Nimesulid syrup for children. Instructions for use, dosage, price

Release forms and composition of the drug

The drug is available in pharmacies in several dosage forms. However, for children only syrup for oral use is used, packaged in 60 ml dark glass bottles. Each bottle is placed in an individual cardboard box, where you can also find instructions that describe in detail all the rules for using the medication.

The syrup or suspension is a sweet, dark-colored liquid. When you separate the required amount of product, you will notice that it has a viscous consistency. Each box contains not only a bottle and instructions for the product, but also a special measuring cup that makes it easier to dose the medicine at home.

The medicine contains the active substance nimesulide, which has the main therapeutic effect. 1 ml of syrup contains 50 mg of active ingredient.

The composition also contains auxiliary components:

• Macrogol.
• Sodium benzoate.
• Magnesium stearate.
• Sodium disulfite.

Additional substances do not have therapeutic properties. In addition to syrup, gel, oral tablets and lozenges are available. However, these dosage forms are not used in the treatment of children and are indicated only for adults.

Nimulid for children

Nimulid, an antipyretic for children, is available in a special dosage form. The syrup is easy to use in pediatric practice. Nimulid for fever is prescribed to children 2-3 times a day. The instructions recommend calculating the dosage taking into account the child’s weight: 1.5 mg per 1 kg. The suspension for children can also be used by adults if it is impossible to use the tablet form. Reviews of Nimulid for children are mostly positive - the drug has proven its effectiveness as an antipyretic, analgesic, and anti-inflammatory agent.

Pharmacological properties

Nimesulide is a syrup for children with pronounced antipyretic properties. Due to the presence of a sufficient amount of the active component, the product helps to quickly reduce body temperature and also improve the patient’s condition.

The drug also has anti-inflammatory and analgesic properties, which makes it possible to use it for various pathologies of internal organs and systems. The medication has a weak antispasmodic and sedative effect, which has a beneficial effect on the patient’s condition during fever and other conditions accompanied by an increase in body temperature.

Additionally, the medicine normalizes sleep and also eliminates pain in muscles and joints. In case of fever, such manifestations greatly worsen the general condition of the patient, so the use of the product helps eliminate the most pronounced symptoms. The combination of several pharmacological properties helps to shorten the recovery period and prevent some complications.

pharmachologic effect

The active component Nimesulide is a sulfonamide NSAID. Characterized by analgesic, anti-inflammatory and antipyretic effects.

The principle of action is aimed at selective inhibition of the enzyme COX-2 (cyclooxygenase) and suppression of histamine and proteinases, suppression of tumor necrosis factors alpha, platelet activation factors. By suppressing cyclooxygenase, it is possible to significantly slow down the biological synthesis of prostaglandins , which are produced in the inflammatory focus. Selective blocking of COX-2, and not COX-1, avoids negative manifestations associated with suppression of prostaglandin activity in healthy tissues of the body.

Pharmacodynamics and pharmacokinetics

The drug takes effect within a short period of time after ingestion. Its active ingredient is absorbed in the digestive tract and spreads through the systemic circulation, concentrating in the affected area.

Nimesulide belongs to the group of non-steroidal anti-inflammatory drugs, relieves pain and fever, and also helps reduce the temperature in the area of ​​inflammation and general body temperature, which significantly facilitates the course of the disease. Additionally, the active substance blocks components that provoke the inflammatory process, which leads to stopping the progression of the pathology.

The analgesic properties of the drug appear almost immediately after administration, so the patient not only has a decrease in body temperature, but also eliminates pain in the joints and muscles that occurs during short-term or long-term fever.

The active ingredient of the drug affects platelet adhesion. That is, it inhibits this process, which leads to a slight thinning of the blood and easier functioning of the heart. As a result, the load on the vessels and the myocardium is reduced. Nimesulide has a rather aggressive effect on the mucous membranes of the digestive tract, especially the stomach and small intestine.

Despite this, the product is highly effective when used correctly. After the syrup enters the digestive tract, absorption of the active component occurs in the small intestine. The ingredient distributes through the systemic bloodstream and has a therapeutic effect.

