flatulence, gastritis; very rarely - abdominal pain, dyspepsia, stomatitis, tarry stools, gastrointestinal bleeding, ulceration of the mucous membrane and/or perforation of the stomach or duodenum.

From the liver and biliary tract: often - increased levels of liver transaminases; very rarely - hepatitis, fulminant hepatitis, jaundice, cholestasis.

From the kidneys and urinary tract: rarely - dysuria, hematuria, urinary retention, hyperkalemia; very rarely - renal failure, oliguria, interstitial nephritis.

Common disorders: infrequently - swelling; rarely - malaise, asthenia; very rarely - hypothermia.

Gel for external use

For the skin and subcutaneous tissues: infrequently - itching, burning, swelling; very rarely - moderate or severe skin irritation, hyperemia, rash, desquamation, peeling, erythema.

With external use of nimesulide, the possibility of systemic side effects is lower than with oral use. However, one should be aware of the possibility of systemic side effects if nimesulide is used over large areas for a long time and in high doses.

Interaction

Granules for the preparation of suspension for oral administration, tablets

GCS. Increase the risk of gastrointestinal ulcers or bleeding.

Antiplatelet agents and SSRIs. Increase the risk of gastrointestinal bleeding.

Anticoagulants. NSAIDs may enhance the effect of anticoagulants such as warfarin. Due to the increased risk of bleeding, this combination is not recommended and is contraindicated in patients with severe coagulation disorders. If combination therapy cannot be avoided, careful monitoring of blood clotting parameters is necessary.

Diuretics. NSAIDs may reduce the effect of diuretics. In healthy volunteers, nimesulide temporarily reduces the excretion of sodium under the influence of furosemide, and to a lesser extent, potassium, and reduces the diuretic effect itself. Co-administration of nimesulide and furosemide leads to a decrease (by approximately 20%) in AUC and a decrease in the cumulative excretion of furosemide without changing the renal clearance of furosemide. Co-administration of furosemide and nimesulide requires caution in patients with impaired renal or cardiac function.

ACE inhibitors and angiotensin II receptor antagonists. NSAIDs may reduce the effect of antihypertensive drugs. In patients with mild to moderate renal failure (Cl creatinine 30-80 ml/min), when co-administered with ACE inhibitors, angiotensin II receptor antagonists or substances that suppress the COX system (NSAIDs, antiplatelet agents), further deterioration of renal function and the occurrence of acute renal failure, which is usually reversible. These interactions should be considered in patients taking nimesulide in combination with ACE inhibitors or angiotensin II receptor antagonists. Therefore, the combined use of these drugs should be prescribed with caution, especially in elderly patients. Patients should receive sufficient fluids and renal function should be closely monitored after initiating concomitant therapy.

Lithium preparations. There is evidence that NSAIDs reduce the clearance of lithium, which leads to increased plasma lithium concentrations and its toxicity. When prescribing nimesulide to patients receiving lithium therapy, plasma lithium concentrations should be regularly monitored.

Clinically significant interactions with glibenclamide, theophylline, digoxin, cimetidine and antacid drugs (for example, a combination of aluminum and magnesium hydroxide) were not observed.

Nimesulide inhibits the activity of the isoenzyme CYP2C9. When taken simultaneously with nimesulide, drugs that are metabolized with the participation of this isoenzyme, their concentration in plasma may increase.

When used simultaneously with antiepileptic (valproic acid), antifungal (ketoconazole), antituberculosis (isoniazid) drugs, amiodarone, methotrexate, methyldopa, amoxicillin in combination with clavulanic acid, an additive hepatotoxic effect is possible.

Due to the high degree of binding of nimesulide to plasma proteins, patients concomitantly taking sulfonamides should be under medical supervision, undergoing examinations at short intervals. When prescribing nimesulide less than 24 hours before or after taking methotrexate, caution is required, because in such cases, the plasma concentration of methotrexate and, accordingly, its toxic effects may increase. Due to the effect on renal PGs, PG synthetase inhibitors, which include nimesulide, can increase the nephrotoxicity of cyclosporines.

Research in vitro showed that nimesulide is displaced from the binding sites by tolbutamide and salicylic acid. Although these interactions were determined in blood plasma, these effects were not observed during the clinical use of nimesulide.

Gel for external use

When used externally, nimesulide does not cause a clinically significant effect on the metabolism of other drugs.

In the case of prolonged use of nimesulide in the form of a gel in maximum doses, interactions with digoxin, phenytoin, lithium preparations, diuretics, cyclosporine, methotrexate, other NSAIDs, antihypertensive and antidiabetic drugs cannot be excluded. Before using the gel, you should consult your doctor if you are using these drugs or are under medical supervision.

Overdose

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Symptoms: apathy, drowsiness, nausea, vomiting, pain in the epigastric region. Gastrointestinal bleeding may occur. In rare cases, increased blood pressure, acute renal failure, respiratory depression and coma, and anaphylactoid reactions are possible.

