Systemic and local use of NSAIDs: focus on nimesulide

According to the International Association for the Study of Pain (IASP), “Pain is an unpleasant sensation and emotional experience associated with actual or potential tissue damage or described by a person in terms of such damage.” Approximately 40% of general practitioner visits are due to mild to moderate acute pain, and more than 70% of emergency department visits are due to the patient having severe acute pain [1]. Pain management plays an important role in the work of many medical specialties. Adequate relief of acute pain in most cases helps prevent its chronicity [2]. In such a situation, the most popular tool for analgesic therapy is non-steroidal anti-inflammatory drugs (NSAIDs) [3,4]. They belong to different chemical classes and therefore have different pharmacokinetic and pharmacodynamic properties [5]. A rational choice of NSAIDs involves taking into account the main properties of the drug (the predominance of analgesic or anti-inflammatory activity), as well as possible negative effects (the risk of developing NSAID gastropathy and decompensation of cardiovascular diseases) [6]. One of the NSAIDs widely used in Russia is nimesulide. Nimesulide was introduced into clinical practice in the early 1980s. During the period of use of drugs based on it, they have established themselves as effective, well-tolerated and affordable drugs [7]. Recently, studies are also underway examining the role of nimesulide as an additional treatment for COVID-19. The reason for these studies was a finding suggesting that nimesulide may be a potent inhibitor of the B0AT1 subunit of the ACE2 receptor, which is a target of SARS-CoV-2 [8].

Nimesulide has a balanced effect on both forms of COX with predominant inhibition of COX-2 [5].

Thanks to this, on the one hand, the risk of developing gastrointestinal complications is significantly reduced compared to that when taking non-selective NSAIDs, and on the other hand, there is no significant cardiovascular toxicity characteristic of highly selective COX-2 inhibitors - coxibs [9]. The nimesulide molecule, unlike the molecules of other NSAIDs, has alkaline properties. This allows the substance to easily penetrate into areas of inflammation and accumulate there in higher concentrations than in blood plasma. Already 30 minutes after oral administration, the concentration of the drug in the blood reaches 25–80% and the analgesic effect begins to develop. Peak concentrations and, therefore, maximum analgesic effect are observed one to three hours after administration [7,10].

Nise® (nimesulide) is a drug of the NSAID class. It is firmly entrenched in the arsenal of rheumatologists, internists, family doctors and doctors of other specialties. The drug combines high analgesic and anti-inflammatory potential and a good safety profile. In addition, it is available in different dosage forms [7, 11]. Innovative dosage form (3D effect) of Nise® tablets from Dr. Reddys has become an undeniable advantage in the speed of onset of the analgesic effect compared to other generic nimesulide [12]. Pharmaceutical workers must not forget that all drugs for systemic use containing nimesulide are available with a doctor’s prescription [11]. To relieve pain in the back, joints, and muscles, it is advisable to recommend that the patient use external forms of NSAIDs in the form of gels, ointments, and creams (all of which are approved for over-the-counter release). The vast majority of non-steroidal drugs produced in forms for external use are non-selective drugs [11]. The only representatives of selective NSAIDs in the segment of external forms are nimesulide preparations (Nise® Activegel). Nise® ActiveGel also contains an effective conductor, dimethyl sulfoxide, which improves the penetration of the drug into tissues [13, 14].

Conclusion

NISE® is a modern selective COX-2 analgesic for the relief of both acute and chronic pain, which can be used in the treatment of many diseases accompanied by acute inflammation: arthritis of various origins, osteochondrosis with radicular syndrome, myalgia, inflammation of ligaments, tendons, bursitis, post-traumatic inflammation soft tissues, as well as for headaches, toothache and primary dysmenorrhea [10, 14].

