Buy Nemulex granules for suspension 100 mg 2 g No. 30 in pharmacies

Drugs from the NSAIDs (non-steroidal anti-inflammatory drugs) group are used to treat acute back and joint pain. Nemulex and Nimesil are two medications that are similar in their therapeutic effects. They contain nimesulide, a substance that can reduce pain, lower temperature and relieve inflammation. A special release form (powder for dissolution in water) ensures rapid absorption of drugs, and their effect manifests itself quite quickly.

Comparison of the effectiveness of Nimesil and Nemulex

The effectiveness of Nimesil is quite similar to Nemulex - this means that the ability of the drug substance to provide the maximum possible effect is similar.
For example, if the therapeutic effect of Nimesil is more pronounced, then using Nemulex even in large doses will not achieve this effect.

Also, the speed of therapy - an indicator of the speed of therapeutic action - is approximately the same for Nimesil and Nemulex. And bioavailability, that is, the amount of a drug reaching its site of action in the body, is similar. The higher the bioavailability, the less it will be lost during absorption and use by the body.

Experience of using the drug Nemulex in the complex treatment of patients with osteoarthritis

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Regular issues of "RMZh" No. 0 dated October 31, 2013 p. 16

Category: Pain syndrome

Author: Lakhin D.I.

For quotation:

Lakhin D.I. Experience of using the drug Nemulex in the complex treatment of patients with osteoarthritis. RMJ. 2013;16.

Osteoarthritis (OA) is the most common pathology in the structure of rheumatic diseases, which occurs in 10–20% of the adult population of the world [1]. Radiological manifestations of OA are observed in 50% of the European population over 65 years of age, clinical manifestations in 12.5%, and in people over 80 years of age, OA is detected in almost 100% of cases [2]. In addition, OA is one of the main causes of premature disability, second only to coronary heart disease. OA itself leads to a decrease in women’s life expectancy by 10–15 years [3]. Moreover, OA is the most common reason for hip and knee replacement. In Europe every 1.5 minutes. replace the affected joint; approximately 500 thousand endoprosthetics are performed annually in the USA [4]. However, the decrease in life expectancy in elderly patients depends more on the intensity of pain than on the presence of concomitant life-threatening diseases [5]. Thus, non-steroidal anti-inflammatory drugs (NSAIDs), which can reduce pain and inflammation, and also significantly improve the quality of life of patients with OA, come to the fore in the treatment of OA. One of the brightest representatives of drugs in this group is the drug Nemulex, the basis of which is nimesulide, which primarily blocks cyclooxygenase-2 (COX-2), which takes part in the synthesis of prostaglandins, which act as mediators of inflammation and pain.

Purpose of the study: to evaluate the clinical effectiveness and safety of the drug Nemulex (nimesulide) in patients with OA. Material and methods The study included 30 patients with diagnosed OA who were hospitalized in the rheumatology department of the State Healthcare Institution “Regional Hospital No. 2” in Lipetsk in 2012. Patients aged 42–67 years were observed (average – 54±2.3 years ), of which 19 are women and 11 are men. The diagnosis was confirmed x-ray: stage 2 of the disease was diagnosed in 26 (86.7%) patients, stage 3 in 4 (13.3%) patients. The study lasted for 15 days, with complex treatment including the administration of Nemulex 1 sachet (100 mg) 2 times a day, chondroprotectors - chondroitin sulfate (Chondroguard) 200 mg/day IM, and physiotherapy. In patients, the range of motion in the joints was determined in degrees, the severity of pain syndrome was determined on a visual analogue scale (VAS) in mm, and general clinical tests were assessed: complete blood count, urinalysis, blood glucose, liver enzymes (AST, ALT) and C-level. reactive protein on the 1st and 15th days of treatment. Possible adverse reactions and assessment of patient tolerability of treatment were also taken into account. Results During an objective examination of patients on day 1, 27 (90%) people were diagnosed with synovitis of the knee and ankle joints; the severity of the pain syndrome was assessed as high – 69.3±0.74 mm on the VAS scale. As a result, on the 15th day of treatment, no deformed joints were found in patients, pain intensity significantly decreased to 21.2±0.29 mm (p<0.001) on the VAS scale (Table 1), range of motion in 12 (40% ) patients was restored completely, in the remaining 18 (60%) patients it increased significantly. When assessing the general blood test indicators, a significant decrease in the ESR level was noted from 29.8±0.18 mm/h to 11.3±0.12 mm/h (p<0.001), with significant changes in blood cells, no leukocyte formula was noted (Table 2). At the same time, no significant changes were recorded in the parameters of the general urine analysis; the parameters remained stable within normal values ​​both on the 1st and 15th days of therapy. In a biochemical blood test, the glucose level also did not exceed normal values, liver enzyme values ​​did not exceed threshold values, and the CRP level significantly decreased from 8.23±1.04 to 1.22±0.27 (p<0.001) (Table 3 ). Among the adverse reactions, NSAID gastropathy was noted in the form of intermittent pain and a burning sensation in the epigastrium in 2 (6.7%) patients (with a history of gastric ulcer), which required the prescription of proton pump blockers (omeprazole) in a full therapeutic dose ( 20 mg x 2 times / day). No NSAID gastropathy was observed during gastroprotection. No other adverse reactions were observed during the study during the combined use of Nemulex and Chondrogard. When assessing the tolerability of this complex treatment regimen for OA, 23 (76.7%) patients noted it as good, 7 (23.3%) patients as satisfactory. Conclusion and conclusions Currently, complex treatment of OA including chondroprotectors and NSAIDs has the highest evidence base (1A) in terms of the effectiveness and safety of the therapy (EULAR, 2003). In this case, the main contribution to reducing the severity of pain and inflammation belongs to NSAIDs. Among the large number of NSAIDs on the pharmaceutical market, the most justified is the prescription of predominantly selective NSAIDs in relation to COX-2, which includes Nemulex. In our study, the phenomena of NSAID gastropathy were identified in 2 patients with a history of gastric ulcer, which were completely eliminated due to gastroprotection. Also, no hepatotoxic effect of the drug was detected in the presence of significant anti-inflammatory (as evidenced by the levels of ESR and CRP) and analgesic effects (on the VAS scale). Patients' tolerability of the prescribed therapy was also assessed as satisfactory and good. The results obtained confirm the clinical effectiveness and safety of Nemulex and allow the drug to be included in the complex treatment of patients with OA. References 1. Smith MM, Ghosh P. Osteoarthritis: current status and future directions // APLAR J. Rhtum. 1998. Vol. 2. P. 27–53. 2. Perrot S., Menkes CJ Nonpharmacological approaches to pain in osteoarthritis // Available Options. Drugs. 1996. Vol. 52. P. 21–26. 3. Arden N., Nevitt MC Osteoarthritis; Epidemiology // Best Practice and Research Clinical Rheumatology. 2006. Vol. 20, No. 1. P. 3–25. 4. Rational pharmacotherapy of rheumatic diseases: a guide for practicing physicians / Ed. V.A. Nasonova, E.L. Nasonova. M., 2003. 507 p. 5. Pincus T., Sokka T. Abstract presented during the American college of rheumatology // Scientific Session. San Diego, California, 2005.

