Combined use advantages of nimesulide oral and local forms in pain syndrome treatment
https://doi.org/10.21518/ms2025-042
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually prescribed either locally (topical forms) at the first stage, or orally at the second stage, if the effect of local pain relief when using NSAIDs has not been achieved. The combined use of different forms with the same NSAID molecule will enhance and prolong the anti-inflammatory and analgesic effect, reduce the dosage of the oral drug, and thereby reduce the risks of adverse events (AE). Nimesulide is a representative of the sulfonanilide class among NSAIDs, refers to drugs that inhibit mainly the enzyme cyclooxygenan-2 (COX-2), and has no effect on COX-1. Selective COX-2 inhibitors are significantly less likely to cause the development of NSAID-gastropathies. Nimesulide is characterized by a low range of relative risks (RR) compared to other commonly prescribed NSAIDs: <2 for rofecoxib, celecoxib, nimesulide; from 2 to < 5 for naproxen, ibuprofen, diclofenac, etoricoxib, meloxicam; and ≥ 5 for ketoprofen, piroxicam, ketorolac. The anti-inflammatory and analgesic effect of nimesulide is achieved by inhibiting the release of tumor necrosis factor alpha (TNF-alpha), histamine, inhibiting the formation of reactive oxygen species, releasing matrix metalloproteases (MMPs), and inhibiting chondrocyte apoptosis. The clinical effectiveness of the analgesic effect of nimesulide has been proven in pain syndrome in patients with osteoarthritis (OA), lower back pain (LBP), gouty arthritis. The anti-inflammatory effect of nimesulide is manifested in the suppression of pro-inflammatory cytokines. Nimesulide has a low level of AE from the gastrointestinal tract (GIT), therefore it can be recommended for elderly patients.
Supporting agencies: The article was published with the support of the LLC “Dr. Reddys Laboratories”
About the Author
O. A. Shavlovskaya
International University of Restorative Medicine
Russian Federation
Russian Federation
Olga A. Shavlovskaya, Dr. Sci. (Med.), Associate Professor, Professor of the Department of Restorative Medicine and Medical Rehabilitation
18, Bldg. 2, Furmannyy Lane, Moscow, 105062
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For citations:
Shavlovskaya OA. Combined use advantages of nimesulide oral and local forms in pain syndrome treatment. Meditsinskiy sovet = Medical Council. 2025;(5):17-23. (In Russ.) https://doi.org/10.21518/ms2025-042
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