The maximum concentration of the substance in the blood is achieved 20-40 minutes after oral administration. However, when taken simultaneously with food, this period is extended, which does not weaken the effectiveness of the drug.

There is a slight accumulation of active ingredients in tissues. When following pharmacokinetic characteristics, a moderate dose of nimesulide can be found in the connective tissue of articular joints, cartilage and synovial fluid.

Metabolism of the active substance occurs in the liver, where it breaks down into metabolites. The effect of the product lasts for 6-8 hours depending on the patient’s body. It is worth noting that the high effectiveness of the drug is due to good binding to blood plasma proteins and bioavailability, which reaches 95%.

After processing the active ingredient, it is excreted through the urinary system. About 70% of metabolites are evacuated with urine, the rest with feces. With damage to the digestive tract, namely the small intestine.

There is a slight slowdown in the absorption of the active ingredients, which affects the excretion process. In each individual case, this time may vary.

Description

A mixture of powder and granules from almost white to light yellow in color with an orange odor. Inhomogeneity of color is allowed.

The finished suspension is white to light yellow in color with an orange odor.

Pharmacotherapeutic group:

non-steroidal anti-inflammatory drug (NSAID).

ATX code:

M01AX17

Pharmacological properties

Pharmacodynamics:

Nimesulide is a non-steroidal anti-inflammatory drug from the sulfonamide class. Has anti-inflammatory, analgesic and antipyretic effects. Unlike non-selective NSAIDs, nimesulide mainly inhibits cyclooxygenase-2 (COX-2), inhibits the synthesis of prostaglandins at the site of inflammation; has a less pronounced inhibitory effect on cyclooxygenase-1 (COX-1).

Pharmacokinetics:

Suction

Nimesulide is well absorbed from the gastrointestinal tract (GIT).

The maximum concentration in blood plasma (Cmax) after oral administration of a single dose of nimesulide (100 mg) is achieved on average after 2-3 hours and is 3-4 mg/l.

Distribution

Communication with blood plasma proteins up to 97.5%.

Penetrates into the tissues of the female genital organs, where after a single dose its concentration is about 40% of the concentration in plasma. Penetrates well into the acidic environment of the inflammation site (40%) and synovial fluid (43%). Easily penetrates histohematic barriers.

Metabolism

Nimesulide is actively metabolized in the liver using the cytochrome P450 (CYP)2C9 isoenzyme. There is a possibility of drug interaction with nimesulide when used simultaneously with drugs metabolized by the CYP2C9 isoenzyme. The main metabolite is the pharmacologically active parahydroxy derivative of nimesulide - hydroxynimesulide, found in blood plasma mainly in conjugated form, in the form of glucuronate.

Removal

The half-life (T1/2) of nimesulide is about 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%) and undergoes enterohepatic recirculation.

Use in elderly patients
The
pharmacokinetic profile of nimesulide in elderly patients does not change when using single and multiple/repeated doses.

Use in patients with kidney disease

In a short-term study conducted in patients with mild to moderate renal failure (creatinine clearance 30-60 ml/min), Cmax of nimesulide and its main metabolite were no higher than in healthy volunteers.

AUC and T1/2 were 50% higher, but were within the range of AUC and T1/2 values ​​observed in healthy volunteers during the use of nimesulide. Repeated use did not lead to the accumulation of nimesulide.

Indications for use

Nimesulide is used to treat children of all ages.

Syrup is prescribed if there are the following indications:

• Acute and chronic myalgia in school-age children. Syrup is usually not prescribed to babies, as they rarely suffer from such disorders.
• Joint pain due to colds or inflammation. In the second case, the medicine is used as part of complex therapy to enhance the effect of drugs from other groups.
• Fever due to infectious diseases.
• Increased body temperature due to viral and cold pathologies of varying severity.

• Influenza in children of preschool and school age.
• Feverish state in arthritis of rheumatic and other origins.
• Pain in the limbs due to bruises of soft tissues, muscles or sprained ligaments.
• Recovery period after bone fractures.
• Inflammation of the joint capsule with the development of a purulent process or without the appearance of such disorders.