Literature

1. Kotova O.V., Akarachkova E.S. Acute pain syndromes in neurological practice // Effective pharmacotherapy. 2014. No. 31
2. Eliseev M.S. Treatment of acute pain //EFFECTIVE PHARMACOTHERAPY. Rheumatology, traumatology and orthopedics. 2022. No. 2
3. RATIONAL USE OF NON-STEROID ANTI-INFLAMMATORY DRUGS. Clinical guidelines 2022. doi: 10.14412/1995-4484-2018-1-29
4. Shukhov V.S. About non-steroidal anti-inflammatory drugs. //Attending doctor. 2001-02-24.
5. Kotova O. V. Are there differences between non-steroidal anti-inflammatory drugs? Nimesulide in the spotlight // Attending physician. 09-11-2016
6. Marusenko I.M. The choice of non-steroidal anti-inflammatory drugs for the treatment of arthritis on an outpatient basis. //EFFECTIVE PHARMACOTHERAPY. Rheumatology, traumatology and orthopedics. No. 1 (10)
7. Karateev D.E., Luchikhina E.L., Tangieva A.R. Choice of non-steroidal anti-inflammatory drug for symptomatic treatment of rheumatic diseases: focus on nimesulide. //EFFECTIVE PHARMACOTHERAPY. Rheumatology. Traumatology. Orthopedics. No. 2 (19)
8. Mariafrancesca Scalise, Cesare Indiveri Repurposing of nimesulide, a potent inhibitor of the B0AT1 subunit of the SARS-CoV-2 receptor, for use as a therapeutic adjuvant for COVID-19. //Manage Pain. 2022. No. 3
9. Morozova T. E., Shmarova D. G., Rykova S. M. The choice of non-steroidal anti-inflammatory drugs in rheumatological patients with concomitant cardiovascular diseases // Attending physician. 2016-08-17
10. Instructions for medical use Nise® tablets 100 mg, No. P N012824/03
11. https://grls.rosminzdrav.ru/Default.aspx
12. Review of international literature on nimesulides: 3D differentiation of the drug Nise // Manage Pain, 2022, No. 1.
13. https://nisepro.rf/active-gel
14. Instructions for use of the medicinal product for medical use NIZE®, P N012824/02

Interested in the article? You can find out even more in the section Working in a pharmacy

What does Nimesulide help with and indications for use?

Before using the drug, consult a doctor.

It is important to remember that Nimesulide does not affect the causes of diseases and does not treat them. This drug is symptomatic and is used to relieve and alleviate clinical manifestations.

The main indications for taking the drug are:

1. Diseases of the musculoskeletal system with severe pain (arthritis of various origins, including rheumatoid, bursitis, tendonitis, osteoarthritis, myalgia).
2. Early postoperative period.
3. Headache or toothache.
4. Periodic pain in women.

NON-STEROID ANTI-INFLAMMATORY DRUGS IN DENTISTRY

Sologova Diana Igorevna Puntovaya Kristina Dmitrievna Federal State Autonomous Educational Institution of Higher Education “First Moscow State Medical University named after. THEM. Sechenov Ministry of Health of Russia" (Sechenov University)

EFFECTIVENESS OF NSAID USE

In terms of the strength of the analgesic effect, Ketorolac is significantly superior to other NSAIDs. The drug does not depress respiration, does not affect opioid receptors, does not cause drug dependence, and does not have a sedative or anxiolytic effect. It is also important that the drug begins to have an analgesic effect within 15–30 minutes. after reception. The drug is recommended for use as a means of pathogenetic and symptomatic therapy in the conservative and surgical treatment of generalized periodontitis. With its use, earlier relief of pain and signs of local inflammatory reaction (swelling and bleeding of the gums) are recorded. The drug is also capable of reducing the rate of bone tissue resorption, incl. and in the presence of microorganisms, which is a significant factor in favor of including the drug in the pharmacotherapy regimen for periodontitis.

In addition, because Ketorolac has high analgesic activity; it is used as an alternative to narcotic analgesics for moderate or severe pain after surgery in the maxillofacial area.

• Ketoprofen is a powerful non-steroidal anti-inflammatory drug.

It relieves pain well and helps with most of these symptoms, and also relieves inflammation in soft tissues. In addition, ketoprofen helps lower the temperature if it is elevated due to some serious pathology. It is used in the form of a rinse solution - symptomatic treatment of inflammatory diseases of the oral cavity, such as stomatitis, glossitis, gingivitis, periodontitis, periodontal disease, for analgesia during the treatment and extraction of teeth (as an auxiliary drug). Ketoprofen relieves pain quite quickly, but this is not enough. It does not affect the cause of the disease (caries, pulpitis or periodontitis). The main danger of the drug is that a person can suppress the pain for a very long time and not go to the doctor, and this will lead to complications both for dental diseases and for the whole body (possible development of dizziness, lethargy, vomiting, nausea, abdominal pain) .

