Nimesulide tablets: instructions, reviews and prices. A drug of the NSAID group with selective action nimesulide: what is it prescribed for and how to take the drug for orthopedic pathologies

Acute pain cannot be tolerated: measures must be taken immediately to eliminate it. Many as an "ambulance" resort to the drug "Nimesulide". How it affects the body, the properties of the active substance, the features of the application - about this in the article.

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

You can use different forms of medicines:

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

Auxiliary components for each form of the drug have their own. They help to increase the shelf life of the drug, improve its taste and structural 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 NVPS. Yes, and it is forbidden to take it with a fever of infectious genesis or during a cold.

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

The gel is quickly absorbed and almost instantly anesthetizes 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 cure 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.

Also, the drug is used for other pathologies accompanied by acute pain syndrome.

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

In addition, the gel is used for:

• tendinitis;
• lumbago;
• sprains, muscles;
• osteoarthritis;
• periarthritis.

Instructions for use and dosage

Any of the forms of the drug is available only to patients who have reached the age of 12 years. Use at an earlier age is fraught with serious complications.

The dosage should be selected the smallest, which is effective. The course of admission should not be continued for more than 14 days.

Nimesulide tablets

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 steps. Maximum - 400 mg per day. Children over 12 years of age should take 50-100 mg 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). Drink immediately, do not store the solution.

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

Gel Nimesulide

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

Do not use the drug on open wounds or in places near the eyes and lips. In case of accidental swallowing, rinse your mouth and take sorbents.

During pregnancy and lactation

Pregnant women are most at risk of catching 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. Can they be eliminated with Nimesulide?

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

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 threatens with serious complications for the mother and fetus:

• pressure drops that threaten premature birth;
• kidney failure;
• the likelihood of premature closure of the arterial duct;
• decrease in the amount of water;
• stop uterine contractions;
• bleeding;
• edema.

During lactation, Nimesulide can also not be used for pain relief. The substance enters the milk and adversely affects infants.

Can I drink alcohol while taking the drug

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

Medicine has a firm conviction regarding this issue: the simultaneous intake of alcohol and a potent anti-inflammatory drug does not heal, but cripple 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 breaks down under the influence of alcohol. "Nimesulide" is a very toxic drug, it also significantly increases the load on the liver. And the cocktail that is obtained when combined causes severe malfunctions in the liver, which can result in complete dysfunction and hepatitis.

Therefore, it is necessary to take a pill only when at least 10 hours have passed since the last glass of alcohol drunk. Otherwise, the expected effect will not be, but only complications will appear.

drug interaction

• Other NSAIDs, when taken together with the drug, cause an aggravation of the toxic effects. You shouldn't do that!
• If you take glucocorticosteroids and antithrombotic drugs with the drugs under discussion, the likelihood of internal bleeding in the digestive tract increases.
• Nimesulide reduces the effectiveness of diuretics and furasemide, together with the latter drug, complicating the withdrawal 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 cyclosporine causes an increased burden 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 drugs when used and dosed correctly.

Contraindications, side effects and overdose

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

That is why, eliminating unwanted symptoms in the form of fever or acute pain, it at the same time affects other body systems. 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;
• violation of the rhythm of the myocardium;
• pulse jumps;
• general weakness, fatigue;
• increase in the content of potassium in plasma;
• swelling of the skin;
• frequent dizziness;
• a sharp increase, and then a decrease in blood pressure;
• allergic skin rash, scabies;
• uncontrolled muscle spasms;
• hyperhidrosis;
• breathing problems, shortness of breath;
• spasms in the bronchi;
• increased gas formation;
• ulcerative pathologies, erosion, bleeding in the gastrointestinal tract;
• inflammation of the liver;
• urination disorders;
• wounds in the mouth, gums;
• vision problems;
• panic syndrome;
• anxiety;
• kidney failure;
• decline in temperature indicators;
• excessive activity, aggressiveness.

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

To reduce the level of toxic effects on the body, the medication should be taken 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 the possibility of acute renal failure, respiratory arrest, anaphylactic shock, convulsions and coma. In case of an overdose, it is necessary to take sorbents and immediately call a doctor.

