Composition
active ingredient: nimesulide;
1 sachet (2 g of granules) contains nimesulide 100 mg;
Excipients: lactose monohydrate, povidone, sodium saccharin, citric acid monohydrate; orange flavoring, colloidal anhydrous silicon dioxide.
Dosage form
Granules.
Main physicochemical properties: light yellow granules with an orange odor.
Pharmacotherapeutic group
Nonsteroidal anti-inflammatory and antirheumatic drugs. ATC code M01A X17.
Pharmacological properties
Pharmacodynamics.
Nimid® is a nonsteroidal anti-inflammatory drug of the methanesulfonanilide group, which exhibits anti-inflammatory, analgesic and antipyretic effects. The therapeutic effect of Nimid is due to the fact that it interacts with the arachidonic acid cascade and reduces prostaglandin biosynthesis by inhibiting cyclooxygenase.
Pharmacokinetics.
In humans, nimesulide is well absorbed after oral administration, reaching a maximum plasma concentration after 2-3 hours. Up to 97.5% of nimesulide is bound to plasma proteins. Nimesulide is actively metabolized in the liver with the participation of CYP2C9, an isoenzyme of cytochrome P450. The main metabolite is a parahydroxy derivative, which also has pharmacological activity. The half-life is from 3.2 to 6 hours. Nimesulide is excreted from the body with urine - about 50% of the dose taken. About 29% of the dose taken is excreted with feces in a metabolized form. Only 1-3% is excreted from the body unchanged. The pharmacokinetic profile in the elderly does not change.
Indication
Treatment of acute pain, primary dysmenorrhea.
Nimesulide should only be used as a second-line drug.
The decision to prescribe nimesulide should be made based on an assessment of all risks for the individual patient.
Contraindication
Known hypersensitivity to nimesulide or any component of the drug.
History of hyperergic reactions (bronchospasm, rhinitis, urticaria) to the use of acetylsalicylic acid or other nonsteroidal anti-inflammatory drugs. History of hepatotoxic reactions to nimesulide.
Concomitant use of other substances with potential hepatotoxicity.
Alcoholism and drug addiction.
History of gastrointestinal bleeding or perforation associated with previous use of nonsteroidal anti-inflammatory drugs.
Gastric or duodenal ulcer in the acute phase, history of ulcer, perforation or bleeding in the digestive tract.
History of cerebrovascular bleeding or other hemorrhages, as well as diseases accompanied by bleeding.
Severe blood clotting disorders.
Severe heart failure.
Severe renal impairment.
Liver dysfunction.
Patients with fever and/or flu-like symptoms.
Children under 12 years old.
Third trimester of pregnancy and breastfeeding.
Interaction with other medicinal products and other types of interactions
Pharmacodynamic interactions.
Corticosteroids: Increased risk of gastrointestinal ulceration or bleeding.
Antiplatelet agents and selective serotonin reuptake inhibitors (SSRIs): increased risk of gastrointestinal bleeding.
Anticoagulants: NSAIDs may enhance the effect of anticoagulants such as warfarin or acetylsalicylic acid, which is why this combination is contraindicated in patients with severe coagulation disorders. If such combination therapy cannot be avoided, careful monitoring of blood coagulation parameters is necessary.
Diuretics, angiotensin-converting enzyme inhibitors and angiotensin II antagonists.
NSAIDs may weaken the effect of diuretics and other antihypertensive drugs. In some patients with impaired renal function (for example, dehydrated patients or elderly patients), the combined use of ACE inhibitors, angiotensin II antagonists or substances that inhibit the cyclooxygenase system may lead to further deterioration of renal function and the development of acute renal failure, which is usually reversible. These interactions should be taken into account when the patient uses Nimid® simultaneously with ACE inhibitors or angiotensin II antagonists. Great caution should be exercised when using such a combination, especially in elderly patients. Patients should receive sufficient fluid, and renal function should be carefully monitored after the start of such a combination. Nimesulide temporarily weakens the effect of furosemide on the excretion of sodium and, to a lesser extent, the excretion of potassium, and also reduces the diuretic effect. The simultaneous use of furosemide and Nimid in patients with impaired renal or cardiac function requires caution.