Ketoprofen in the form of a 1% cream, when applied 1.8 ml once a day for 6 months to the gum area of ​​rhesus monkeys with periodontitis, promoted the restoration of alveolar bone and significantly reduced the levels of PGE2 and LT B4 in the periodontal fluid (after 2 and 3 months of treatment ). The drug in the form of a 2% gel, when applied to the gums of patients with chronic periodontitis in addition to instrumental therapy, contributed to a significant reduction in probing depth.

• Nimesulide . Toothache is not a direct indication for taking this drug.

The drug is used primarily for rheumatic diseases that affect the joints and surrounding tissues. The action of the medicine is aimed at eliminating the symptoms of inflammation, which include pain, incl. and dental. But it must be remembered that the effectiveness of Nimesulide depends on the reason for the toothache. In severe dental pathologies, even potent analgesics cannot eliminate the symptom.

It is effective to use the drug for gingivitis, because it eliminates swelling and helps normalize local temperature. The effect after administration is observed quite quickly; on average, it begins to act within 25–30 minutes. The analgesic effect lasts for a fairly long period of time - up to 10 hours.

Important! The medicine is also characterized by a number of disadvantages: it cannot be used during pregnancy and children; it is not intended for long-term use; there is a possibility of addiction; toxic effects on the liver; potential - overdose and poisoning.

• Ibuprofen inhibits the synthesis of prostaglandins, which, in turn, increase the sensitivity of nociceptive receptors.

Due to this, pain is reduced, but the effect is temporary (lasts up to 12 hours). You can take the drug for toothache, but no more than 5 days in a row.

The administration of Ibuprofen to patients with chronic periodontitis after 14 days was accompanied by a significantly more pronounced reduction in bleeding and hyperemia of the gums, as well as the depth of periodontal pockets compared to the group without pharmacotherapy.

Use of NSAIDs:

• for acute pain resulting from advanced caries or pulpitis;
• before hygienic procedures (removal of hard deposits, bleaching), with an increased pain threshold in the patient;
• to relieve pain that occurs after treatment;
• to eliminate pain during the period of getting used to braces, prosthesis and other structures;
• in inflammatory processes in the soft tissues of the oral cavity (periodontitis, periodontitis, stomatitis).

You should not take NSAIDs if:

• intestinal diseases;
• pregnancy more than 24 weeks;
• liver and kidney failure;
• Do not lie;
• blood clotting disorders;
• recently undergone SS operations.

In order to avoid intoxication and negative effects on the gastric mucosa, it is necessary to take the drug after meals.

NSAIDs. GENERAL CHARACTERISTICS

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that are widely used in clinical practice, many of which can be purchased without a prescription. More than thirty million people worldwide take NSAIDs daily, with 40% of these patients over 60 years of age. The great popularity of NSAIDs is explained by the fact that they have anti-inflammatory, analgesic and antipyretic effects and bring relief to patients with corresponding symptoms (inflammation, pain, fever), which are observed in many diseases. The use of the term “non-steroidal” emphasizes their difference from glucocorticoids, which have not only an anti-inflammatory effect, but also other, sometimes undesirable properties of steroids.

Over the past 30 years, the number of NSAIDs has increased significantly, and currently this group includes a large number of drugs that differ in their characteristics of action and use.

More than 60 million packages of Ibuprofen and Ketorolac, more than 25 million packages of Diclofenac, and almost 20 million packages of Nimesulide are sold annually in Russia.

