Inside. The contents of the sachet are dissolved in approximately 100 ml of water at room temperature (a white or light yellow suspension is formed). The prepared solution cannot be stored. The drug is used only for the treatment of patients over 12 years old. Adults and children over 12 years old: 1 sachet twice a day, after meals. Elderly patients: in the treatment of elderly patients, the need to adjust the daily dose is determined by the doctor based on the possibility of interaction with other drugs. Patients with renal insufficiency: in patients with renal insufficiency of mild to moderate severity (creatinine clearance 30-60 ml / min) dose adjustment is not required, while in patients with severe renal impairment (creatinine clearance <30 ml / min) the drug is contraindicated ... Patients with hepatic impairment. The use of the drug in patients with hepatic impairment is contraindicated. To reduce the likelihood of side effects, it is recommended to take the lowest effective dose for the shortest possible time. The maximum daily dose for adults and children over 12 years of age is 200 mg. The maximum duration of the course of treatment is 15 days.

Hypersensitivity to nimesulide or other components of the drug; a history of hyperergic reactions (bronchospasm, rhinitis, urticaria) associated with the use of acetylsalicylic acid or other NSAIDs, including nimesulide; complete or incomplete combination of bronchial asthma, recurrent polyposis of the nose or paranasal sinuses with intolerance to acetylsalicylic acid and other NSAIDs (including a history); a history of hepatotoxic reactions to nimesulide; simultaneous use with other drugs with potential hepatotoxicity (for example, other NSAIDs); chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis) in the acute phase; period after coronary artery bypass grafting; febrile syndrome with colds and acute respiratory viral infections; suspicion of acute surgical pathology; peptic ulcer of the stomach or duodenum in the acute phase; erosive and ulcerative lesions of the gastrointestinal tract; a history of perforation or gastrointestinal bleeding; history of cerebrovascular bleeding or other diseases accompanied by increased bleeding; severe blood clotting disorders; severe heart failure; severe renal impairment (creatinine clearance <30 ml / min), confirmed hyperkalemia; liver failure or any active liver disease; children under 12 years of age; pregnancy and the period of breastfeeding; alcoholism, drug addiction; hereditary fructose intolerance, sucrase-isomaltase deficiency and glucose-galactose malabsorption syndrome.

Disorders of the blood and lymphatic system. Rarely: anemia, eosinophilia, hemorrhages; very rare: thrombocytopenia, pancytopenia, thrombocytopenic purpura. Immune system disorders. Rarely: hypersensitivity reactions; very rare: anaphylactoid reactions. Skin and subcutaneous tissue disorders. Uncommon: itching, skin rash, excessive sweating; rarely: erythema, dermatitis; very rare: urticaria, angioedema, facial edema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome). Nervous system disorders. Uncommon: dizziness; very rare: headache, drowsiness, encephalopathy (Reye's syndrome). Violation of the psyche. Rarely: a feeling of fear, nervousness, nightmares. Violations of the organ of vision. Rarely: blurred vision; very rare: visual impairment. Hearing impairment and labyrinthine disorders. Very rare: vertigo. Violations of the cardiovascular system. Uncommon: increased blood pressure; rarely: tachycardia, lability of blood pressure, "hot flashes" of blood to the skin of the face, palpitations. Respiratory system disorders. Uncommon: shortness of breath; very rare: exacerbation of bronchial asthma, bronchospasm. Disorders from the gastrointestinal tract. Often: diarrhea, nausea, vomiting; infrequently: constipation, flatulence, gastritis, gastrointestinal bleeding, ulcer and / or perforation of the stomach or duodenum; very rare: abdominal pain, dyspepsia, stomatitis, tarry stools. Liver and biliary tract disorders. Often: increased activity of "liver" enzymes; very rare: hepatitis, fulminant (fulminant) hepatitis (including deaths), jaundice, cholestasis. Disorders of the kidneys and urinary tract. Rarely: dysuria, hematuria, urinary retention; very rare: renal failure, oliguria, interstitial nephritis. Water-electrolyte metabolism disorders. Rare: hyperkalemia. Others. Uncommon: peripheral edema; rarely: malaise, asthenia; very rare: hypothermia.

