Mesulid (Nimesulide)

• Nimesulide is an NSAID that reduces inflammation and pain by inhibiting cyclooxygenase‑2.
• Acute pain: provides rapid analgesic relief in short‑term painful episodes.
• Dysmenorrhea: alleviates menstrual cramps and associated discomfort.
• Osteoarthritis: reduces joint inflammation and improves mobility.
• Rheumatoid arthritis: helps control chronic inflammatory joint disease.
• Fever: lowers elevated body temperature in febrile conditions.

• Nimesulide selectively inhibits the cyclooxygenase‑2 (COX‑2) enzyme, which catalyzes the conversion of arachidonic acid to prostaglandins. By blocking COX‑2, it decreases the synthesis of prostaglandin E2 and other mediators responsible for inflammation, pain, and fever, while sparing COX‑1 activity that protects gastric mucosa. This selective inhibition contributes to its analgesic, antipyretic, and anti‑inflammatory effects.

Common Side Effects

• Gastro‑intestinal discomfort or dyspepsia.
• Nausea or vomiting.
• Headache.
• Dizziness.
• Mild skin rash.
• Elevated liver enzymes (asymptomatic).

Serious or Rare Side Effects

• Hepatotoxicity, including severe liver injury.
• Stevens‑Johnson syndrome or toxic epidermal necrolysis.
• Anaphylactic reactions.
• Severe cutaneous adverse reactions (SCARs).
• Hemorrhagic events, especially gastrointestinal bleeding.
• Renal impairment in susceptible individuals.

Before initiating therapy, consider the following precautions:

• Assess liver function: monitor hepatic enzymes before and during treatment.
• Evaluate hypersensitivity: avoid in patients with known allergy to nimesulide or other NSAIDs.
• Cardiovascular risk: use with caution in patients with existing heart disease or hypertension.
• Concomitant anticoagulants: be aware of increased bleeding potential when combined with warfarin or similar agents.
• Pregnancy and lactation: avoid use during pregnancy, especially the third trimester, and while breastfeeding.
• Store at room temperature: keep in the original container, protect from moisture and light.

Nimesulide may interact with several medicines; careful assessment is required.

Major Interactions (Avoid)

• Other NSAIDs or COX‑2 inhibitors: heightened risk of gastrointestinal bleeding.
• Anticoagulants (e.g., warfarin, heparin): increased bleeding tendency.
• Hepatotoxic drugs (e.g., isoniazid, methotrexate): potential additive liver injury.
• Sulfonylureas: may potentiate hypoglycaemic effect.
• Lithium: possible elevation of lithium serum levels.

Moderate Interactions (Monitor Closely)

• CYP2C9 substrates (e.g., phenytoin, warfarin): may alter plasma concentrations.
• SSRIs or SNRIs: moderate increase in bleeding risk.
• Diuretics: may affect renal clearance of nimesulide.