The main mechanism of action of NSAIDs is the suppression of the activity of cyclooxygenase (COX), an enzyme that regulates the conversion of arachidonic acid into prostaglandins (PG), prostacyclin (PG12) and thromboxane (TxAg). The nature of the effect of NSAIDs on the COX isoforms—COX-1 and COX-2—is especially important. COX-1 is constantly present in most tissues (albeit in varying quantities) and belongs to the category of “constitutive” (“structural”) enzymes that regulate the physiological effects of PG. COX-2 plays the role of a “structural” enzyme only in some organs (brain, kidneys, bones, reproductive system in women), and is not normally found in other organs. However, the expression of COX-2 increases significantly under the influence of immune mediators (cytokines) involved in the development of the immune response, inflammation, cell proliferation, etc.

Inhibition of COX-2 is one of the important mechanisms of anti-inflammatory and analgesic activity, and COX-1 of the toxicity of NSAIDs. Non-selective NSAIDs inhibit the activity of both COX isoforms to the same extent and therefore have approximately similar effectiveness. This discovery served as the basis for the creation of a new group of NSAIDs that predominantly inhibit COX-2 (selective COX-2 inhibitors). They have all the positive properties of non-selective NSAIDs, but are less toxic, at least in relation to the gastrointestinal tract. Based on their selectivity of action against COX isoforms, NSAIDs are divided into 4 groups (Table 1).

Table 1 Classification of NSAIDs by selectivity of action on COX isoforms

In addition, NSAIDs are classified depending on the severity of their anti-inflammatory activity and chemical structure. The first group includes drugs with a pronounced anti-inflammatory effect. NSAIDs of the second group, which have a weak anti-inflammatory effect, are often designated by the terms “non-narcotic analgesics” or “analgesics-antipyretics” (Table 2).

Table 2 Classification of NSAIDs depending on the severity of anti-inflammatory activity and chemical structure

NSAIDS IN DENTISTRY

According to Orenburg State University, the list of the most commonly used non-steroidal anti-inflammatory drugs in dental practice in tablet form as of 2015 was as follows (Fig.):

• Ketoprofen - prescription frequency 56%, duration of action 6 hours.
• Ketorolac - prescription frequency 20%, duration of action 4-5 hours.
• Nimesulide - prescription frequency 14%, duration of action 5 hours.
• Ibuprofen - prescription frequency 8%, duration of action 4 hours.
• Metamizole sodium - prescription frequency 2%, duration of action 4 hours.

Rice.

In dental practice, NSAIDs are widely used for inflammatory diseases of the maxillofacial region and oral mucosa, inflammatory swelling after injuries, operations, pain syndrome, arthrosis and arthritis of the temporomandibular joint, myofascial pain syndrome of the maxillofacial region, neuritis, neuralgia, postoperative pain, feverish conditions.

Contraindications

The drug is prohibited for gastric and duodenal ulcers, especially in the acute stage, for bleeding disorders and increased bleeding, Crohn's disease, bronchial asthma, inflammatory processes in the intestines, polyposis of the nasal cavity and paranasal sinuses.

Also, the use of Nimesulide is limited in case of individual intolerance to NSAIDs, severe chronic, renal and liver failure, in children under 12 years of age, during pregnancy and lactation.

Action of Nimesil

Nimesil for toothache, when entering the body, inhibits the formation of prostaglandins. The latter are chemical compounds, the synthesis of which occurs in almost all tissues, including blood vessels. Prostaglandins do not have a direct effect on the course of pain. However, they enhance the effect of compounds that provoke the development of the inflammatory process.

Nimesil is prescribed for toothache caused by:

• Caries
• Pulpitis
• Gum pathologies and other dental ailments

At the same time, the medicine suppresses the development of the inflammatory process. It is important to understand that Nimesil for toothache is a temporary remedy. It is not able to eliminate the disease that caused the discomfort. To eliminate the latter, other measures are necessary.

Side effects and overdose

Taking Nimesulide in some cases may be accompanied by the development of unwanted side reactions. These include:

• From the side of the central nervous system: dizziness, anxiety, headaches, nightmares.
• Urinary system: decreased amount of urine excreted, hematuria, exacerbation of chronic renal failure.
• From the gastrointestinal tract: dyspeptic syndrome (nausea, vomiting, stool disorders), abdominal pain, flatulence, bleeding, gastritis, ulcerative lesions, jaundice as a result of cholestasis, increased transaminases.
• Skin: increased sweating and allergic reactions of varying severity (itching, urticaria, swelling, Stevens-Johnson syndrome).
• From the cardiovascular system: hypotension, increased heart rate.
• Hematopoietic organs: anemia, pancytopenia, increased clotting time.
• Respiratory system: shortness of breath, spasm of smooth muscles in the bronchi, exacerbation of COPD or bronchial asthma.
• Organ of vision: blurred perception.