In healthy volunteers, nimesulide rapidly reduces the sodium-excreting and, to a lesser extent, potassium-excreting effects of furosemide, and also reduces the diuretic effect. Simultaneous administration of nimesulide and furosemide leads to a decrease (approximately 20%) in the area under the concentration-time curve (AUC) and a decrease in the cumulative excretion of furosemide without changes in the renal clearance of furosemide.
There have been reports that NSAIDs reduce lithium clearance, leading to increased plasma lithium levels and lithium toxicity. When prescribing Nimid to patients receiving lithium therapy, frequent monitoring of plasma lithium levels should be performed.
There is no clinically significant interaction with glibenclamide, theophylline, warfarin, digoxin, cimetidine and antacids (aluminum and magnesium hydroxide combination) in vivo. Nimesulide inhibits the activity of the CYP2C9 enzyme. When drugs that are substrates of this enzyme are used simultaneously with Nimesulide, their concentration in the blood plasma may increase. Caution is required if nimesulide is prescribed less than 24 hours before or less than 24 hours after taking methotrexate, since it is possible to increase the level of the latter in the blood serum and increase its toxicity.
Due to their effect on renal prostaglandins, synthetase inhibitors, to which nimesulide belongs, may increase the nephrotoxicity of cyclosporines.
The effect of other drugs on nimesulide.
In vitro studies have shown that nimesulide is displaced from its binding sites by tolbutamide, salicylic acid and valproic acid. Although these interactions have been identified in plasma, these effects have not been observed during clinical use of the drug.
Application features
Undesirable side effects can be minimized by using the lowest effective dose for the shortest period of time necessary to control symptoms.
If the treatment is ineffective (reduction in symptoms of the disease), therapy with the drug should be discontinued.
During treatment with nimesulide, it is recommended to avoid the simultaneous use of hepatotoxic drugs, as well as to refrain from drinking alcohol. The use of nonsteroidal anti-inflammatory drugs may mask an increase in body temperature associated with a background bacterial infection. In the event of an increase in body temperature or the appearance of flu-like symptoms in patients using nimesulide, the drug should be discontinued.
There have been reports of serious liver reactions during treatment with nimesulide, including fatal outcomes. Patients who experience symptoms similar to those of liver damage, such as anorexia, nausea, vomiting, abdominal pain, fatigue, dark urine, or patients whose laboratory liver function tests are abnormal, should discontinue the drug. Re-administration of nimesulide to such patients is contraindicated. During treatment with Nimesulide, the patient should refrain from taking other analgesics. Concomitant use of other NSAIDs, including selective cyclooxygenase-2 inhibitors, should be avoided.
Patients taking nimesulide who develop flu-like symptoms should discontinue its use.
Elderly patients have an increased frequency of adverse reactions to NSAIDs, especially possible bleeding and perforations in the digestive tract, which can be fatal.
Ulceration, bleeding or perforation in the digestive tract can be life-threatening, especially if there is a history of similar events in the patient when using any other NSAIDs (without a prescription). The risk of such events increases with increasing NSAID dose in patients with a history of gastrointestinal ulcer, especially complicated by bleeding or perforation, and in elderly patients. In such patients, treatment should be started with the lowest possible effective dose. For these patients, as well as for those taking low doses of acetylsalicylic acid or other drugs that increase the risk of gastrointestinal complications, the possibility of using combination therapy with protective agents, such as misoprostol or proton pump inhibitors, should be considered.
Patients with toxic lesions of the digestive tract, especially elderly patients, should report any unusual symptoms that occur in the digestive tract, especially bleeding. This is especially important in the initial stages of treatment. Patients taking concomitant medications that may increase the risk of ulceration or bleeding, such as corticosteroids, anticoagulants, selective serotonin reuptake inhibitors, antiplatelet agents (acetylsalicylic acid), should be informed of the need to exercise caution when using nimesulide.
If a patient receiving Nimid® experiences bleeding or ulcers in the digestive tract, treatment with the drug should be discontinued.