An overdose when using the gel can occur only in the case of a significantly higher dose of the drug (more than 50 g). Symptoms of the condition are 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 pathology;
• reduced blood clotting;
• pregnancy (in the first and last trimester);
• ulcerative processes in the stomach;
• the period after coronary bypass surgery;
• lactation;
• fever and fever in 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, if necessary, dose reduction or discontinuation of the drug.

Nimesulide's analogs

Full synonyms of the drug are presented in pharmacology with various medicines with nimesulide in the composition.

Among them:

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

Other NSAIDs act similarly on the body, eliminating pain, fever and blocking the development of inflammation. The range of medicines is wide because there are many synonymous series of medicines with the same active substance.

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 is produced in various pharmacological forms. Detailed instructions for nimesulide for proper use are presented below.

The use of Nimesulide tablets

Nimesulide (in Latin -nimesulide) is part of many drugs, 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 made only after consulting a doctor and according to the instructions, because if used incorrectly, serious side effects are possible. A suitable dosage will help get rid of unpleasant symptoms.

What are Nimesulide tablets from?

A non-steroidal anti-inflammatory drug is a great way to quickly get rid of pain, swelling inside the body. It is important to understand that the 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 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 ;
• inflammation of the tendons;
• muscle pain.

Nimesulide - release form

Today, a large number of drugs are on the market, which include nimesulide. They differ not only in the brand of production and price. The release form is of great importance 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).

Ingredients of 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 having a harmful effect on the human body. The basis of gels and ointments are thimerosal and alcohols. As for dragees, corn starch and aspartame predominate there.

The drug Nimesulide - instructions for use

According to the observations of doctors, the substance, like its analogues, always gives a tangible effect, but it is better to keep it as a last resort. A large number of contraindications suggests that the instruction of nimesulide is very important for familiarization. There are certain application rules that should 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. It is taken in the same way as dragee, 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. It is not recommended to use over the overlay.

Nimesulide tablets

The most widely used form of release. Nimesulide tablets can be found in pharmacies under different names. Depending on the country of manufacture, the price may vary significantly. The most popular commercial names are Nimesulide, Flolid, Ameolin. Dragees can dissolve with water. It is 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. Tablets are taken 2 times a day after meals.

Nimesulide powder - instructions for use

This form of drug release, like powder, perfectly replaces dragees. Helps to 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 should be diluted 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, dental, headaches and other ailments that require the immediate elimination of discomfort, inflammation. With 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 the amount of 100 mg.

Nimesulide gel - instruction

The gel is prescribed if there are problems with the musculoskeletal system. If the patient feels pain in the joints, then you need to squeeze out a small amount of a creamy substance and apply it to the affected area with massage movements. Rubbing Nimesulide gel takes several minutes. To get a quick result, the procedure should be repeated 3-4 times a day. Please note that it is impossible to apply the gel to open wounds and skin affected by various dermatological problems.

Ointment Nimesulide - instructions for use

Here the situation is almost the same as with gels. Apply Nimesulide ointment is necessary for pain in the joints according to the instructions. Regular rubbing of a creamy substance will get rid of an unpleasant feeling in 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 medicine 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 small patients is a high temperature with SARS. It must be remembered that such a suspension for children is given in cases where a simple one 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 found volume 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.

Nimesulide contraindications

The drug 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. Do not use it for those who are addicted to drugs, drink alcohol, have flu symptoms. In addition to the above, there are such 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 risk on one side. Inclusions are allowed on the surface of the tablets.

pharmachologic effect

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

pharmachologic effect

Non-steroidal 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 history), erosive and ulcerative lesions of the mucous membrane of the stomach or duodenum, active gastrointestinal intestinal bleeding, cerebrovascular or other bleeding, inflammatory bowel disease (Crohn's disease, ulcerative colitis) in the acute phase, hemophilia and other blood clotting disorders, decompensated chronic heart failure, liver failure or any active liver disease, hepatotoxic reactions when using nimesulide in history , 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 grafting, simultaneous administration with other potentially hepatotoxic drugs, fever and / or flu-like symptoms, pregnancy, lactation, children under 12 years of age.

Carefully: coronary artery disease, cerebrovascular disease, chronic heart failure, dyslipidemia/hyperlipidemia, diabetes mellitus, peripheral arterial disease, smoking, renal failure (creatinine clearance less than 60 ml/min), history of gastrointestinal ulceration, presence of 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 (in including citalopram, fluoxetine, paroxetine, sertraline).