Symptoms of overdose are similar to those of adverse reactions. They develop due to non-compliance with doctor’s instructions and uncontrolled use of Nimesulide.

In case of overdose, it is necessary to discontinue the drug, lavage the stomach to clean water and take activated carbon at the rate of 1 tablet per 10 kg of body weight.

Method of administration

Nimesil is used for tooth pain only after consultation with a doctor and with his direct participation. One of the main advantages that the medicine has is its release form.

The suspension is prepared from powder according to the instructions

Nimesil is produced in the form of a powder intended for the preparation of a suspension. This solution is quickly absorbed, resulting in relief within 30 minutes. During this period, the concentration of the active substance reaches 50% of the maximum possible.

Before you start using Nimesil, it is recommended that you read the attached instructions. The drug is approved for use subject to a number of conditions:

• The patient's age is over 12 years
• The product is taken only after meals
• The prepared solution is not intended for long-term storage
• The powder is dissolved in half a glass of warm water

The drug is taken daily no more than twice a day. At least 12 hours must pass between each dose.

Interactions

Nimesulide increases the activity of antiplatelet agents and anticoagulants. Concomitant use of this drug with diuretics reduces their effectiveness, which can lead to edema, especially in patients with hypertension and renal failure.

Nimesulide also increases the toxicity of cyclosporine and methotrexate. And its simultaneous use with GCS and serotonin reuptake inhibitors significantly increases the risk of bleeding in the digestive tract.

Dangers of taking Nimesil

Many patients confirm the high effectiveness of Nimesil for relieving toothache. However, according to several studies conducted on this medicine, it can cause a number of negative effects caused by toxicological effects on the kidneys and liver. Therefore, the sale of Nimesil was banned in the United States, and in European countries the drug is sold with a mark prohibiting its administration to children.

Data from various studies have shown that negative consequences from the action of the drug occur only if the specified conditions of administration are not observed and if the prescribed dosage is exceeded.

When purchasing the drug, you should be advised about the specifics of use and contraindications of Nimesil.

Dentists recommend taking Nimesil to relieve tooth pain only in cases where other medications that have a safe effect on the body are not able to eliminate the pain. In addition, the drug is contraindicated for long-term use, since the liver is subjected to severe stress.

During studies of the drug's effect, no other negative effects were identified. Only a number of subjects refused to continue taking the medication due to the fact that they were diagnosed with disorders of the digestive system. Moreover, cases of severe liver damage have not yet been reported in medical practice.

"Magic" pills

There is a group of drugs collectively called non-steroidal anti-inflammatory drugs (NSAIDs), which we all have taken at least once in our lives, and many regularly. These are drugs that have analgesic, anti-inflammatory and/or antipyretic effects. Examples include Aspirin, Nurofen, Nice, Ketanov, Ketoprofen and others. Considering the “magical effects” of their action - relieving inflammation, pain and fever - they are prescribed by almost everyone, everyone, always. Prescribed by traumatologists, rheumatologists, therapists, ENT specialists, dentists. Plus, they can be purchased completely freely at any pharmacy. But, along with the “magical properties”, these drugs have a number of side effects that can be divided into 2 groups: cardio risks and gastro risks. Actually, gastrorisks will be discussed in this article.

Medicines in dental practice. Part II

In the last post, we talked about the general principles of prescribing medications in outpatient dentistry. The topic is still relevant, it can be commented on and discussed.

Today I propose to take a more specific look at painkillers and anti-inflammatory drugs in dental practice, and at the end of this post you will find a small gift.

In order not to turn all this into a dull lecture on pharmacology, I will tell you only about those drugs that I use myself and for which I have my own clinical observations.

Attention!