Treatment: symptomatic. There is no specific antidote. If an overdose has occurred within the last 4 hours, it is necessary to induce vomiting and/or take activated carbon (60 to 100 g per adult) and/or an osmotic laxative. Forced diuresis and hemodialysis are ineffective due to the high binding of nimesulide to plasma proteins.

Gel for external use

Cases of overdose of nimesulide when used externally have not been described.

When large amounts of gel (exceeding 50 g) are applied to large areas of the skin or accidentally ingested, systemic adverse reactions (nausea, vomiting) may develop.

Treatment: gastric lavage, induction of vomiting, activated charcoal, forced diuresis, symptomatic therapy. There is no specific antidote. You need to see a doctor.

Routes of administration

Inside, outside.

Precautionary measures for the substance Nimesulide

Granules for the preparation of suspension for oral administration, tablets

Nimesulide should be used with caution in patients with a history of gastrointestinal diseases (ulcerative colitis, Crohn's disease), since exacerbation of these diseases is possible.

The risk of gastrointestinal bleeding, gastric or duodenal ulcer/perforation increases with increasing dose of NSAIDs in patients with a history of gastric or duodenal ulcers, especially complicated by bleeding or perforation, as well as in elderly patients, so treatment should be started as early as possible doses. Patients receiving drugs that reduce blood clotting or suppress platelet aggregation also increase the risk of gastrointestinal bleeding. If gastrointestinal bleeding or gastric or duodenal ulcers occur in patients taking nimesulide, treatment should be discontinued.

When using nimesulide for more than 2 weeks, monitoring of liver function indicators (liver transaminase activity) is necessary.

If signs of liver damage appear (itching, yellowing of the skin, nausea, vomiting, abdominal pain, dark urine, increased activity of liver transaminases), you should stop taking nimesulide and consult your doctor.

Nimesulide should be prescribed with caution to patients with arterial hypertension, cardiac disorders, and cerebrovascular diseases. If the condition worsens, treatment with nimesulide should be discontinued.

Since nimesulide is partially excreted by the kidneys, its dose for patients with impaired renal function should be reduced depending on creatinine clearance. If renal function deteriorates, nimesulide should be discontinued.

Nimesulide can change the properties of platelets, so caution must be exercised when using it in people with hemorrhagic diathesis, however, nimesulide does not replace the preventive effect of acetylsalicylic acid in cardiovascular diseases.

During treatment with nimesulide, it is recommended to avoid the simultaneous use of hepatotoxic drugs, analgesics, other NSAIDs (with the exception of low doses of acetylsalicylic acid used in antiplatelet doses) and the use of ethanol.

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Nimesulide – medicine with anti-inflammatory effect. It is available in different forms, which allows patients to take the drug externally and internally. Effect of the drug: relieve inflammation, remove pain. The drug nimesulide helps reduce the patient's elevated temperature.

It is effective and safe, which contributes to its high popularity compared to other drugs.

A little about the drug

The medicine is the result of the work of Macedonian pharmacists and belongs to the group of sulfonamides. How does the inflammatory process begin? As a result of reactions occurring in tissue cells, arachidonic acid is released, becoming prostaglandins. They form swelling, affect pain receptors, cause redness of tissues and increase the patient’s body temperature. The medicine prevents prostaglandins from being synthesized by blocking their enzyme, stopping the inflammation process. The inflammatory reaction stops, its symptoms disappear: swelling, fever, pain.

Nimesulide has a great advantage compared to other drugs, aimed at relieving inflammation, for example, aspirin. The drug is less likely to cause side effects. As the dose of the drug used increases, the likelihood of side effects increases, possibly damage to the gastrointestinal tract and kidneys.

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Irina Martynova. Graduated from Voronezh State Medical University named after. N.N. Burdenko. Clinical resident and neurologist of the BUZ VO \"Moscow Polyclinic\".

The great advantage of the product is the low likelihood of allergies, which allows almost every patient to take it.

Forms of release of the drug

The drug with the active substance nimesulide can be purchased in pharmacies in the following forms:

• Soluble tablets. They consist of the active substance, talc, corn starch and aspartame. Average price at a pharmacy kiosk: 80–90 rubles.
• Insoluble tablets. The composition is similar to the above. Average price in a pharmacy: 50–70 rubles.
• Suspension (syrup). To produce the syrup, pineapple flavoring, yellow dye, sucrose and xanthan gum are used. The cost of this form of medicine is no less than 200–230 rubles.
• Nimesulide gel. To produce this form of medicine, alcohols and mercury compounds are used, which do not have a toxic effect. The price of nimesulide ointment starts from 150 rubles.
• Powder for preparing a suspension. Its composition is similar to that of tablets, but talc is excluded from it. The patient will have to spend 430–480 rubles on medicine, depending on the name of the pharmacy chain and region of residence.