Pregnancy and lactation

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

Dosage and administration

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 insufficiency with a creatinine clearance of 30-80 ml / minute, as well as elderly patients, do not need to reduce the dose.

Side effect

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

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

Mental disorders: nervousness, anxiety, nightmares.

From the side of the eyes: visual impairment.

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

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

From the side of the liver: increased activity of "liver" transaminases, hepatitis, fulminant hepatitis (including fatal), cholestatic jaundice.

From 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 upon discontinuation of the drug. Gastrointestinal bleeding may occur. Arterial hypertension, acute renal failure, respiratory depression may occur, but very rarely.

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

Interaction with other drugs

With the simultaneous use of nimesulide with the following drugs, drugs compete for communication with plasma proteins: with digoxin; phenytoin and lithium preparations; diuretics and antihypertensive drugs; other NSAIDs; cyclosporine; methotrexate and antidiabetic agents.

The effect of drugs that reduce blood clotting is enhanced by their simultaneous use with nimesulide. In patients taking warfarin and acetylsalicylic acid preparations, the risk of bleeding increases, so this combination is not recommended. If the appointment cannot be avoided, then the dose of warfarin should be under strict medical supervision.

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

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

The level of lithium in plasma increases with the simultaneous administration of lithium preparations and nimesulide, so the serum concentration of lithium 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 the supervision of a physician, undergoing examination at short intervals.

Nimesulide may enhance the nephrotoxic effect of cyclosporine.

Application features

With prolonged use, systematic monitoring of kidney function is necessary.

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Characteristics of the substance Nimesulide

NSAIDs from the class of sulfonamides.

Pharmacology

pharmachologic effect- anti-inflammatory, antipyretic, analgesic.

Pharmacodynamics

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

It reversibly inhibits the formation of PGE 2 both in the focus of inflammation and in the ascending pathways of the nociceptive system, including the pathways for 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 prostanoid EP-type 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 in 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. joint pain 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 Cmax in blood plasma after 2-3 hours.

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

Metabolism. It is metabolized in the liver by the cytochrome P450 isoenzyme CYP2C 9. The main metabolite is the pharmacologically active parahydroxy derivative of nimesulide, hydroxynimesulide.

Withdrawal. T 1 / 2 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%), undergoes enterohepatic recirculation.

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

According to a pilot study conducted with the participation of patients with mild to moderate renal insufficiency (Cl creatinine 30-80 ml / min) and healthy volunteers, Cmax of nimesulide and its metabolite in the plasma of patients did not exceed the concentration of nimesulide in healthy volunteers. AUC and T 1/2 in patients with renal insufficiency were higher by 50%, but within the pharmacokinetic values. With repeated administration of nimesulide, cumulation is not observed.

Pills

Suction. After oral administration, nimesulide is well absorbed from the gastrointestinal tract. Eating reduces the rate of absorption without affecting its degree. T max - 1.5-2.5 hours. C max nimesulide in 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. It penetrates into the tissues of the female genital organs, where after a single dose the concentration is about 40% of the plasma concentration. It penetrates well into the acidic environment of the focus of inflammation (40%), synovial fluid (43%). Easily penetrates through the BBB.

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

Withdrawal. T 1/2 of nimesulide is 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.

Pharmacokinetics in special clinical situations. In patients with mild to moderate renal impairment (Cl creatinine 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. C max nimesulide in plasma after a single application is noted by the end of the first day, its value is more than 300 times lower than that for oral dosage forms of nimesulide. There are no traces of the main metabolite of nimesulide (4-hydroxynimesulide) in the blood.

Application of the substance Nimesulide

Granules for suspension for oral administration

Acute pain (pain in the back, lower back; pain syndrome in the pathology of the musculoskeletal system, including injuries, sprains and dislocations of the 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 the ligaments, tendons, bursitis, incl. post-traumatic inflammation of soft tissues, pain syndrome of various origins (including in the postoperative period, with injuries, algomenorrhea, toothache, headache, arthralgia, lumbar ischialgia).

