Nimesulide gastrointestinal

Bj arnason I, Thjodleifsson B. Gastromtestmal toxicity of non-steroidal anti-inflammatory drugs the effect of nimesulide compared with naproxen on the human gastrointestinal tract. Rheumatology (Oxford) 1999 38(Suppl l) 24-32. 

Gastrointestinal symptoms (pyrosis, pain, nausea) can occur (1), but in a short-term endoscopic study nimesulide caused less gastric damage than indometacin (SEDA-15, 104). 

Nimesulide is anti-inflammatory, analgesic, and antipyretic and reportedly is associated with a low incidence of gastrointestinal adverse effects. Given its selectivity profile, it is not a logical alternative for patients switching from the coxibs because of the risk of cardiovascular and cerebrovascular events. 

In pharmacological studies, nimesulide did not alter the effects of acenocoumarol or warfarin. Note that all NSAIDs increase the risk of gastrointestinal bleeding, and an increased risk is seen when they are combined with anticoagulants. 

The studies above suggest that no coumarin dose adjustments are expected to be needed when nimesulide is used. However, eare is still needed with every NSAID , (p.427), because, to a greater or lesser extent, they irritate the stomach lining, which can result in gastrointestinal bleeding, which will be more severe in anticoagulated patients. 

Gastrointestinal Nimesulide is a frequently used NSAID in Italy, whereas it is less frequently used in other European countries. In a cohort and nested case-control study among NSAID users, the risk of upper GI complications was compared for users of nimesulide and other commonly used NSAIDs in Italy, using data from 2001 to 2008 from regional health databases. The relative risk of upper GI complications was 3.28 for current use of NSAIDs (95%CI 2.86-3.76), was <2 for rofecoxib, celecoxib and nimesulide, 2 to <5 for naproxen, ibuprofen, diclofenac, etoricoxib and meloxicam, and >5 for ketoprofen, piroxicam and ketorolac [52 ]. 

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