Nimesulide in the Treatment of Patients Intolerant of Aspirin and other NSAIDs

Abstract

Aspirin (acetylsalicylic acid) and other NSAIDs are responsible for many adverse effects. Among them, pseudo-allergic reactions (urticaria/angioedema, asthma, anaphylaxis) affect up to 9% of the population and up to 30% of asthmatic patients. The mechanisms provoking these reactions have not been fully elucidated, but it appears that inhibition of cyclo-oxygenase (COX) plays a central role. The anti-inflammatory action of nimesulide differs from that of other NSAIDs, possibly because of its chemical structure. In particular, nimesulide is selective for COX-2 and displays additional properties in terms of its effects on inflammatory mediator synthesis and release. For these reasons, nimesulide is generally well tolerated by NSAID-intolerant patients and patients with NSAID-induced asthma. The good tolerability of nimesulide as an alternative drug for use in patients with NSAID intolerance has been demonstrated in a large number of clinical studies.

Cyclooxygenase Isozymes: The Biology of Prostaglandin Synthesis and Inhibition

“…Data from the Spanish Pharmacovigilance System reported a higher rate of hepatic injury with nimesulide than with other NSAIDs during the 1990s (Maciá et al, 2002) At therapeutic doses, nimesulide does not appear to precipitate asthma in NSAID-sensitive asthmatics. This supports the concept that aspirin-induced asthma is caused by inhibition of COX-1 (Bianco et al, 1993;Senna et al, 1996;Gryglewski, 1998;Bennett, 2000). Prolonged treatment with nimesulide has delayed premature labor for up to 34 weeks without serious fetal side effects and resulted in a successful delivery (Sawdy et al, 1997).…”

Current status of the therapeutic uses and actions of the preferential cyclo-oxygenase-2 NSAID, nimesulide

“…Several reviews have been published in recent years on the adverse reaction profi le of nimesulide in comparison with that of other NSAIDs (Rainsford, 1996(Rainsford, , 1998(Rainsford, , 1999b(Rainsford, , 2001Bianco et al, 1993;Senna et al, 1996;Conforti et al, 2001;Lanas 2001;Boelsterli, 2002aBoelsterli, , 2000bTraversa et al, 2003;Laporte et al, 2004). These studies show that nimesulide has, overall, a pattern of organ reactions similar to that from other NSAIDs, though there are quantitative differences in the incidence of adverse reactions.…”

“…A particular advantage in the respiratory conditions is the relatively low likelihood of asthmatic and other allergic reactions with nimesulide (Bianco et al, 1993, Senna et al, 1996Bianchi et al, 2005).…”

“…Intolerance to nimesulide is rare in patients with pseudo-allergic reactions to other NSAID and aspirinsensitive asthmatic patients (Bianco et al, 1993;Senna et al, 1996).…”

Aspirin and other anti-inflammatory drugs

“…Interestingly, nimesulide seems safe to use in aspirin sensitive asthmatic patients. Several recent studies in NSAID intolerant asthmatic patients have shown that therapeutic doses of nimesulide did not induce asthmatic attacks while high doses of 400 mg only precipitated mild asthma in 10% of patients 77. Perhaps aspirin induced asthma is associated with COX-1 inhibition?…”