They are produced by different pharmaceutical companies, but the active element in each dosage form is the same - nimesulide, for example, the drug Nise or nimesulide maxpharma. And the patient can choose a more convenient form of using the medicine.

Nimesulid-teva

Nimesulide-teva is based on the active substance nimesulide; it contains 100 mg in each tablet. The composition of the tablet is supplemented with magnesium, vegetable oil and other components.

Nimesulid-teva eliminates pain, relieves inflammation and fever, begins to act half an hour after administration. The components of the drug nimesulide-teva are excreted from the body within 24 hours along with urine.

Nimesulide-teva helps with myalgia, arthritis, osteoarthritis, toothache, and relieves pain from bone and tissue injuries.

These are yellow, round, scored tablets. The package contains 10, 20 or 60 tablets. Taken orally. Course of treatment with the product: up to 14 days. Not for use during pregnancy and not recommended for nursing mothers. Not tolerated by patients with stomach ulcers, liver problems, etc. The medicine should not be taken if there are infectious diseases.

Nimesulid-teva cannot be combined with other drugs of a similar spectrum of action. Does not combine well with diuretics and drugs based on lithium. To avoid side effects, the dosage of the medication should be observed.

Side effects include nausea, vomiting, and increased blood pressure.

Shelf life: 2 years from the date of manufacture.

Nimesulide Canon

Nimesulide Canon is available in the form of granules. Ingredients: nimesulide, orange flavor, citric acid, sucrose, etc. Packaged in 2 gram bags; packs of 9, 15, 30 bags.

Nimesulide Canon is a mixture of granules and yellow powder with an orange aroma. The drug anesthetizes, relieves fever, eliminates inflammatory processes. Excreted in bile. It is also excreted through the kidneys. Relieves pain in the lower back, eliminates the consequences of injuries, and eliminates toothache.

Nimesulide Canon contraindicated in case of intolerance to fructose and the active substance of the drug. It is not recommended for people with stomach ulcers, internal bleeding, or blood diseases. The product should not be used by people with kidney failure, pregnant or lactating women. Not recommended for use by children under 12 years of age. The duration of the course of the drug nimesulide Canon is no more than 15 days. Side effects: anemia, allergic reactions, urticaria, swelling, dizziness, migraines, increased blood pressure, shortness of breath.

Stored at temperatures up to 25 degrees Celsius.

Nimesulide Vidal

According to the Vidal medical directory, the registration certificate for the release of the drug belongs to REPLEKPHARM, the country of origin is Macedonia. The medicine is registered by the World Health Organization and is available with a doctor's prescription.

Used to treat arthritis and arthrosis of various origins, myalgia, relieves pain after injuries and operations. Treats bursitis, migraines and toothache.

Aimed at relieving pain, swelling and inflammation. The drug is taken orally. It is not used for patients under 12 years of age. The dosage is reduced for patients suffering from renal failure. As the dosage of nimesulide increases, side effects may increase.

Not prescribed for patients with asthma, nasal polyposis, ulcers, or internal bleeding. The drug is dangerous for people with blood clotting disorders; drug and alcohol abusers. It is not recommended for use as therapy for nursing and pregnant women, children under 12 years of age, and people with kidney disease.

Dosage and instructions for use

Pills

The tablet form is either water-soluble or regular. The amount of active substance in soluble tablets is halved and amounts to 50 mg.

Nimesulide tablets, according to the instructions for use, are taken as follows:

• A dose of 100 mg (2 soluble tablets or 1 regular tablet) 2 times a day is recommended for adults. If ineffective, the dosage is increased, reaching a maximum of 400 mg (4 standard tablets, 8 soluble tablets). Regular tablets can be taken with meals, but the soluble form can be taken only after meals or at the end of a meal. A soluble tablet is diluted in a teaspoon of water. Regular tablets are not given to children under 12 years of age.
• As prescribed by a doctor, soluble tablets are prescribed in exceptional cases for children over 3 years of age. The dose of the drug is calculated depending on the weight (3-5 mg per kg of weight). In this case, this daily dosage is divided into 2-3 doses. If a child weighs more than forty kilograms, then he can be given the same amount of medicine as an adult.

Nimesulide is available under several brand names. These are Novolid, Aponil, Mesulide, Nise, etc. Soluble forms are called Prolide, Nise, Nimulid. There is complete correspondence between the drugs in terms of indications and mechanism of action; the composition, manufacturer and administration of the drug differ slightly.

Powder

This form of the medicine is diluted to a suspension in water. Open the bag, pour into half a glass of water until completely dissolved, stir and drink. The medicine is taken after eating food.