Gel for external use

Acute and chronic inflammatory diseases of the musculoskeletal system (articular syndrome during exacerbation of gout, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, osteoarthritis, osteochondrosis with radicular syndrome, sciatica, inflammatory lesions of ligaments and tendons, bursitis, sciatica, lumbago), muscle pain of rheumatic and non-rheumatic origin, post-traumatic inflammation of soft tissues and the musculoskeletal system (damages and ruptures 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 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 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 polyposis of the nose and paranasal sinuses and intolerance to acetylsalicylic acid or other NSAIDs (in history), erosive and ulcerative lesions of the gastrointestinal tract in the acute stage, dermatosis, damage to the epidermis and infection of the skin 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.

Application restrictions

Granules for suspension for oral administration, tablets

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

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

Gel for external use

Erosive and ulcerative lesions of the gastrointestinal tract in history (including peptic ulcer of the stomach and duodenum); hepatic and renal insufficiency of mild and moderate severity; severe heart failure; arterial hypertension; elderly age; children's age over 12 years; diabetes; violation of blood clotting (including hemophilia, prolongation of bleeding time, tendency to bleed).

Use during pregnancy and lactation

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

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

infrequently - itching, rash, increased sweating; rarely - erythema, dermatitis; very rarely - urticaria, angioedema, swelling of the face, erythema multiforme exudative, 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 sense organs: rarely - blurred vision.

From the CCC: 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, mucosal ulceration and / or perforation of the stomach or duodenum.

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

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

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

Gel for external use

From 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 administration. However, one should be aware of the possibility of systemic side effects if nimesulide is used on large areas for a long time and in high doses.

Interaction

Granules for suspension for oral administration, tablets

GKS. Increase the risk of gastrointestinal ulcers or bleeding.

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

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

Diuretics. NSAIDs may reduce the effect of diuretics. In healthy volunteers, nimesulide temporarily reduces the excretion of sodium under the action of furosemide, to a lesser extent - potassium, and reduces the actual diuretic effect. Co-administration of nimesulide and furosemide leads to a decrease (approximately 20%) in AUC and a decrease in the cumulative excretion of furosemide without changing the renal clearance of furosemide. The 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 insufficiency (Cl creatinine 30-80 ml / min), with the joint appointment of ACE inhibitors, angiotensin II receptor antagonists, or substances that suppress the COX system (NSAIDs, antiplatelet agents), further deterioration of kidney 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 joint intake of these drugs should be prescribed with caution, especially in elderly patients. Patients should be adequately hydrated and renal function should be closely monitored after initiation of concomitant therapy.

lithium preparations. There is evidence that NSAIDs reduce the clearance of lithium, which leads to an increase in the concentration of lithium in the blood plasma and its toxicity. When prescribing nimesulide to patients receiving lithium therapy, regular monitoring of plasma lithium concentrations should be carried out.

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. With simultaneous administration of drugs metabolized with the participation of this isoenzyme with nimesulide, their plasma concentration may increase.

With simultaneous use with antiepileptic (valproic acid), antifungal (ketoconazole), anti-tuberculosis (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 simultaneously taking sulfonamides should be under the supervision of a physician, undergoing examination at short intervals. When prescribing nimesulide less than 24 hours before or after taking methotrexate, caution is required, because. in such cases, the concentration of methotrexate in plasma and, accordingly, its toxic effects may increase. In connection with the action on renal PG, PG synthetase inhibitors, which include nimesulide, may increase the nephrotoxicity of cyclosporins.

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

Gel for external use

When applied 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 at maximum doses, interactions with digoxin, phenytoin, lithium preparations, diuretics, cyclosporine, methotrexate, other NSAIDs, antihypertensive and antidiabetic drugs cannot be ruled out. Before using the gel, you should consult your doctor if you are using these drugs or are under medical supervision.

Overdose

Granules for suspension for oral administration, tablets

Symptoms: apathy, drowsiness, nausea, vomiting, pain in the epigastric region. Gastrointestinal bleeding may occur. In rare cases, an increase in blood pressure, acute renal failure, respiratory depression and coma, 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 provide activated charcoal (60 to 100 g per adult) and / or an osmotic laxative. Forced diuresis, hemodialysis are ineffective due to the high binding of nimesulide to plasma proteins.

Gel for external use

Cases of overdose of nimesulide with external use have not been described.

When applying large amounts of gel (exceeding 50 g) on ​​large areas of the skin or in case of accidental ingestion, 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.