Quite often, the remedy is used to relieve pain in children during teething, as well as as a treatment for fever after the administration of vaccines. In the second case, the drug is combined with antihistamines to enhance effectiveness.

The use of nimesulides in pediatric practice: pros and cons

Nimesulide is one of the widely used non-steroidal anti-inflammatory drugs (NSAIDs) used in clinical, including pediatric, practice in many countries around the world. Nimesulide's membership in the group of selective cyclooxygenase-2 (COX-2) inhibitors, which results in good gastroenterological tolerability, provides it with clear advantages over other NSAIDs and explains the growing popularity of the drug among doctors and patients. At the same time, the higher effectiveness of nimesulides as an antipyretic agent compared to paracetamol and ibuprofen, traditionally used for hyperthermia, proven in numerous controlled clinical trials, as well as the experience in the practical use of drugs of this group that has accumulated in recent years, has led to the fact that many practicing doctors began to give preference to nimesulides over other NSAIDs. The rapidly increasing share of nimesulides in the pharmaceutical NSAID market could not but cause concern among pharmaceutical companies competing for this market. Thus, by 2000, i.e. 15 years (!) after the development and appearance of nimesulide in the pharmacy chain and after the sale by the Swiss development company Helsinn Healthcare of a license for the production of nimesulide to the largest pharmaceutical companies in the world, the active discussions regarding the advisability of using nimesulide due to its potential hepatotoxicity. Popular medical publications, first foreign and now Russian, have become the arena for these discussions, and the analysis of the information published in them cannot always be considered objective. Supporters of limiting the use of nimesulides in pediatric practice often cite as an argument references to literary sources whose titles include the keywords “hepatotoxicity of nimesulides,” although the content of the works indicates the opposite. An example is a large-scale study carried out in Italy by G. Traversa et al. and published in print and on the BMJ website in 2003 under the title “Cohort study of hepatotoxity associated with nimesulide and other nonsteroidal anti-inflammatory drugs.” The study was devoted to studying the population frequency of hepatotoxic reactions associated with taking nimesulide and other NSAIDs, and covered 397,537 patients using NSAIDs, and a total of 2 million prescriptions were analyzed from 1997 to 2001. The total incidence of hepatopathy was 29.8 per 100,000 patient-years and was associated more with other NSAIDs (diclofenac - 39.2 per 100,000 patient-years; ketorolac - 66.8 and ibuprofen - 44.6) than with nimesulide (35.3 per 100,000 patient-years) -years).

It is quite remarkable that during the period from 1985 to 2001, information was collected on only 195 cases (of which 123 were serious) of the development of adverse reactions after the use of nimesulide, despite the fact that about 304 million patients received this drug, and the frequency of hepatopathies that occurred on during treatment with nimesulide, was 0.1 per 100,000. Even more surprising is the fact that from 1985 to 1997, only 25 cases of hepatopathy associated with taking nimesulide were noted, and in the next 3 years this figure increased to 170. Such statistics can be explained either by increased attention to this problem, or by some other reasons. In this regard, it should be noted that recent years have been marked by a rapid surge in the incidence of viral hepatitis, and the spectrum of hepatotropic viral agents is becoming increasingly numerous and diverse, and their mass diagnosis is far from the proper level.

A clear exaggeration of the scale of the problem of NSAID-induced hepatopathies is evidenced by objective data from leading hepatologists, according to whom NSAIDs are actually in last place among the causes of drug-induced liver damage and are many times inferior to such common drugs in terms of the incidence of hepatopathies. like antibiotics. In addition, it is known that NSAID-induced hepatopathies are rare, unpredictable, idiosyncratic side effects and are much more dependent on other factors (including genetic, infectious, nutritional, polypharmacy, alcohol consumption, etc.) than on the actual mechanism of action of NSAIDs. Compared with the risk of developing NSAID-induced gastropathy, which, as has become known in recent years, is relevant not only for adult rheumatological patients, but also for children, the risk of NSAID-associated liver damage is minimal. From this relationship it follows that when choosing NSAIDs, preference should be given to selective COX-2 inhibitors, including nimesulides.

