Nimulid gel 1% 30gr

Nimulid instruction

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Composition

The tablet contains 100 mg of Nimulid.
Excipients:
    starch from corn;
    Mg stearate;
    hydrochloric acid;
    povidone;
    silica;
    lactose;
    water;
    polysorbate;
    croscarmellose Na;
    lactose.
1 gram of gel contains 10 mg of Nimulid.
Excipients:
    phosphoric acid;
    hydroxypropyl cellulose;
    ethanol;
    perfume;
    triacetin;
    water;
    carbomer;
    dimethylacetamide.
50 ml of the suspension (Nimulid for children) contain 50 mg of Nimulid.

Form of issue

The medicine is available in several forms:
    pills;
    lozenges;
    gel (applied externally);
    suspension (used in pediatric practice).
Tablets of light yellow color, have biconvex, round form. On one side is engraved an inscription with the name of the medication in Latin "NIMULID"; on the other side a logo is engraved. In one convolute 10 tablets. The package can have 3 or 10 convolutes (30 and 100 pieces respectively). Similarly, tablets for resorption are packaged.
Gel Nimulid 1% is packed in special tubes of aluminum with a volume of 10, 20 and 30 grams.
The Nimulid suspension is packed in 60 ml glass vials. The package contains a special measuring cup and 1 bottle.

pharmachologic effect

The active component of Nimulid refers to sulfonylamides of NSAIDs. Characteristic analgesic, anti-inflammatory and antipyretic effects. The principle of action is directed to selective inhibition of the enzyme COX-2 (cyclooxygenase) and inhibition of histamine and proteinases, suppression of tumor necrosis factors alpha, platelet activation factors. Due to the suppression of cyclo-oxygenase, it is possible to significantly slow down the biological synthesis of prostaglandins, which are produced in the inflammatory focus. Selective blocking of COX-2, rather than COX-1, avoids the negative manifestations associated with the suppression of prostaglandin activity in healthy body tissues.

Pharmacodynamics and pharmacokinetics

The absorption index at reception per os is quite high. Food does not affect the degree of absorption, but slows its speed. With lipoproteins binds to 1%, with erythrocytes - 2%, with plasma proteins - 95%, with acid alpha-1-glycoproteids - by 1%. Dose fluctuations do not affect the degree of binding. The active substance is able to penetrate into the tissues of the female genital organs (after one-time administration, the concentration of the active ingredient is equal to 40% of the concentration in the plasma). Nimulid penetrates easily through the histohematological barrier. The active substance is found in the synovial fluid (43%), in the inflammatory focus (40%).
Metabolism is carried out with the involvement of tissue monooxygenases in the hepatic system. The main metabolite is 4-hydroxynimidesulide, which has a similar pharmacological activity, despite the fact that it diffuses rapidly through the hydrophobic channel of COX-2 due to its small size to the active binding center of the methyl group. Metabolite is a water-soluble compound that is excreted without the participation of glutathione and without conjugation of the second phase of metabolism (glucuronidation, sulfation, etc.). The main metabolite is excreted through the renal system (65%), in part - with bile. Characterized by enterohepatic recirculation. The half-life of the metabolite is 2.89-4.78 hours, Nimulid - 1.56-4.95 hours. In elderly patients and patients with pathology of the renal system, the pharmacokinetic profile differs from that in young and healthy individuals.

Indications for use

The main indications for the use of Nimulid (from which tablets, gel and suspeniz):
    psoriatic arthritis;
    osteoarthritis;
    gout (articular syndrome with exacerbation);
    rheumatoid arthritis;
    post-traumatic inflammation of soft tissues;
    Myalgia (non-rheumatic and rheumatic origin);
    inflammation of tendons, ligamentous apparatus;
    bursitis;
    osteochondrosis with radicular syndrome;
    symptomatic treatment to reduce the severity of the pain syndrome and the inflammatory process (does not affect the progression of the disease);
    pain syndrome of various origins (lumboishalgia, headache, toothache, algodismenorea, arthralgia, after trauma and surgical interventions);
    ankylosing spondylitis.

Contraindications

    pronounced pathology of the coagulating system of blood;
    active gastrointestinal bleeding;
    erosive changes, ulcers on the mucous membranes of the digestive tract (duodenum, stomach);
    diagnosed hyperkalemia;
    inflammatory bowel disease in the acute stage;
    pregnancy;
    insufficiency of the cardiovascular system, severe course;
    progressive disease of the renal system;
    individual hypersensitivity;
    aortocoronary bypass surgery;
    severe pathology or active liver disease;
    breast-feeding;
    diagnosis of rhinitis, bronchial obstruction, hives in a history after taking any NSAID;
    the age limit is 12 years.

Relative contraindications:

    cerebrovascular disease;
    diagnosis of Helicobacter pylori;
    peripheral arterial disease;
    insufficiency of the cardiovascular system, stagnant form;
    dyslipidemia, hypercholesterolemia;
    elderly age;
    long-term use of NSAIDs;
    cardiac ischemia;
    ulcerative lesions of the digestive tract in anamnesis;
    smoking;
    diabetes;
    alcoholism.
The medicine is prescribed with caution when taking the following medicines:
    antiaggregants;
    anticoagulants;
    selective serotonin reuptake inhibitors;
    oral forms of glucocorticosteroids.