This entry is not a doctor’s prescription, not a recommendation for patients, but a simple information message, a generalization of one’s own experience with medications. Never take medications without a doctor's prescription.

So, let's begin.

General information about pain medications.

All medications that we call “painkillers” (analgesics) can be divided into two large groups.

First group

- narcotic analgesics: morphine, heroin, fentanyl, sodium hydroxybutyrate, etc.

A distinctive feature is the effect, first of all, on the central nervous system (CNS), hence the ability to relieve even very severe pain.

The disadvantages are addiction, sedation, mental or physical dependence, depression of vital CNS centers up to cardiac and respiratory arrest.

In outpatient dentistry, narcotic analgesics are not used. For obvious reasons, drug use should be supervised by a doctor.

Second group

- non-narcotic analgesics: analgin, ibuprofen, butadione, nimesulide, etc.

Nise or ibuprofen: which is better and what is the difference (differences in composition, reviews from doctors)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used by specialists in all areas of medicine to relieve pain and inflammation. Only a doctor can prescribe Nise or Ibuprofen, choosing the drug that will cause the least harm to the patient’s health. The choice of remedy will depend on the age of the patient and the nature of the disease.

Only a doctor can prescribe Nise or Ibuprofen, choosing the drug that will cause the least harm to the patient’s health.

Characteristics of Nise

The active ingredient of the drug is nimesulide. Auxiliary:

• microcrystalline cellulose;
• corn starch;
• calcium hydrogen phosphate;
• sodium starch glycolate;
• magnesium stearate;
• anhydrous colloidal silicon and purified talc.

The active ingredient of the drug is nimesulide.
Nise is produced in the form:

• tablets;
• gel;
• suspensions for children.

Tablets for toothache: how to choose the right one

As you can easily see, the list of painkillers is long. Remember that painkillers do not eliminate the cause of pain, but only relieve the symptom. To eliminate the cause of tooth pain, a visit to the doctor and proper treatment are necessary.

Remember that toothache pills do not work the same for everyone. If diclofenac helped your friend, this does not mean that you can take the drug with the same success. Ketorolac or a combination pain reliever may be right for you.

When choosing an anesthetic drug, it is also worth considering the nature of the pain. If the tooth pain is mild, then you can cope with the help of antispasmodics. Attacks of severe pain may require the use of powerful medications that can only be purchased with a doctor's prescription.

Important! Read the instructions for the medications carefully. Particular caution should be exercised by persons with chronic diseases due to the high risk of side effects when taking medications. The information we provide about the 10 most popular medications for toothache is generalized and incomplete, so read the instructions and consult your doctor.

What can replace Nimesulide?

There are a huge number of drugs on the pharmaceutical market with the main active substance – nimesulide. In fact, these are synonymous drugs that have the same composition and indications. Minor differences may only be in the list of excipients. So, in addition to the drug of the same name, the following drugs based on nimesulide are available:

• Nise;
• Nimesil;
• Nimulid;
• Mesulide;
• Novolid;
• Aponil;
• Flolide;
• Aulin et al.

The listed drugs are available in various forms and dosages, so you can choose the best option for each case. When choosing what is best to use - Nimesulide, Nimesil, Nise or another substitute drug from the above list, you can be guided by the financial availability of these drugs or personal preferences.

In some cases, it becomes necessary to replace Nimesulide with other non-steroidal anti-inflammatory drugs. In this case, the safest drugs are selected, the effects of which are comparable to the effects of Nimesulide. The following analogues of the drug in question are most often used:

• Diclofenac;
• Meloxicam;
• Amtolmetin;
• Indomethacin;
• Diacerein, etc.

It is worth considering that these drugs are also available under different trade names. The choice of an analogue drug should be made only by the attending physician.

Nimesulide or Meloxicam – which is better?

Nimesulide or Ibuprofen – which is better?

Ibuprofen is a widely used non-steroidal anti-inflammatory drug used in the treatment of various rheumatic pains and inflammatory processes in the musculoskeletal system.

It is characterized by good tolerability and effectiveness. However, in comparison with Nimesulide, it is worth noting the more powerful anti-inflammatory properties of the latter.

Ibuprofen is great for menstrual pain by reducing intrauterine pressure and uterine contractions.

