Nimesulide is a non-steroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic properties. It is a sulfonanilide derivative and a preferential cyclooxygenase-2 (COX-2) inhibitor. It is widely used in India for the short-term management of acute pain and primary dysmenorrhea. Its use is restricted to a maximum of 15 days due to hepatotoxicity concerns.
Adult: 100 mg twice daily, after meals. The tablet should be swallowed whole with a glass of water.
Note: Take after food to minimize gastric irritation. The tablet should not be broken, chewed, or crushed. Treatment duration must not exceed 15 days.
Nimesulide inhibits the synthesis of prostaglandins, key mediators of inflammation, pain, and fever, by blocking the cyclooxygenase (COX) enzyme pathway. It shows a preferential selectivity for the inducible COX-2 isoform over the constitutive COX-1 isoform. This may contribute to a lower incidence of gastrointestinal side effects compared to non-selective NSAIDs, though it does not eliminate the risk.
Pregnancy: Category C (US FDA). Avoid use, especially in the first and third trimesters. In the third trimester, it is contraindicated due to risk of premature closure of ductus arteriosus and potential for prolonged labor. Use only if potential benefit justifies potential risk to the fetus.
Driving: May cause dizziness, vertigo, or drowsiness in some patients. Patients should be cautioned about operating machinery or driving if they experience these effects.
| Warfarin, Acenocoumarol | Increased risk of bleeding due to displacement from protein binding sites and potential antiplatelet effect. | Major |
| Lithium | Decreased renal clearance of lithium, leading to increased lithium levels and toxicity. | Major |
| Methotrexate | Reduced renal clearance of methotrexate, increasing its hematologic and renal toxicity. | Major |
| Diuretics (Furosemide, Hydrochlorothiazide) | Reduced diuretic and antihypertensive efficacy; increased risk of renal impairment. | Moderate |
| ACE Inhibitors (Ramipril, Enalapril) / ARBs (Losartan) | Reduced antihypertensive effect; increased risk of renal impairment, especially in dehydrated patients. | Moderate |
| Corticosteroids (Prednisolone) | Increased risk of gastrointestinal ulceration and bleeding. | Moderate |
| Selective Serotonin Reuptake Inhibitors (SSRIs) e.g., Fluoxetine | Increased risk of upper gastrointestinal bleeding. | Moderate |
| Other NSAIDs (e.g., Diclofenac, Ibuprofen) | Increased risk of GI side effects and renal toxicity without therapeutic benefit. | Major |
| Cyclosporine, Tacrolimus | Increased risk of nephrotoxicity. | Major |
| Sulfonylureas (Glibenclamide, Glimepiride) | Enhanced hypoglycemic effect due to displacement from protein binding. | Moderate |