Lemesilin (Nimesulide)

Nimesulide acts by inhibiting cyclo‑oxygenase‑2, providing analgesic and anti‑inflammatory effects in several acute conditions.

• Acute pain: delivers rapid analgesia for short‑term painful episodes such as dental or musculoskeletal pain.
• Primary dysmenorrhea: reduces menstrual cramps and associated discomfort in women.
• Postoperative pain: helps control pain following minor surgical procedures.

• Nimesulide preferentially inhibits the cyclo‑oxygenase‑2 (COX‑2) enzyme, decreasing the conversion of arachidonic acid to prostaglandins that mediate inflammation, pain and fever. By sparing COX‑1 activity, it aims to limit gastrointestinal toxicity while still providing effective anti‑inflammatory and antipyretic actions. The inhibition is reversible and dose‑dependent, leading to reduced synthesis of inflammatory mediators in peripheral tissues and the central nervous system, which contributes to its analgesic and antipyretic properties.

Nimesulide may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Gastrointestinal discomfort: nausea, dyspepsia, abdominal pain or mild diarrhoea that usually resolves after discontinuation.
• Headache: mild to moderate headache episodes occurring shortly after dosing.
• Skin rash: transient erythematous eruptions or pruritus that typically subside without intervention.

Serious or Rare Side Effects

• Hepatotoxicity: severe liver injury manifested by jaundice, elevated transaminases, and possible hepatic failure.
• Stevens‑Johnson syndrome: life‑threatening skin reaction with blistering, mucosal involvement and systemic symptoms.
• Renal impairment: acute kidney injury or reduced renal function, especially in patients with pre‑existing kidney disease.

When prescribing Nimesulide, clinicians should observe several precautionary measures to minimise risk.

• Liver function assessment: evaluate baseline hepatic enzymes before initiating therapy.
• Avoid in hepatic disease: contraindicated in patients with active liver impairment.
• Use lowest effective dose: prescribe the minimal dose needed for symptom control.
• Monitor gastrointestinal bleeding: be vigilant in patients with ulcer history or concurrent anticoagulants.
• Caution in renal impairment: adjust use in patients with reduced kidney function.
• Store at room temperature: keep tablets in the original packaging, protect from moisture and heat.

Nimesulide can interact with several medicines; understanding the interaction level guides safe co‑administration.

Major Interactions (Avoid)

• Anticoagulants (e.g., warfarin): increased risk of bleeding.
• Other NSAIDs or aspirin: additive gastrointestinal toxicity.
• Lithium: elevated lithium serum concentrations.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or ARBs: possible reduction in antihypertensive effect and renal function.
• Diuretics: enhanced risk of renal impairment and electrolyte imbalance.