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Nimesulide: a nonsteroidal anti-inflammatory that can cause fatal hepatitis

When a nonsteroidal anti-inflammatory is necessary, it is best to avoid nimesulide in favour of another drug with a better risk-benefit balance.

Nimesulide is a nonsteroidal anti-inflammatory drug (NSAID) available on the market for treating certain types of pain in adults and children over the age of 12. Copies (or generics) are now available, but nimesulide's risk-benefit balance remains unfavourable. Nimesulide’s efficacy is similar to that of other NSAIDs, but it exposes patients to an added risk of severe, sometimes fatal, liver damage, which is why it has been withdrawn from the market in several countries: Finland, Spain, Ireland and Singapore.

When medication is considered necessary for pain relief, paracetamol is the drug of reference. If this is not sufficient, a normal dosage of ibuprofen is the NSAID offering the best risk-benefit balance.

It is unacceptable that the European health authorities have not decided to withdraw nimesulide throughout the European Union, and that generics have been authorised.

©Prescrire December 2009

Source: "Nimésulide : hépatites mortelles injustifiées" Rev Prescrire 2009 ; 29 (313) ; 824.

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