Drug reference

Nimesulide

Selective COX-2 inhibitor (sulfonanilide NSAID) · Anti-inflammatory, Antipyretic, Analgesic

START

100 mg PO twice daily for ≤15 days

TYPICAL MAX

200 mg/day for ≤15 days

STOP IF

Any hepatic enzyme rise, jaundice, GI bleed, AKI, or rash

WATCH

LFTs at baseline (and during use if prolonged); GI symptoms; renal function

CDSCO approvedSchedule HATC M01AX17

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · absorption
PEAK: 2h · Tmax
t½: 3.5h · t½
DURATION: 7h · per dose

EXCRETION

Renal — mainly metabolites

route + CYP

INTERACTIONS

4 major

SEVERE in our sources

PREGNANCY

Avoid; 3rd trimester contraindicated.

FDA category + note

Top interactionssee all 12 →

LithiumSevereDatabaseKimi deep-research + Cla
AnticoagulantsSevereDatabaseKimi deep-research + Cla
Other Hepatotoxic DrugsSevereDatabaseKimi deep-research + Cla
WarfarinSevereDatabase

Mechanism

Selective COX-2 inhibitor with additional anti-inflammatory actions (reduced PMN activation, scavenging of reactive oxygen species) — analgesic, antipyretic, and anti-inflammatory; preferential COX-2 selectivity less than coxibs.

Indications

Acute pain (musculoskeletal, dysmenorrhoea, dental — short-term ≤15 days)Osteoarthritis (short-term)Fever (regions where licensed)

Dosing

Adult: 100 mg PO twice daily for ≤15 days; do not exceed treatment duration.
Pediatric: Generally not recommended; FEVER in <12 y contraindicated.
Renal adjustment: Reduce in significant impairment; avoid severe.
Hepatic adjustment: Contraindicated in any hepatic impairment.
Geriatric: Lower doses; GI/hepatic/renal risk.
Max dose: 200 mg/day for ≤15 days

Pharmacokinetics

Onset

Analgesia ~30 min

Peak effect

~2 h (Tmax)

Duration

~6–8 h

Half-life

~2–5 h

Bioavailability

Well absorbed orally

Protein binding

>99%

Metabolism

Hepatic (active hydroxy metabolite)

Excretion

Renal (mainly metabolites)

Contraindications

Active GI ulcer / bleeding
Hepatic impairment (any) — significant hepatotoxicity signal
Severe heart failure
Severe renal impairment
Third trimester pregnancy
Fever in children <12 y
Hypersensitivity / aspirin-asthma triad

Side effects

Common

Nausea / dyspepsiaDiarrhoeaHeadacheDizzinessRash

Serious

Hepatotoxicity (severe — withdrawal reason in many countries)
Acute liver failure
GI bleeding / ulcer
AKI
Severe skin reactions (SJS/TEN)
Reye-like syndrome in children

Pregnancy & lactation

Pregnancy

Avoid; 3rd trimester contraindicated.

Lactation

Avoid (limited data; safer alternatives).

Drug interactions

Lithium

Severe

Database

Reduced renal clearance

Monitor levels

Source: Kimi deep-research + Cla

Anticoagulants

Severe

Database

Additive bleeding (selective-COX-2 less than non-selective NSAID, still significant)

Avoid; gastroprotection

Source: Kimi deep-research + Cla

Other Hepatotoxic Drugs

Severe

Database

Additive hepatic injury

Avoid stacking; nimesulide already withdrawn in many countries for hepatotoxicity

Source: Kimi deep-research + Cla

Warfarin

Severe

Database

Increased risk of bleeding (gastrointestinal, other sites), increased INR

Avoid concomitant use. If unavoidable, monitor INR very closely and adjust warfarin dose. Consider alternative analgesics.

Ace Inhibitors (e.g., Enalapril, Ramipril)

Moderate

Database

Reduced antihypertensive effect, increased risk of renal impairment (especially in dehydrated or elderly patients), potential for hyperkalemia.

Monitor blood pressure and renal function (creatinine, electrolytes). Ensure adequate hydration. Avoid in patients with pre-existing renal dysfunction. Consider alternative analgesics.

Angiotensin Receptor Blockers (arbs) (e.g., Losartan, Telmisartan)

Moderate

Database

Reduced antihypertensive effect, increased risk of renal impairment (especially in dehydrated or elderly patients), potential for hyperkalemia.

Monitor blood pressure and renal function (creatinine, electrolytes). Ensure adequate hydration. Avoid in patients with pre-existing renal dysfunction. Consider alternative analgesics.

Aspirin (low Dose)

Moderate

Database

Increased risk of gastrointestinal bleeding and ulceration. Nimesulide may interfere with aspirin's antiplatelet effect if taken concurrently.

Avoid concomitant use if possible. If unavoidable, monitor for signs of bleeding. Consider a proton pump inhibitor (PPI) for gastroprotection. Administer nimesulide at least 2 hours after aspirin.

Corticosteroids (e.g., Prednisolone)

Moderate

Database

Increased risk of gastrointestinal ulceration and bleeding.

Use with caution. Consider a proton pump inhibitor (PPI) for gastroprotection, especially in patients with a history of GI issues.

Cyclosporine

Moderate

Database

Increased risk of nephrotoxicity and renal impairment.

Avoid concomitant use. If unavoidable, monitor renal function (creatinine, BUN) closely. Consider alternative analgesics.

Diuretics (e.g., Furosemide, Hydrochlorothiazide)

Moderate

Database

Reduced diuretic and antihypertensive effect, increased risk of renal impairment (especially in dehydrated or elderly patients).

Monitor blood pressure and renal function (creatinine, electrolytes). Ensure adequate hydration. Consider alternative analgesics if renal risk is high.

Methotrexate

Moderate

Database

Increased plasma concentrations of methotrexate, leading to methotrexate toxicity (myelosuppression, mucositis, renal failure).

Avoid concomitant use, especially with high-dose methotrexate. If unavoidable, monitor methotrexate levels and signs of toxicity. Consider alternative analgesics.

Ace Inhibitors

Moderate

Database

Triple-whammy AKI

Monitor renal function

Source: Kimi deep-research + Cla