NSAIDs should be prescribed with caution to patients with Crohn's disease or a history of nonspecific ulcerative colitis, as nimesulide may lead to their exacerbation.
Concomitant use of nimesulide with other drugs, such as oral contraceptives, anticoagulants, antiplatelet agents, may cause exacerbation of Crohn's disease and other diseases of the digestive tract.
Clinical trials and epidemiological data suggest that some NSAIDs, especially at high doses and with long-term use, may carry a small risk of arterial thrombotic events, such as myocardial infarction and stroke. There is insufficient data to exclude a risk of such events with nimesulide.
Patients with uncontrolled hypertension, acute heart failure, established ischemic heart disease, peripheral arterial disease and/or cerebrovascular disease should be prescribed nimesulide after careful assessment of the condition. The same should be done before prescribing the drug to patients with risk factors for cardiovascular disease, such as hypertension, hyperlipidemia, diabetes mellitus, and smoking.
Patients with impaired renal function or heart failure should be prescribed the drug with caution due to the possibility of worsening renal function. In case of deterioration of the patient's condition, treatment should be discontinued.
Elderly patients should be carefully monitored for the possibility of bleeding and perforation of the gastrointestinal tract, deterioration of renal, hepatic or cardiac function. Since nimesulide may affect platelet function, it should be prescribed with caution to patients with hemorrhagic diathesis. However, nimesulide does not replace acetylsalicylic acid in the prevention of cardiovascular diseases.
There have been rare reports of severe skin reactions with NSAIDs, some of which may be fatal, such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis. In most cases, if these reactions occurred during the first month of previously prescribed treatment, the risk of their occurrence in patients is significantly increased. Nimid® should be discontinued at the first signs of skin rash, mucosal lesions and other allergic manifestations.
Excipients: This medicinal product contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.
Use during pregnancy or breastfeeding
Inhibition of prostaglandin synthesis may adversely affect pregnancy and/or foetal development. Epidemiological data suggest that use of prostaglandin synthesis inhibitors in early pregnancy may increase the risk of spontaneous abortion, foetal heart defects and gastroschisis. The absolute risk of cardiovascular malformation has been reported to increase from less than 1% to approximately 1.5%. The risk is thought to increase with dose and duration of exposure.
Nimesulide should not be taken during the first and second trimesters of pregnancy unless clearly necessary. If the drug is used in women attempting to conceive or during the first and second trimesters of pregnancy, the lowest possible dose and the shortest possible duration of treatment should be used.
In the third trimester of pregnancy, all prostaglandin synthesis inhibitors can lead to the development of the following in the fetus:
• pneumocardial toxic lesion (with premature closure of the ductus arteriosus and hypertension in the pulmonary artery system);
• renal dysfunction, which may progress to renal failure with the development of oligohydramnios.
In the mother and fetus at the end of pregnancy, it is possible:
• increased bleeding time, anti-aggregation effect, which may occur even when using very low doses of the drug;
• suppression of uterine contractile activity, which may lead to a delay or prolongation of the period of labor.
Therefore, nimesulide is contraindicated in the third trimester of pregnancy.
As an NSAID that inhibits prostaglandin synthesis, nimesulide can cause premature closure of the ductus arteriosus, pulmonary hypertension, oliguria, oligohydramnios. The risk of bleeding, labor weakness and peripheral edema increases. There are isolated reports of renal failure in infants whose mothers used nimesulide at the end of pregnancy. Animal studies have shown atypical reproductive toxicity of the drug, but there are no reliable data on the use of nimesulide in pregnant women. The potential risk for humans has not been determined, therefore, the use of nimesulide in the I and II trimesters of pregnancy is not recommended. Since it is not known whether nimesulide penetrates into breast milk, its use is contraindicated during breastfeeding.
Nimesulide may impair female fertility and is therefore not recommended for use in women attempting to conceive. Women who are unable to conceive or who are undergoing investigation of infertility should consider discontinuing nimesulide. If pregnancy occurs during treatment with nimesulide, the doctor should be informed.
Ability to influence reaction speed when driving vehicles or other mechanisms
No studies have been conducted on the effect of nimesulide on the ability to drive or use machines, but if patients experience headache, dizziness, or drowsiness while taking nimesulide, they should refrain from driving or operating machinery.