Precautions for the substance Nimesulide

Granules for suspension for oral administration, tablets

Nimesulide should be used with caution in patients with a history of gastrointestinal disease (ulcerative colitis, Crohn's disease), as 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 ulcer, especially complicated by bleeding or perforation, as well as in elderly patients, so treatment should be started as soon as possible. doses. Patients receiving drugs that reduce blood clotting or inhibit platelet aggregation also increase the risk of gastrointestinal bleeding. In the event of gastrointestinal bleeding or gastric or duodenal ulcers in patients taking nimesulide, treatment should be discontinued.

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

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

Nimesulide should be used with caution in patients with arterial hypertension, cardiac disorders, 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 the indicators of creatinine clearance. In case of deterioration of kidney function, nimesulide should be discontinued.

Nimesulide can change the properties of platelets, so care must be taken when using it in people with hemorrhagic diathesis, but 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 - anti-inflammatory drug. It is produced in different forms, which allows patients to take the drug externally and internally. Action of the drug: removal of inflammation, removal of pain. The drug nimesulide helps to 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, which becomes prostaglandins. They form edema, act on pain receptors, cause tissue redness and increase the patient's body temperature. The drug prevents the synthesis of prostaglandins, blocking their enzyme, stopping the inflammation process. The inflammatory reaction stops, its symptoms disappear: swelling, fever, pain.

Nimesulide has a great advantage over other drugs aimed at relieving inflammation, for example, aspirin. The drug rarely gives side effects. With an increase in the dose of the drug used, the likelihood of side effects increases, possibly damage to the gastrointestinal tract and kidneys.

Ask your question to a neurologist for free

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

The great advantage of the remedy is the low probability of allergies, which allows it to be taken by almost every patient.

Forms of drug release

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

• Dissolvable tablets. They consist of the active substance, talc, corn starch and aspartame. The average price in a pharmacy kiosk: 80–90 rubles.
• Non-dissolving tablets. The composition is the same as above. The average price in a pharmacy: 50-70 rubles.
• Suspension (syrup). For the production of syrup, pineapple flavor, yellow dye, sucrose and xanthan gum are used. The cost of this form of medicine is not less than 200-230 rubles.
• Gel nimesulide. For the manufacture of this form of medicine, alcohols and mercury compounds are used that do not have a toxic effect. The price of nimesulide ointment starts from 150 rubles.
• Powder for suspension. Its composition is similar to the composition 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 the region of residence.

Their release is carried out by different pharmaceutical companies, but the active element in each dosage form is the same - nimesulide, for example, the drug Nise or nimesulide maxfarma. And the patient can choose for himself a more convenient form of drug use.

Nimesulide-teva

The basis of nimesulide-teva is the active substance nimesulide, it contains 100 mg in each tablet. Supplement the composition of the tablet: magnesium, vegetable oil and other components.

Nimesulide-teva relieves pain, relieves inflammation and fever begins to act half an hour after ingestion. 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, relieves pain from injuries of bones and tissues.

These are yellow, round, scored tablets. The package contains 10, 20 or 60 tablets. It is taken orally. The course of treatment means: up to 14 days. Not to be used during pregnancy and not recommended for breastfeeding mothers. Not tolerated by patients with stomach ulcers, liver problems, etc. Do not take the medicine if there are infectious diseases.

Nimesulide-teva do not combine with other means of a similar spectrum of action. Poorly combined with diuretics, drugs based on lithium. To avoid side effects, the dosage of the medicine should be observed.

Side effects are expressed by nausea, vomiting, increased 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. Packing in 2 gram bags; packs of 9, 15, 30 bags.

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

Nimesulide Canon contraindicated in case of intolerance to fructose and the active substance of the drug. It is not recommended to take people with stomach ulcers, internal bleeding, blood diseases. Do not use the remedy for people with renal insufficiency, pregnant and lactating women. Not recommended for use in children under 12 years of age. The duration of the course of the drug nimesulide Canon is not more than 15 days. Side effects: anemia, allergic reactions, urticaria, edema, dizziness, migraine, increased pressure, shortness of breath.

Stored at temperatures up to 25 degrees Celsius.

Nimesulide vidal

According to the medical reference book Vidal, the registration certificate for the release of the drug belongs to REPLEKPHARM, the country of origin is Macedonia. The drug is registered by the World Health Organization, is dispensed by prescription.