The question of the likelihood that nimesulides are capable of having a hepatoxic effect on the body (in particular, several examples of acute hepatitis in adult patients receiving nimesulide have been described in the literature) has become the focus of attention of pediatric specialists thanks to a series of articles posted on the website BMJ. Some materials in this series concerning the use of nimesulide in children appear to be quite tendentious, unconvincing and overly emotional. For example, in a publication by K. Saha from the University Medical Center in Ohio (USA), there is a call to stop the use of nimesulides in children, although the proposed alternative, acetaminophen (paracetamol), is quite comparable to nimesulide in terms of the frequency of hepatological adverse reactions mentioned in the literature. In Russia, supporters of restricting the use of nimesulide in pediatric practice cite the fact that nimesulide is not registered as a drug used in children in the USA and many European countries, which cannot be considered a sufficiently weighty argument. It should be emphasized that the most common NSAID in Russia, diclofenac sodium, is also practically not used in children with rheumatic diseases in most countries of Europe and North America. In Europe, the most used NSAID is naproxen - a drug that Russian pediatricians are not able to prescribe, since the generics of naproxen currently available on the domestic pharmaceutical market are limited in use in children under 16 years of age, do not have “children’s” dosage forms, and their quality causes complaints from practicing doctors. Regarding NSAIDs in pediatric practice in the USA, it is appropriate to note that during a discussion at the Congress of Pediatricians held in Russia in February 2005, the famous American professor of pediatrics and pediatric rheumatologist from New York T. Lehman admitted that the most commonly used NSAID is indomethacin , although this particular drug has established itself as the most aggressive agent in terms of the development of adverse reactions. In addition, it is known that the most popular of this group of drugs for use in children in the United States is still aspirin, the hepatotoxicity of which is beyond doubt. Moreover, if in relation to nimesulide, adverse hepatological reactions were recorded in adults, then the development of Reye's syndrome (severe liver dysfunction accompanied by acidosis and encephalopathy while taking aspirin) is observed almost exclusively in children. It should also be noted that in the same series of response articles on the BMJ website there are also notes with the exact opposite content under the titles “Defending Nimesulide Use!” (“Let's protect the use of nimesulide!”) and “Science or Commerce?” (“Science or Commerce?”) and provides data on at least 50 cases of the development of Reye’s syndrome as a result of the use of drugs other than aspirin, most often paracetamol. Apparently, in the pathogenesis of Reye's syndrome, as well as other serious adverse reactions, processes associated with drug interactions and the body's response to the active replication of certain viruses play an important role. These data confirm that almost any drug, even the safest one, can act as the last (but not the most important) link in a complex pathogenetic chain leading to adverse consequences. That is why the decision to choose a drug in a specific clinical situation should be made only by a competent doctor, informed about all possible side effects and risks, and over-the-counter use of NSAIDs is possible only for a very limited period of time and only with the use of drugs and those low doses (acetaminophen - 10 mg/kg, ibuprofen - 5–10 mg/kg), which are recognized as safe by WHO. At the same time, every practicing physician must understand that the advantages of a drug are always a continuation of the disadvantages and vice versa. Thus, acetaminophen and ibuprofen are the shortest-acting antipyretic and anti-inflammatory drugs, which determines, on the one hand, their relative safety, and on the other, in some situations, insufficient effectiveness in terms of duration of action.

In an outpatient setting, provided adequate medical supervision is ensured, and in a hospital setting, there is no reason to limit the doctor’s right to choose an effective drug if the drug is approved for use in children and if there are indications for its use. In hospital pediatric practice, doctors sometimes encounter restrictions on the use of nimesulide, which were carried out without sufficient justification at the administrative level. This also applies to hospitals in Moscow and some regions of Russia, which have accumulated many years of successful experience in using “children’s” dosage forms of nimesulide. At the same time, in our country there is a fairly tolerant attitude towards the use of unregistered medicines in pediatric practice. It should be emphasized that the list of NSAIDs approved for use in children, subject to minor age restrictions, includes ibuprofen, indomethacin and only two generics of nimesulide, marketed under the trade names Nise® and Nimulide®. Certain dosage forms of diclofenac sodium, depending on the specific trade name, are approved for use in children over 6, or 12, or 15 years of age. Meloxicam is approved for use in children over 15 years of age, many new NSAIDs are approved only after 18 years of age. Every doctor should understand that an adverse reaction that develops to a drug prescribed by him, depending on whether it is registered for use in the relevant age group, can have various consequences, including legal ones. In this regard, it is appropriate to note that Nise, approved for use from 2 years of age, successfully passed the re-registration procedure in 2004, partly because over 5 years of its use on the domestic pharmaceutical market, no serious adverse reactions induced by with this drug.