• The dosage of the medicine for adults and adolescents over 12 years of age is 1 sachet 2 times a day. Increases in dosage occur only as prescribed by a doctor.
• For older people, the dosage is the same.
• For patients suffering from renal failure, the dose of the medicine is reduced to 1 sachet per day.

Maximum course: 15 days. If the medicine relieves the symptoms of the disease, the dosage is reduced to avoid side effects.

The powder is produced under the trademarks Nise, Florid, Nimesil, etc.

Syrup

The concentration of the active substance in the suspension is reduced to 10 mg. Based on this, the dose of the medicine is calculated.

• This is nimesulide for children, it can be used to treat a child under 12 years of age. The dosage is calculated as follows: from 1.5 to 3 mg per kilogram of the baby’s weight. This is a daily dose, which is divided into two or three doses. For convenient administration of the syrup, the package contains a special measuring syringe. The maximum amount of active substance is 5 mg per kg of weight.
• For adolescents and adults, the dosage does not need to be calculated by kilograms. Take it 100 mg 2 times a day.

The suspension is produced under the trademarks Nise and Nimulid.

Gel

This form of the product is applied to the affected area. Gel is for external use only. The skin is washed with warm water and wiped dry, spreading 3 centimeters of ointment and rubbing.

Treatment lasts 10 days; the affected area is smeared three to four times a day. It is not recommended to apply it to open wounds. The gel should not come into contact with mucous membranes or eyes. Do not apply bandages on top of the gel, and wash your hands with soap after it.

Trademarks of nimesulide gel: Nimulid, Nimesuli-Darnitsa, etc.

Indications for use

Nimesulide powder is aimed at relieving acute pain (post-traumatic pain, bursitis, toothache, radiculitis, back pain), osteochondrosis.

The tablets treat arthritis, relieve exacerbations in the joints due to gout, arthritis, spondylitis, and myalgia. They perfectly eliminate pain from osteochondrosis, sprains, and inflammation in tissues. They eliminate pain of various origins.

The gel is used to relieve inflammation in diseases of the musculoskeletal system, muscle pain, ligament rupture, etc.

Suspension used for joint diseases, high fevers. The syrup is prescribed as a remedy to relieve pain symptoms after operations, to eliminate pain of various origins.

Contraindications of the drug

The medicine is not used to treat patients with gastrointestinal inflammation (colitis, Crohn's disease). It is not recommended to prescribe it to patients with asthma or nasopharyngeal polyps. It is also not used to treat patients with intolerance to acetylsalicylic acid and people with erosion or stomach ulcers.

It should not be used by people recovering from bypass surgery or by patients suffering from heart failure.

special instructions

In case of kidney disease, the excretion of nimesulide worsens. Therefore, in case of pronounced renal failure (creatinine clearance less than 30 milliliters per minute) and the development of other kidney diseases, the drug is contraindicated. It is used with caution in cases of renal failure (creatinine clearance from 30 to 60 milliliters per minute). In this case, the dose of the medicine is reduced. If the medicine provokes an exacerbation, then nimesulide is discontinued.

The medicine is contraindicated in patients with liver failure. If liver disease manifests itself during the course of therapy, the attending physician discontinues the medicine and does not subsequently use it to treat the patient.

The medicine is not prescribed to pregnant women and women during lactation.

It is used with extreme caution in elderly people. During this period, they are more likely than other patients to experience side effects: internal bleeding, tachycardia, and problems with the kidneys and liver.

For children under 12 years of age, the drug is prescribed only in 2 forms, where the concentration of the active substance is reduced: soluble tablets and syrup. The dosage is calculated based on the child’s weight and divided into several doses.

Interaction with other drugs

You should not take the drug with warfarin due to the high risk of internal bleeding. If co-administration cannot be avoided The attending physician must monitor the patient's blood clotting.

The drug does not combine well with medications containing lithium. Concomitant use concentrates lithium in the blood, which causes a toxic effect.

A toxic effect can be caused by taking medications against epilepsy, fungal infections, and anti-tuberculosis medications.

Interaction with alcohol

The drug cannot be combined with alcohol, and combined use puts a strain on the liver and kidneys, causing a toxic effect. This leads to irreversible consequences.

Storage, release from pharmacies

The medicine can only be obtained with a prescription from your doctor. It should be stored in places inaccessible to children. Storage temperature: from 0 to 25 degrees Celsius.

Drug analogues

Analogs of the drug are produced under the following brand names:

• "Nise." The price varies from 130-200 rubles.
• " ". The average cost of a package is from 580 to 630 rubles.

More about analogues

Cheap analogues

There are several analogues of the drug that are sold at a lower price:

• Prolid. Medicine made in India. Active substance: nimesulide. Price: 50–55 rubles.
• Nimika. Also the result of the work of Indian pharmacists. Cost: 49–52 rubles.
• Cockstral. Manufacturer: Czech Republic. Price: 65–70 rubles.