Nimesulide

What it is

Nimesulide is a non-steroidal anti-inflammatory drug that leans towards blocking the form of cyclo-oxygenase which appears at sites of inflammation. Damping that pathway lowers prostaglandin production and with it pain and swelling. Where it is still marketed it reaches patients only through a pharmacy on a doctor's prescription, and is used there for pain and inflammation; Finland's Fimea and Spain's AEMPS withdrew it over liver injury.

A usual adult range, not a national label — the dose and the timing differ by country and by product.

Used for

• Pain
• Inflammation

Approved uses differ by country — some of these may be off-label or unapproved where you live.

What to know while taking it

It is taken with food, and the stomach-bleeding warning is the class effect showing through. What sets nimesulide apart is the liver: ALT, AST and total bilirubin are the markers followed on it, and the reason the labels that still carry it, after the EMA's review, hold it to a course of about two weeks rather than everyday painkilling. Liver injury from it tends to be quiet at first, which is why those blood values carry more weight than how the person feels. It is not taken alongside anticoagulants such as warfarin, since bleeding risk adds up.

When to see a doctor

Yellow eyes or skin, dark urine, pale stools, itching, or nausea and loss of appetite that drag on are the liver signs that call for a doctor without delay. Black or tarry stools and coffee-ground vomit mean the same for the stomach.

Worth knowing

• Watch liver enzymes
• Raises the risk of stomach bleeding
• Short courses only

Markers to watch

• ALT
• AST
• Total bilirubin