To minimize possible unwanted side effects, the minimum effective dose should be used for the shortest possible time. It is recommended to take after meals.
The maximum duration of the course of treatment with Nimid is 15 days.
Adults: 1 sachet (100 mg) 2 times a day.
Elderly patients: No dose adjustment is required.
Children over 12 years of age: No dose adjustment is required.
Patients with renal impairment. For patients with mild or moderate renal impairment (creatinine clearance 30-80 ml/min), no dose adjustment is required, while severe renal impairment (creatinine clearance < 30 ml/h) is a contraindication to the use of Nimid.
The contents of the sachet should be dissolved in 1 glass of warm water before use and drunk immediately.
Children
Nimid® is contraindicated in children under 12 years of age.
Overdose
Symptoms of acute overdose with nonsteroidal anti-inflammatory drugs (NSAIDs) are usually limited to: apathy, drowsiness, nausea, vomiting, epigastric pain. These symptoms are usually reversible with supportive therapy. Gastrointestinal bleeding, hypertension, acute renal failure, respiratory depression, coma are possible, but such phenomena are rare. There have been reports of anaphylactoid reactions when using therapeutic doses of NSAIDs and in case of their overdose. There is no specific antidote. Treatment of overdose is symptomatic and supportive. There is no data on the removal of nimesulide by hemodialysis, but if we take into account the high degree of binding of nimesulide to plasma proteins (up to 97.5%), dialysis is unlikely to be effective. In the presence of symptoms of overdose or after the use of a large dose of the drug within 4 hours after its administration, patients may be prescribed: artificial induction of vomiting and/or administration of activated charcoal (60-100 g for adults), and/or administration of an osmotic laxative. Forced diuresis, increased urine alkalinity, hemodialysis and hemoperfusion may be ineffective due to the high degree of binding of nimesulide to blood plasma proteins. Kidney and liver function should be monitored.
Adverse reactions
From the blood and lymphatic system: anemia, eosinophilia, thrombocytopenia, pancytopenia, purpura.
Immune system disorders: hypersensitivity, anaphylaxis.
Metabolic disorders: hyperkalemia.
On the part of the psyche: feelings of fear, nervousness, terrible dreams.
From the nervous system: dizziness, headache, drowsiness, encephalopathy (Reye's syndrome).
From the organs of vision: blurred vision, visual disturbances.
From the organs of hearing and balance: vertigo (dizziness).
Cardiovascular system: tachycardia, hemorrhage, blood pressure lability, hot flashes, arterial hypertension, increased risk of arterial thrombotic complications, such as myocardial infarction or stroke, heart failure.
From the respiratory system: shortness of breath, asthma, bronchospasm.
On the part of the digestive tract: diarrhea, nausea, vomiting, including vomiting with blood, constipation, flatulence, gastritis, abdominal pain, dyspepsia, stomatitis, black stools, bleeding in the digestive tract, duodenal/gastric ulcer and perforation, exacerbation of colitis and Crohn's disease.
Hepatobiliary system: hepatitis; fulminant hepatitis, with fatal outcome, including jaundice; cholestasis.
Skin: itching, skin rash, increased sweating, erythema, dermatitis, urticaria, angioedema, facial edema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.
From the urinary system: dysuria, hematuria, urinary retention, renal failure, oliguria, interstitial nephritis.
General disorders: edema, malaise, asthenia, hypothermia.
Laboratory indicators: increased liver enzymes.
Expiration date
4 years.
Storage conditions
Store at a temperature not exceeding 25 °C.
Keep out of reach of children.
Packaging
2 g per sachet. 30 sachets per carton.
Vacation category
According to the recipe.
Producer
Kusum Healthcare Pvt Ltd/
Kusum Healthcare Pvt Ltd.
Location of the manufacturer and its business address.
SP-289 (A), RIICO Industrial Area, Chopanki, Bhiwadi, Dist. Alwar (Rajasthan), India/
SP-289 (A), RIICO Industrial area, Chopanki, Bhiwadi, Dist. Alwar (Rajasthan), India.
