Mesulid (Nimesulide)

• Mesulid (nimesulide) acts on inflammatory pathways mediated by cyclo‑oxygenase‑2, providing analgesic and anti‑inflammatory effects.
• Mild to moderate pain: provides analgesic relief in conditions such as musculoskeletal discomfort.
• Osteoarthritis: reduces joint inflammation and improves functional mobility.
• Dysmenorrhea: alleviates menstrual cramps and associated pain.

• Nimesulide preferentially inhibits the cyclo‑oxygenase‑2 (COX‑2) enzyme, decreasing the conversion of arachidonic acid to prostaglandins that mediate pain, fever and inflammation. By sparing COX‑1 activity, it aims to maintain gastric mucosal protection while delivering anti‑inflammatory and analgesic 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 therapeutic effect.

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

Common Side Effects

• Gastrointestinal discomfort: nausea, dyspepsia or abdominal pain.
• Headache: mild to moderate intensity.
• Dizziness or vertigo: transient episodes.
• Skin rash: mild erythema or itching.

Serious or Rare Side Effects

• Hepatotoxicity: elevated liver enzymes or severe liver injury.
• Severe skin reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Gastrointestinal bleeding or ulceration.
• Renal impairment: acute kidney injury or reduced renal function.

When prescribing Mesulid, clinicians should consider several precautionary measures to minimise risk.

• Assess liver function: obtain baseline hepatic enzymes before initiating therapy.
• Avoid in known NSAID hypersensitivity: contraindicated for patients with previous allergic reactions to NSAIDs.
• Use lowest effective dose: limit duration to the shortest period necessary for symptom control.
• Monitor renal function: especially in elderly, dehydrated or renally compromised patients.
• Caution with anticoagulants: evaluate bleeding risk when combined with warfarin or other anticoagulants.
• Store at room temperature: keep in the original packaging, protect from moisture and direct sunlight.

Nimesulide can interact with other medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Warfarin or other anticoagulants: increased risk of bleeding.
• Other NSAIDs or aspirin: additive gastrointestinal toxicity.
• Lithium: heightened lithium serum concentrations.

Moderate Interactions (Monitor Closely)

• ACE inhibitors or diuretics: possible reduction in antihypertensive effect and renal function.
• Methotrexate: reduced clearance may raise toxicity risk.
• SSRIs or other antidepressants: modest increase in bleeding tendency.