How to apply Nimesil: properties of the drug, instructions for the use of tablets, indications and contraindications

Nimesil is a medical product that belongs to the group of anti-inflammatory non-hormonal agents.The active ingredient is nimesulide - a substance that relieves pain, lowers temperature, fights against inflammation.

By its effect Nimesil can be compared with such drugs as, for example, Ibuprofen, Diclofenac.All medications of this group have a powerful systemic effect, but, these tablets have much less influence on the state of the gastrointestinal tract.Nimesil treats both adults and children, with pain caused by trauma, rheumatic and infectious lesions, feverish conditions.

Pharmacological action

Pharmacodynamics.Nimesulide is an anti-inflammatory nonsteroidal drug( NSAID) from the sulfonamide group.Creates an antipyretic, analgesic and anti-inflammatory effect of .The tablets act as an inhibitor of cyclooxygenase extracts, which is responsible for the formation of prostaglandins and inhibits mainly cyclooxygenase-2.

Pharmacokinetics:

• After ingestion, the drug is well absorbed into the digestive tract, reaching the highest concentration in the circulatory system in a few hours.
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• Interaction with plasma proteins - 97.6%.
• The elimination half-life is 3.3-5.5 hours.

Easily passes through the histohematological protection.In the liver, it is metabolized by cytochrome isoenzyme. The main metabolite is hydroxynimidesulide , which comes out with bile in a metabolized form( found only in the form of glucuronate).

Nimesulide is released from the body, usually only by the kidneys( approximately 52% of the used dosage).The pharmacokinetic profile of tablets in elderly people does not change during the administration of any doses.

Indications for use

Nimesil in tablets is indicated for the following diseases:

• treatment of osteoarthritis symptoms;
• treatment of acute painful sensations( back pain, back pain, pain in the muscular and bony system, toothache, bursitis, tendenitis);
• reduces inflammation and pain at the time of admission;
• algodismenorea.

Dosage and route of use

Nimesil is indicated for oral use, 1 tablet twice daily.The drug is recommended to eat after eating.The preparation is stirred with water , approximately 100 ml.Nimesil is used only to treat people over 12 years of age.

1. Adolescents( 12-18 years): taking into account the pharmacodynamic characteristics and the pharmacokinetic profile of nimesulide, there is no need to adjust the dosage in adolescents.
2. People with kidney failure: taking into account the pharmacokinetic profile, there is no need to adjust the dosage in people with moderate and mild degrees of renal failure.
3. Older people: the need to adjust the daily dose is determined by the doctor, taking into account the interaction with other medications.The maximum duration of the course is 2 weeks.To reduce the risk of side effects, it is necessary to take the minimum effective dose of the drug.

Usage specificities

The drug should be used with caution in people with gastrointestinal illnesses( Crohn's disease, ulcerative colitis), since may possibly exacerbate these diseases .The risk of bleeding in the stomach, ulcers increases with an increase in the dosage of NSAIDs in people with a history of ulcer, the more complicated the perforation or bleeding, and also in the elderly, so treatment must begin with a minimally effective dose.

People taking medications that inhibit platelet aggregation or reduce blood clotting, and also increase the risk of bleeding in the stomach .If ulcers or bleeding occur, Nimesil treatment should be discontinued.Since the tablets partially go out with the help of the kidneys, doses for people with impaired renal function should be reduced, taking into account the degree of urination.

There is evidence of a negative reaction of the liver to the drug.If symptoms of liver damage occur( yellowing of the skin, pruritus, vomiting, nausea, darkening of the urine, pain in the stomach), it is necessary to complete taking the pills and to consult with the doctor .

Despite the rare occurrence of eye disorders in people who use Nimesulide along with other drugs, treatment should immediately stop.Tablets can delay fluid in the tissues, so people with high blood pressure and with heart problems should use Nimesil very carefully.

Epidemiological data and clinical studies have shown that NSAIDs, at elevated doses and prolonged use, result in a minor risk of stroke or heart attack.

Nimesil contains sucrose, this must be taken into account by people who suffer from diabetes and patients on a low-calorie diet.The drug is undesirable to prescribe to people with rare diseases, such as a lack of sucrose-isomaltose, malabsorption of galactose-glucose or intolerance to fructose.

The drug can change the properties of platelets, because should be careful patients with hemorrhagic diathesis, while the drug does not replace the preventive effect of acetylsalicylic acid in cardiovascular diseases.

Like all NSAIDs that inhibit the formation of prostaglandins, Nimesulide can adversely affect the course of pregnancy and lead to the following consequences:

• pulmonary arterial hypertension;
• closure of the arterial duct;
• increased risk of bleeding;
• disturbance of kidney function;
• appearance of peripheral puffiness;
• decreased uterine contractility.

Therefore Nimesulide is prohibited during pregnancy and during lactation.The use of Nimesil adversely affects the fertility of women and is not desirable for patients who plan a pregnancy.