Side effects

The digestive tract:
    epigastric pain;
    diarrheal syndrome;
    gastritis;
    flatulence;
    a tarry chair;
    stomatitis;
    constipation;
    vomiting;
    nausea;
    ulcerative lesions or perforation of the digestive tract;
    jaundice;
    hepatitis (including lightning-fast form);
    cholestasis;
    increase of enzymes of the hepatic system (bilirubin, ALT, AST).
Nervous system:
    headache;
    nightmarish dreams;
    increased nervousness;
    a feeling of fear, of fear;
    dizziness;
    excessive drowsiness;
    Reye's syndrome (encephalopathy).
Urinary system:
    retention of urination;
    swelling;
    oliguria;
    kidney failure;
    hyperkalemia;
    dysuria;
    interstitial nephritis;
    hematuria.
Allergic Answers:
    Lyell's syndrome;
    exudative erythema multiforme;
    hives;
    hypersensitivity reactions;
    angioedema;
    anaphyllactoid reactions;
    swelling on the face.
Other reactions:
    bronchospasm;
    dyspnea;
    bronchial asthma (exacerbation of a chronic disease);
    tides;
    hemorrhage;
    tachycardia;
    arterial hypertension;
    blurred vision;
    increased sweating;
    skin rashes;
    dermatitis;
    anemia;
    itching;
    erythema;
    severe weakness;
    thrombocytopenia;
    prolongation of the bleeding period;
    purpura;
    hypothermia;
    pancytopenia;
    eosinophilia.

Instructions for use Nimulid (Method and dosage)

The drug is issued in several forms, each of which has its own recommendations for use.

Nimulid tablets, instructions for use

This dosage form is intended for administration per os. Nimulid tablets appoint 1 pc. twice a day, washed down with water. The maximum dose is calculated according to the scheme: 5 mg / kg / day. In diseases of the renal system, the daily dose is reduced to 100 mg. Duration is determined by the doctor.

Gel Nimulid, instructions for use

Ointment is applied only externally. Affected areas are treated 4 times a day, squeezing out 3 cm of gel and distributing accurately the movements in an even layer. Do not rub. It is recommended to wash your hands thoroughly after washing with soap.

Nimulid suspension, instructions for use

This dosage form is designed specifically for children, but can also be used in the adult category of patients. Nimulid baby is calculated according to the scheme: 1.5 mg / kg, taking this dose 2-3 times a day. Adult syrup is prescribed for 100-200 mg twice a day.

Overdose

It manifests increased drowsiness, apathy, vomiting, nausea. In severe cases, bleeding from the digestive tract is recorded, respiratory depression is observed, acute renal failure is manifested.
Treatment is phased, posindromnoe. A specific antidote for Nimulid poisoning has not been developed. If less than 4 hours have passed since the overdose, effective treatment is directed at calling up vomiting, taking enterosorbents (60-100 g of Activated Carbon) and osmotic laxatives. The active substance binds well to plasma proteins, which makes it difficult to purify the blood during intoxication through hemodialysis and forced diuresis.

Interaction

Nimulid is able to enhance the action of medications that slow blood clotting. Suppression of Furosemide activity is observed. The drug increases the severity of side effects of Methotrexate. There is a decrease in the effect of taking antihypertensive medications. The increase in the level of lithium is registered with simultaneous therapy with lithium and Nimulid preparations. With regard to Cyclosporin, the nephrotoxic effect of the antidepressant on the renal system is enhanced. The risk of bleeding from the digestive tract increases with simultaneous reception of drugs-inhibitors of re-uptake of serotonin and glucocorticosteroids.

Storage conditions

Syrup Nimulid, gel and tablets should be stored in their original packaging from the manufacturer. The temperature is 15-25 degrees.
Shelf life - 60 months.

special instructions

Patients with a high risk of bleeding, with diseases of the upper digestive tract, as well as people taking anticoagulants, Nimulid is appointed with caution. Given that the active substance is excreted by the kidney system, with kidney pathology, the dosage is reduced, focusing on the creatinine clearance. In patients taking other NSAIDs, visual impairment was recorded, so Nimulid treatment is immediately stopped when the first signs of visual impairment are seen before being examined by an ophthalmologist. The active substance is able to retain fluid in the organs and tissues, which must be taken into account for patients suffering from arterial hypertension and with severe pathology of the cardiovascular system. The selection of the lowest effective dosage for the shortest possible time allows avoiding negative reactions from the digestive tract.
Side effects, when registering it is not recommended to drive a motor vehicle:
    increased drowsiness;
    dizziness;
    blurred vision.

Nimulid for children

Antipyretic for children is available in a special dosage form. Syrup is suitable for use in pediatric practice. Nimulid is prescribed from temperature to children 2-3 times a day. The instruction is recommended to calculate the dosage taking into account the weight of the child: 1.5 mg per 1 kg. Suspension for children can also be used by adults when it is not possible to use a tablet form. Reviews for Nimulid for children are mostly positive - the drug has proven effective as an antipyretic, analgesic, anti-inflammatory drug.

During pregnancy (and lactation)

Breastfeeding, pregnancy are absolute contraindications.

Reviews of Nimulid

The drug is recommended as an effective tool in the therapy of pain syndrome.
Reviews about tablets are different. The tablet form is convenient in application and guarantees a quick effect, but more often it causes negative symptoms from the digestive system in the form of gastropathies, dyspepsias, gastrointestinal disorders. Patients note that tablets for resorption are faster, which is explained by the rapid intake of active substance into the body due to sublingual absorption.
Reviews for ointment are positive, the drug has a warming, analgesic effect when applied to the affected joints. External application of the drug is in addition to the main therapy. The gel leaves no residue on clothes, it is convenient to use, does not have a specific smell.
Reviews of Nimulid suspension for children are positive. Young parents note that the correct calculation of dosage allows to avoid negative symptoms and guarantees antipyretic effect. Comments of doctors (therapists, rheumatologists, pediatricians) allow us to conclude that the drug is effective, but is not intended for long-term therapy, because can provoke disturbances in the digestive system.