Extensive experience in using Nise has been accumulated in the children's clinic of the Institute of Rheumatology. Over 5 years of using the drug in our clinic, in 385 patients aged from 1 year 2 months to 18 years, suffering from various rheumatic diseases, only 16 cases of adverse reactions were noted. The spectrum of adverse reactions included: moderate dyspeptic symptoms that occurred mainly after taking the suspension - in 9 children, a slight (1.5-2.5 times) increase in transaminases - in 2 children, minimal edema syndrome with a tendency to oliguria - in 4 children , as well as a hematological reaction in the form of a tendency to leukopenia and changes in the blood count - in 1 patient. All adverse reactions were easily eliminated by discontinuation of the drug and did not require the use of additional drugs. It should be emphasized that in 369 children, long-term continuous use of the drug (from 1.5 months to 5.2 years) in high doses of 4–5 mg/kg was not accompanied by adverse reactions, including 113 patients who simultaneously received such hepatotoxic drugs , such as methotrexate, cyclosporine A or sulfasalazine, as well as those with a history of hyperfermentemia while taking diclofenac and other NSAIDs.

An increase in the proportion of inpatients and outpatients with juvenile arthritis taking Nise for a long time as monotherapy or as part of complex therapy, from 5–10% in 2000–2001. to 55–64% in 2003–2005. indicates the recent commitment of doctors and patients to the use of this drug.

Analysis of literature data and extensive clinical experience allow today to consider Nise as the drug of choice among NSAIDs when it comes to its use in children.

Arguments in favor of using Nise in children:

• grounds regulating the possibility of use in children starting from 2 years of age;
• release of dosage forms intended for children and providing the ability to select the optimal dosage;
• sufficient effectiveness as an anti-inflammatory agent in children with rheumatic diseases;
• preferential inhibition of COX-2, providing less gastrotoxicity and nephrotoxicity compared to “traditional” NSAIDs;
• antihistamine and antibradykinin action, allowing it to be considered as the drug of choice in children with an allergic predisposition and bronchial asthma;
• chondroprotective effect of nimesulide, relevant for childhood, taking into account the increased vulnerability of the child’s cartilage tissue in conditions of incomplete bone formation.

Of course, a balanced and cautious approach to prescribing nimesulides in pediatric practice is necessary due to the potential risk of adverse reactions, especially with polypharmacy, and the development of comorbid conditions; In all cases, the appropriate procedure for medical monitoring of the safety of therapy should be followed.

For questions regarding literature, please contact the editor.

I. P. Nikishina , Candidate of Medical Sciences Institute of Rheumatology, Moscow

Contraindications

The drug is not prescribed to patients who suffer from intolerance to the components of the composition or have a tendency to allergic manifestations. Do not use the product for children who weigh less than 6 kg.

In addition, contraindications include severe liver and kidney failure, as well as acute hepatitis of viral or other origin.

Contraindications include blood clotting disorders accompanied by deterioration in platelet production. The medicine is not prescribed during lactation and pregnancy, since its effect on the body of the mother and child can lead to complications.

Patients with severe heart and vascular diseases should not take the medicine. Uncontrolled arterial hypertension is considered a reason to refuse therapy.

You should not take syrup if internal bleeding is detected, or if there is an exacerbation of gastric and duodenal ulcers. A tendency to such pathologies is also considered a relative contraindication for therapy.

You should not use the medication for acute gastritis, as well as pancreatitis, cholecystitis in the acute stage. It is especially dangerous to use the medicine if the bacteria Helicobacter pylori is detected in the body.