Comparison of the effectiveness of OKI and Nimesil

The effectiveness of OCI is quite similar to Nimesil - this means that the ability of the drug substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of OCI is more pronounced, then using Nimesil even in large doses will not achieve this effect.

Also, the speed of therapy - an indicator of the speed of therapeutic action - is approximately the same for OCI and Nimesil. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.

Comparison of addiction between OKI and Nimesil

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values ​​of such parameters as “syndrome o” in OKI is quite similar to the similar values ​​in Nimesil. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, the OCI syndrome values ​​​​are quite small, however, the same as with Nimesil.

NSAID gastropathy

In the scientific literature, this problem is called “NSAID gastropathy.”
The term was first proposed in 1986 to distinguish specific damage to the gastric mucosa that occurs with long-term use of NSAIDs from classic peptic ulcer disease. The difference between NSAID gastropathy and peptic ulcer disease can also be traced by the affected area. Most often, ulcers can be seen in the stomach, and not in the duodenum. Plus, the changes are more common in older people than in younger people.

Myths that we encounter in daily practice

Myth 1. Using NSAID drugs in the form of suppositories is less aggressive for the stomach than taking pills

This is 100% a myth. The pathogenic, destructive effect of the drug is realized through the blood, delivering it through the vessels to the stomach.

Myth 2. Medicines from the group of antacids - Rennie, Maalox, Phosphalugel and H2-blockers (Ranitidine and Famotidine) can be used as “gastroprotectors”

In this case they are not effective.

Myth 3. You can't take proton pump inhibitors regularly

The fact is that if an elderly person has been prescribed an anti-inflammatory drug for life, it is absolutely pointless to prescribe gastroprotection for a month. In such cases, medications should be taken strictly in parallel.

Myth 4. Food products (jelly, etc.) can act as “gastroprotectors”

We will leave this myth as absolutely fantastic without comment.

Possible side effects

Nimesil in some cases provokes the appearance of many side effects, manifested in the form of:

• Attacks of headaches and dizziness
• Problems with stool
• Nausea and vomiting
• Increased sweating
• Allergic reaction in the form of skin rashes
• Anemia
• Decreased vision
• Increased blood pressure
• Increased nervousness
• Insomnia
• Shortness of breath
• Stomatitis and hepatitis
• Urinary retention

Basically, the negative consequences that occur when taking Nimesil are associated with the functioning of the gastrointestinal tract. Side effects manifest themselves in the form of diarrhea, constipation, pain localized in the abdomen.

Some numbers

Some statistics. In the UK, approximately 24 million NSAIDs are prescribed per year. 70% of people over 70 years of age take NSAIDs once a week, and 34% daily. In the United States, up to 6 billion worth of NSAIDs are sold annually. As a result, the risk of developing gastrointestinal bleeding (GIB) increases 3–5 times, perforation by 6 times, and the risk of death from complications by up to 8 times. Up to 40–50% of all cases of acute gastrointestinal tract infections are associated with NSAIDs.

This problem is also relevant in our country, for example, according to the Scientific Center for Cardiovascular Surgery named after. A.N. Bakulev, out of 240 patients taking aspirin daily, even in small doses, gastroscopy revealed lesions of the stomach and 12 p.c. in 30% (of which ulcers - in 23.6%, erosions - in 76.4%). A similar picture was observed among colleagues from the All-Russian Research Institute of Rheumatology of the Russian Academy of Medical Sciences - in 2126 patients taking NSAIDs without “covering” (protection) of the stomach, erosions and ulcers of the gastroduodenal zone were found in 33.8% of cases. These are very impressive and dramatic numbers of complications from taking NSAIDs, considering the number of people using these drugs in developed countries.

Reviews

In this section you can read user reviews about the drug Nimesulide and its analogues, the effectiveness of the drug, side effects, and features of administration.

Nimesulide is a drug with a pronounced analgesic effect, which occurs by eliminating the inflammatory reaction. The medicine helps eliminate toothache, but has only a symptomatic effect.

To prevent the recurrence of the disease, you need to visit the dentist and eliminate the reason why it occurs.