Glucocorticosteroids increase the risk of gastrointestinal ulcers or bleeding. Antiplatelet agents and selective serotonin reuptake inhibitors such as fluoxetine increase the risk of gastrointestinal bleeding. NSAIDs can enhance the effect of anticoagulants, such as warfarin. Due to the increased risk of bleeding, this combination is not recommended and is contraindicated in patients with severe coagulation disorders. If combination therapy cannot be avoided, it is necessary to carefully monitor blood clotting parameters. Diuretics NSAIDs can reduce the effect of diuretics. In healthy volunteers, nimesulide temporarily reduces sodium excretion under the action of furosemide, to a lesser extent - potassium excretion and reduces the diuretic effect itself. The simultaneous use of nimesulide and furosemide leads to a decrease (by approximately 20%) in the area under the concentration-time curve (AUC) and a decrease in the cumulative excretion of furosemide without changing the renal clearance of furosemide. The simultaneous use of furosemide and nimesulide requires caution in patients with renal or heart failure. ACE inhibitors and angiotensin II receptor antagonists. NSAIDs can reduce the effect of antihypertensive drugs.In patients with mild to moderate renal insufficiency (creatinine clearance 30-80 ml / min) with the simultaneous use of ACE inhibitors, angiotensin II receptor antagonists and agents that suppress the cyclooxygenase system (NSAIDs, antiplatelet agents), it is possible further deterioration of renal function and the emergence of acute renal failure, which is usually reversible. These interactions should be considered in patients taking nimesulide in combination with ACE inhibitors or angiotensin II receptor antagonists. Therefore, the simultaneous use of these drugs should be done with caution, especially in elderly patients. Patients should receive adequate fluid intake and renal function should be closely monitored after concomitant use. Mifepristone. It is theoretically possible to reduce the effectiveness of mifepristone and prostaglandin analogues when used simultaneously with NSAIDs (including acetylsalicylic acid) due to the antiprostaglandin action of the latter. Limited data show that the use of NSAIDs on the same day as a prostaglandin analog does not adversely affect the effect of mifepristone or a prostaglandin analog on cervical dilatation, uterine contractility, and does not reduce the clinical efficacy of medical abortion. There is evidence that NSAIDs reduce the clearance of lithium, which leads to an increase in the concentration of lithium in the blood plasma and its toxicity. When using nimesulide in patients on therapy with lithium preparations, regular monitoring of the concentration of lithium in the blood plasma should be carried out. There were no clinically significant interactions with glibenclamide, theophylline, digoxin, cimetidine and antacids (for example, a combination of aluminum and magnesium hydroxides). Nimesulide inhibits the activity of the isoenzyme CYP2C9. While taking drugs that are substrates of this enzyme with nimesulide, the concentration of these drugs in the plasma may increase. When prescribing nimesulide less than 24 hours before or after taking methotrexate, caution is required, since in such cases, the plasma level of methotrexate and, accordingly, the toxic effects of this drug may increase. Due to the effect on renal prostaglandins, inhibitors of prostaglandin synthetases, such as nimesulide, can increase the nephrotoxicity of cyclosporins.

Symptoms: apathy, drowsiness, nausea, vomiting, pain in the epigastric region. These symptoms are usually reversible with symptomatic and supportive therapy. It is possible to increase blood pressure, the occurrence of gastrointestinal bleeding, acute renal failure, respiratory depression, coma, anaphylactoid reactions. Treatment. Symptomatic and supportive therapy. There is no specific antidote. In the event that an overdose has occurred within the last 4 hours, it is necessary to induce vomiting and / or ensure the intake of activated charcoal (60 to 100 g for an adult) and / or an osmotic laxative. Forced diuresis, hemodialysis, hemoperfusion, urine alkalization are ineffective due to the high degree of binding of nimesulide to blood plasma proteins (up to 97.5%). It is necessary to monitor the state of the function of the nights and liver.