Relative contraindications include the rehabilitation period after surgery, diabetes mellitus and thyroid pathologies. The list of contraindications may increase depending on the characteristics of the individual patient’s body.

Use during pregnancy and breastfeeding

Pregnancy

Like other drugs from the class of NSAIDs that inhibit prostaglandin synthesis, nimesulide can adversely affect the course of pregnancy and/or embryo development and can lead to premature closure of the ductus arteriosus, hypertension in the fetal pulmonary artery system, impaired renal function, which can progress to renal failure with oliguria in the fetus, an increased risk of bleeding, decreased contractility of the uterus, and the occurrence of peripheral edema in the mother. The use of nimesulide during pregnancy is contraindicated.

Breastfeeding period

The use of nimesulide during breastfeeding is contraindicated.

Instructions for use, dosage

For patients of different ages and with different body weights, different treatment regimens are used. The pediatrician prescribes the dosage after a preliminary examination and identification of the cause of the symptoms.

Older children with greater body weight are prescribed from 5 to 7.5 ml of the drug per dose. Repeat it 3 times a day. In each case, the dosage is determined individually, taking into account the symptoms of the pathology, age and the presence of associated complications.

Where to buy Nimesulide and how much does it cost?

The drug is distributed exclusively through pharmacies. To buy it, you must first take care of obtaining a prescription from a doctor. Without this document, the pharmacist has the right to refuse to dispense medication from the pharmacy.

The price of the drug varies depending on the region of distribution and the specific pharmacy price. The right to set the final cost remains with the pharmacy.

When purchasing a drug in a retail network, you need to verify its authenticity by studying the instructions for use of Nimesulide in powder, familiarize yourself with the available contraindications and restrictions on use, and also make sure that the expiration dates are observed. Take the drug according to the regimen recommended by the doctor. If any unwanted reactions from the body are detected, you must immediately stop taking the powder and seek medical help.

Side effects

Nimesulide is a syrup for children, which can cause complications if the rules of use are not followed.

Violations can also develop if all recommendations are followed and affect the functioning of organs and systems:

• From the nervous system, headache, weakness and dizziness may occur. The child may become restless, there is motor activity and worsening sleep. School-age children become inattentive, there is memory deterioration and a decrease in mental performance. Such disorders are accompanied by rapid fatigue, decreased physical strength and endurance.
• From the digestive tract, nausea, pain in the stomach and loss of appetite are observed. Some patients experience stool disorder, manifested as diarrhea. In combination with frequent vomiting, the symptom leads to the development of dehydration, which manifests itself in the form of weakness, pallor and extreme thirst.
• From the cardiovascular system, the development of tachycardia and changes in blood pressure are possible. Such disorders are more typical for children over 12 years of age and adults; they are extremely rare in children.
• From the urinary system, there is increased frequency of urination and pain in the kidney area. Sometimes cystitis develops, but more often in adult patients.
• Disorders of the respiratory system usually develop in patients who suffer from chronic pathologies of the lungs and bronchi. Complications manifest themselves in the form of shortness of breath, asthma attacks or bronchospasm.

Sometimes adverse reactions manifest themselves in the form of allergies. In this case, the patient develops a rash, areas of peeling and irritation. Severe itching and burning of the skin leads to a deterioration of the condition, as well as aggravation of symptoms as a result of damage to the lesions.

If complications occur, it is important to stop using the medication and consult a doctor. Often the symptoms disappear after stopping the medication. However, if the condition worsens, the doctor prescribes symptomatic therapy.

Reviews about Nimulid

The medication has proven to be an effective treatment for pain syndrome.

Reviews about the tablets are different. The tablet form is easy to use and guarantees a quick effect, but more often causes negative symptoms from the digestive system in the form of gastropathy , dyspepsia , and gastrointestinal disorders. Patients note that lozenges act faster, which is explained by the rapid entry of the active substance into the body due to sublingual absorption.

Reviews of the ointment are positive; the drug has a warming, analgesic effect when applied to disease-affected joints. External use of the drug is an addition to the main therapy. The gel does not leave marks on clothes, is easy to use, and has no specific odor.