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

It is aimed at relieving pain symptoms, 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 insufficiency. With an increase in the dosage of nimesulide, an increase in side effects is possible.

Not prescribed for patients with asthma, nasal polyposis, ulcers, internal bleeding. Dangerous drug for people with bleeding disorders; drug and alcohol abusers. It is not recommended to take as a therapy for lactating and pregnant women, children under 12 years old, people with kidney disease.

Dosage and instructions for use

Pills

The tablet form is soluble in water and regular. The amount of active substance in soluble tablets is halved and is 50 mg.

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

• A dose of 100 mg (2 dissolvable tablets or 1 regular tablet) twice daily is recommended for adults. With inefficiency, the dosage increases, reaching the maximum - 400 mg (4 standard tablets, 8 soluble). Ordinary tablets can be taken with meals, and a soluble form only after meals or at the end of a meal. Soluble tablet is diluted in a teaspoon of water. Ordinary tablets are not given to children under 12 years of age.
• According to the doctor's prescription, soluble tablets, in exceptional cases, are prescribed for children from 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, such a 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, Mesulid, Nise, etc. Soluble forms are called Prolide, Nise, Nimulid. Between the drugs, there is full compliance with the indications and the mechanism of action, the composition, manufacturer and administration of the drug differ slightly.

Powder

This form of the drug is diluted to a state of suspension in water. The sachet is opened, poured into half a glass of water until completely dissolved, stirred and drunk. The medicine is taken after eating.

• Dose of medicine for adults and adolescents over 12 years old, 1 sachet 2 times a day. An increase in dosage occurs only as directed by a doctor.
• For the elderly, the dosage is the same.
• For patients suffering from renal insufficiency, the dose of the drug is reduced to 1 sachet per day.

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

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

Syrup

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

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

The suspension is produced under the trademarks Nise and Nimulid.

Gel

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

The treatment is 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 get on the mucous membranes and in the eyes. You can not put 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, sciatica, back pain), osteochondrosis.

Tablets treat arthritis, relieve exacerbations in the joints with gout, arthritis, spondylitis, myalgia. They perfectly eliminate pain in osteochondrosis, sprains, inflammation in the tissues. They eliminate pain of various origins.

The gel is used to relieve the inflammatory process in diseases of the musculoskeletal system, muscle pain, torn ligaments, etc.

Suspension used for diseases of the joints, fevers with high fever. The syrup is prescribed as a means of relieving pain symptoms after surgery, to eliminate pain of various genesis.

Contraindications of the drug

The drug is not used to treat patients with inflammation of the gastrointestinal tract (colitis, Crohn's disease). It is not recommended to prescribe it to patients with asthma, polyps in the nasopharynx. Also, do not use it 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 and patients suffering from heart failure.

special instructions

With kidney disease, the excretion of nimesulide worsens. Therefore, with pronounced renal failure (CC less than 30 milliliters per minute) and the development of other kidney diseases, the drug is contraindicated. With caution, it is used for indications of renal failure (CC from 30 to 60 milliliters per minute). In this case, the dose of the drug is reduced. If the drug provokes an exacerbation, then nimesulide is canceled.

The drug is contraindicated in patients with hepatic insufficiency. If liver disease manifested itself during the course of therapy, then the attending physician cancels the medicine and does not continue to use them to treat the patient.

Pregnant women and women during lactation are not prescribed medication.

It is used with extreme caution in the elderly. During this period, they more often than other patients experience side effects: internal bleeding, tachycardia, and there are 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 according to the weight of the child and is divided into several doses.

Interaction with other drugs

Warfarin should not be taken due to the high risk of internal bleeding. If joint reception cannot be avoided the attending physician must monitor the patient's blood clotting.

The drug is poorly combined with drugs containing lithium. Joint reception concentrates lithium in the blood, which causes a toxic effect.

The toxic effect can provoke the use of drugs against epilepsy, fungal infections, tuberculosis drugs.

Interaction with alcohol

The drug is not combined with alcohol, and the joint use loads the liver and kidneys, exerting a toxic effect. This leads to irreversible consequences.

Storage, dispensing from pharmacies

The medicine can only be obtained with a prescription from your doctor. It should be kept out of the reach of children. Storage temperature: 0 to 25 degrees Celsius.

Medicine analogs

Analogues of the drug are produced under the trademarks:

• "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 drug analogues 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.