Lithium
Severe
Database
Reduced renal clearance
Monitor levels
Source: Kimi deep-research + Cla
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
KDIGO 2024 + manufacturer label
- ONSET
- 30min · absorption
- PEAK
- 2h · Tmax
- t½
- 3.5h · t½
- DURATION
- 7h · per dose
EXCRETION
Renal — mainly metabolites
route + CYP
INTERACTIONS
3 major
SEVERE in our sources
PREGNANCY
Avoid; 3rd trimester contraindicated.
FDA category + note
Top interactionssee all 5 →
- LithiumSevereDatabaseKimi deep-research + Cla
- AnticoagulantsSevereDatabaseKimi deep-research + Cla
- Other Hepatotoxic DrugsSevereDatabaseKimi deep-research + Cla
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
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
Ace Inhibitors
Moderate
Database
Triple-whammy AKI
Monitor renal function
Source: Kimi deep-research + Cla
Corticosteroids
Moderate
Database
Additive GI ulceration
Gastroprotection
Source: Kimi deep-research + Cla
7 additional unreviewed or low-confidence interactions hidden because their provenance or source detail is insufficient.
Related guidelines
Ask House about Nimesulide
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Textbook-sourced·Sources: KD Tripathi 7e·Updated: 2026-05-20·Cockpit curated: 2026-05-20