Reviews of Nimulid suspension for children are positive. Young parents note that correct dosage calculation allows one to avoid negative symptoms and guarantees an antipyretic effect. Reviews from doctors (therapists, rheumatologists, pediatricians) allow us to conclude that the drug is effective, but is not intended for long-term therapy, because may cause disturbances in the digestive system.

Overdose

Cases of drug overdose have been recorded. The condition manifests itself in the form of apathy, depression and lack of appetite. In addition, many patients experience respiratory depression, pale skin and dry mucous membranes of the oral cavity.

In severe cases, overdose is accompanied by repeated vomiting and the development of internal bleeding of the digestive tract. In this case, severe weakness, a critical decrease in blood pressure, and loose stools are noted. Vomit and feces become dark in color, and the general condition worsens.

With such disorders, the patient spends most of the time in a horizontal position and reports dizziness and lack of appetite. Lack of treatment leads to the development of severe complications, including death.

If signs of overdose appear, you should immediately consult a doctor who will prescribe symptomatic therapy. Treatment is usually carried out in a hospital setting.

Nimulid price, where to buy

The cost of the medication depends on the dosage form, pharmacy chain, and region.

The price of Nimulid in tablets 100 mg is 250-350 rubles. The price of the suspension is about 200 rubles. The price of Nimulid gel is about 250 rubles. The drug is not sold as an ointment.

• Online pharmacies in RussiaRussia
• Online pharmacies in KazakhstanKazakhstan

ZdravCity

• Nimulid tablets for rassas.
  100 mg 20 pcs Panacea Biotec RUR 357 order
• Nimulid tablets 100 mg 30 pcs.Panacea Biotec

  RUR 347 order

• Nimulid Susp. for internal approx. 50mg/5ml 60mlPanacea Biotec

  220 rub. order

• Nimulid tablets 100 mg 20 pcs.Panacea Biotec

  RUB 243 order

• Nimulid tablets for rassas. 100 mg 10 pcs Panacea Biotec

  RUB 287 order

Pharmacy Dialogue

• Nimulid suspension bottle 50mg/5ml 60mlPanacea Biotec

  RUB 174 order

  Read also:  Femoral neck fracture. Recovery after surgery
• Nimulid tablets d/ras.100 mg No. 20Panacea Biotec

  RUB 335 order

• Nimulid tablets 100 mg No. 30Panacea Biotec

  RUB 339 order

• Nimulid tablets 100 mg No. 20Panacea Biotec

  RUB 232 order

• Nimulid (tab.d/ras.100mg No. 20)Panacea Biotec

  RUB 357 order

show more

special instructions

Nimesulide is a syrup for children, prescribed only when indicated and after a preliminary diagnostic examination. If complications occur, it is important to stop using the medication immediately. Exceeding the dosage is strongly not recommended, especially when treating children under 1 year of age.

You can drink the syrup with water, as it has a very sweet taste. When treating children, it is important not to give the drug to the patient on an empty stomach. This can lead to complications in the digestive tract.

If the syrup is taken by an adult, he is usually prescribed drugs to suppress the production of hydrochloric acid in order to reduce the weakening of the negative effect of nimesulide on the mucous membranes of the stomach and intestines.

The syrup is prescribed with extreme caution to patients who have a history of blood pathologies characterized by a violation of the process of platelet formation.

In addition, it is worth considering the ability of nimesulide to retain fluid in tissues, which can lead to an increase in blood pressure. That is why the medication is prescribed to adults with caution and only if there are strict indications.

Interaction

Nimesulide can enhance the effect of medications that slow down blood clotting.

Suppression of the activity of Furosemide .

The drug increases the severity of the side effects of Methotrexate .

There is a decrease in the effect of taking antihypertensive drugs.

An increase in lithium levels is recorded during simultaneous therapy with lithium and Nimulide.

With respect to Cyclosporine, there is an increase in the nephrotoxic effect of the antidepressant on the renal system.

The risk of developing bleeding from the digestive tract increases when taking serotonin reuptake inhibitor drugs and glucocorticosteroids simultaneously.