Side effects of Nimesil

Side effects from various systems:

• Allergic reactions: rash, itching, hypersensitivity reactions, sweating, dermatitis, erythema, urticaria, anaphylactoid reactions, erythema multiforme, angioedema, Lyell's syndrome, syndromeStevens-Johnson.
• Lymphatic and circulatory system: eosinophilia, anemia, thrombocytopenia, hemorrhages, purpura thrombocytopenic, pancytopenia.Sense organs: blurred vision.
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• ЦЦЦ: feeling of fear, dizziness, nightmares, nervousness, drowsiness, headache, encephalopathy.
• Respiratory system: bronchospasm, exacerbation of asthma, dyspnea.
• Cardiovascular system: tachycardia, hypertension, "hot flashes", lability of pressure.
• Biliary system and liver: fulminant hepatitis, hepatitis, cholestasis, jaundice.
• Gastrointestinal tract: nausea, diarrhea, constipation, vomiting, gastritis, flatulence, stomach pain, stomatitis, indigestion, stomach bleeding, tarry stool, ulcer.
• Urinary system and kidneys: hematuria, dysuria, renal failure, urinary retention, interstitial nephritis, oliguria.

interaction with other drugs

Nimesulide may interact with other drugs:

1. Selective serotonin inhibitors and antiplatelet agents, eg fluoxetine: increase the risk of bleeding in the stomach.
2. Glucocorticosteroids: increase the risk of bleeding and stomach ulcers.
3. Diuretics: the drug can reduce the effects of diuretines.
4. Anticoagulants: the drug may enhance the effects of anticoagulants, for example, warfarin.Because of the high risk of bleeding, joint administration of these drugs is undesirable and contraindicated in people with an incorrect coagulation function.If the complex combination still can not be avoided, it is necessary to control the level of clotting of the blood.

Contraindications to the use of

Contraindications include the following conditions:

• Hyperergic symptoms( in the anamnesis), for example, urticaria, rhinitis, bronchospasm associated with the use of acetylsalicylic acid or other NSAIDs, including Nimesulide.Hypersensitivity to nimesulide or to any of the substances that is in the preparation.
• Simultaneous use of medications with severe hepatotoxicity, for example, paracetamol or other non-steroidal or analgesic anti-inflammatory drugs.
• Hepatotoxic( a history of) symptoms on Nimesulide.Time during coronary artery bypass grafting.The processes of inflammation or bowel disease, nonspecific ulcerative colitis, Crohn's disease at the stage of exacerbation.
• Complete or partial combination of recurrent polyposis of paranasal sinuses or nose, bronchial asthma with the resistance of acetylsalicylic acid and other NSAIDs.
• Syndrome of fever in acute respiratory infections and colds.Presence of cerebrovascular bleeding or other bleeding, diseases that are accompanied by bleeding.
• Ulcer of the duodenum or stomach at the stage of exacerbation, history of bleeding in the gastrointestinal tract, perforation or ulcers.
• Chronic heart failure.Weak blood coagulation.Liver failure or any active hepatic disease.Chronic renal failure, hyperkalemia.
• Pregnancy and lactation time.Children under 12 years of age.Drug dependence and alcoholism.

Caution must be taken if there are:

• severe forms of diabetes;
• arterial hypertension, ischemic disease, heart failure;
• creatinine clearance less than 60 ml / min, hyperlipidemia / dyslipidemia, cerebrovascular disease;
• smoking, peripheral arterial diseases, infections caused by Helicobacter pylori, severe physical illnesses, anamnestic data on the digestive tract ulcer;
• prolonged previous use of NSAIDs, advanced age.

Concomitant treatment with is allowed with : antiaggregants( eg clopidogrel, acetylsalicylic acid), anticoagulants( eg warfarin), reuptake inhibitors( eg fluoxetine, citalopram, sertraline, paroxetine), oral glucocorticosteroidsExample, prednisolone).

The decision to use Nimesil must be based on a personal assessment of the patient "risk-benefit" during the use of this remedy.

Overdose with

Symptoms: pain in the epigastric region, drowsiness, apathy, vomiting, nausea .During maintenance treatment of gastropathy, these symptoms are usually reversible.There may be a bleeding in the stomach.Sometimes, respiratory depression, severe renal insufficiency, an increase in blood pressure, anaphylactoid reactions, coma are likely.

Treatment: There is no specific antidote.In case the overdose occurred within 5 hours, it is necessary to cause artificial vomiting and to take osmotic laxative or activated charcoal( 70-120 gr. For an adult).Hemodialysis, forced diuresis - ineffective due to increased Nimesil connection with proteins( up to 97.6%).It requires control of the liver and kidneys.

Treatment with Nimesil requires the control of and a serious relationship with the physician if it is used concomitantly with diuretics and anti-inflammatory drugs, as well as with medications that correct the pressure.

Nimesil can have an effective anti-inflammatory and analgesic effect.However, it is necessary to use it not on the advice of friends and relatives, but only after the recommendation of the doctor .Only in this way you will not allow negative consequences, you need to clearly control the dosage of this drug.