Drug interactions

It is strictly forbidden to combine the drug with non-steroidal anti-inflammatory drugs. This can provoke severe complications from internal organs. The medicine is not prescribed in combination with anticoagulants based on acetylsalicylic acid or heparin.

The syrup should not be used simultaneously with loop diuretics and cyclosporines, as the negative effect on the patient’s kidneys increases. Some cytostatics increase the risk of developing renal failure. When combining syrup with glucocorticosteroids, the likelihood of developing gastrointestinal bleeding increases.

It is allowed to use syrup simultaneously with antibiotics, antiviral and vascular agents. There is no development of negative reactions when combined with vitamin complexes, mucolytics and antitussives. In each case, the decision to combine a medication with one or another drug is made by the doctor.

Carefully

• arterial hypertension;
• cardiac ischemia;
• cerebrovascular diseases;
• severe heart failure;
• dyslipidemia/hyperlipidemia;
• diabetes;
• peripheral arterial disease;
• hemorrhagic diathesis;
• smoking;
• renal failure (creatinine clearance 30-60 ml/min);
• anamnestic data on the development of erosive and ulcerative lesions of the gastrointestinal tract, the presence of Helicobacter pylori ;
• elderly age;
• long-term use of non-steroidal anti-inflammatory drugs;
• frequent alcohol consumption, severe somatic diseases, systemic lupus erythematosus (SLE) and other systemic connective tissue diseases;
• concomitant therapy with the following drugs: anticoagulants (for example, warfarin), antiplatelet agents (for example, acetylsalicylic acid, clopidogrel), oral glucocorticosteroids (for example, prednisolone), selective serotonin reuptake inhibitors (for example, citalopram, fluoxetine, paroxetine, sertraline).

Analogs

In some cases, specialists prescribe substitutes for patients with similar medicinal properties.

The most popular substitutes:

• Nemulex is a powder for preparing a solution that is taken orally. Contains the same active ingredient and has similar pharmacological properties, it is prescribed as an analgesic and anti-inflammatory medication for adults and children over 12 years of age. The drug is highly effective and quickly eliminates acute manifestations of the disease.
• Nimegesik – tablets and oral suspension based on nimesulide. It has a pronounced antipyretic, anti-inflammatory and analgesic effect. Prescribed to adults and children over 12 years of age in individual dosages.

Analogs are used for no longer than 5 days in a row and only as prescribed by a doctor.

Directions for use and doses

Before use, Nimesulide powder must be diluted in liquid to obtain a suspension. To do this, you need to open the sachet, pour the contents into a glass and pour in at least 100 ml of boiled water that has cooled to room temperature. The resulting substance must be thoroughly mixed until the drug is completely dissolved. After this, the suspension can be used.

IMPORTANT! Storage of the finished suspension is not allowed! The drug should be diluted immediately before taking it.

Nimesulide powder is taken orally, mainly after meals.

Inside. Adults and children over 12 years of age (body weight more than 40 kg) are prescribed 100 mg 2 times a day. Take after meals with enough water. The maximum daily dose for adults and children over 12 years of age is 200 mg.

Elderly patients:

When treating elderly patients, no adjustment of the daily dose is required.

Patients with renal failure:

in patients with mild to moderate renal failure (creatinine clearance 30-60 ml/min), no dose adjustment is required; in patients with severe renal failure (creatinine clearance less than 30 ml/min), nimesulide is contraindicated.

Patients with liver failure:

the use of nimesulide in patients with liver failure is contraindicated.

Course of treatment: as prescribed by the doctor.
To reduce the likelihood of side effects, it is recommended to take the minimum effective dose for the shortest possible time. The maximum duration of treatment with nimesulide is 15 days. Instructions for use of Nimesulide powder for children
To avoid side effects and to reduce health risks, the drug is not prescribed to children under 12 years of age. Children over 12 years of age can be given the powder according to the same treatment regimen recommended for adults.

IMPORTANT! If the next dose of the drug was missed, increasing the dosage at the next dose is not allowed. If you take a long break from taking the drug, you should consult a doctor and, if necessary, resume the treatment regimen or adjust it.