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Comparison of safety of Nimesil and Nemulex

The safety of a drug includes many factors.

At the same time, with Nimesil it is quite similar to Nemulex. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Nimesil, as well as Nemulex, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Nimesil does not have any risks when used, just like Nemulex.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Nimesil and Nemulex.

Nemulex® (Nemuleks®)

Undesirable side effects can be minimized by using the drug in the minimum effective dose with the minimum duration of use necessary to relieve pain.

There is evidence of very rare cases of serious reactions from the liver, including cases of death, associated with the use of nimesulide-containing drugs. If symptoms similar to signs of liver damage appear (anorexia, itching, yellowing of the skin, nausea, vomiting, abdominal pain, dark urine, increased activity of liver transaminases), you should immediately stop using the drug NEMULEX® and consult a doctor. Repeated use of NEMULEX® in such patients is contraindicated.

Liver reactions, which are in most cases reversible, have been reported with short-term use of the drug.

While using NEMULEX®, the patient should refrain from taking other analgesics, including NSAIDs (including selective COX-2 inhibitors).

NEMULEX® should be used with caution in patients with a history of gastrointestinal diseases (ulcerative colitis, Crohn's disease), since exacerbation of these diseases is possible.

The risk of gastrointestinal bleeding, peptic ulcer/perforation of the stomach or duodenum increases in patients with a history of ulcerative lesions of the gastrointestinal tract (ulcerative colitis, Crohn's disease), as well as in elderly patients, with an increase in the dose of PPVP. Therefore, treatment should be started with the lowest possible dose. In such patients, as well as in patients who require the simultaneous use of low doses of acetylsalicylic acid or other drugs that increase the risk of complications from the gastrointestinal tract, it is recommended to additionally prescribe gastroprotectors (misoprostol or proton pump blockers). Patients with a history of gastrointestinal disease, especially older patients, should report new gastrointestinal symptoms (especially symptoms that may indicate possible gastrointestinal bleeding) to their physician.

NEMULEX® should be administered with caution to patients taking drugs that increase the risk of ulceration or bleeding (oral corticosteroids, anticoagulants such as warfarin, selective serotonin reuptake inhibitors or antiplatelet agents such as acetylsalicylic acid).

If gastrointestinal bleeding or gastrointestinal ulceration occurs in patients taking NEMULEX®, treatment with the drug must be stopped immediately.

Given reports of visual impairment in patients taking other NSAIDs, if any visual impairment occurs, use of NEMULEX® should be immediately discontinued and an ophthalmological examination performed.

Nimesulide can cause fluid retention, therefore, in patients with arterial hypertension, renal and/or heart failure, NEMULEX® should be used with extreme caution. If the condition worsens, treatment with NEMULEX® should be discontinued.

Clinical studies and epidemiological data allow us to conclude that. that NSAIDs, especially in high doses and with long-term use, may lead to a small risk of myocardial infarction or stroke. There is insufficient data to exclude the risk of such events when using nimesulide.

In patients with arterial hypertension, renal and/or heart failure, coronary heart disease, peripheral arterial disease and/or cerebrovascular diseases, with risk factors for the development of cardiovascular diseases (for example, hyperlipidemia, diabetes mellitus, smoking patients), NEMULEX® should be used with special caution. If the condition worsens, treatment with NEMULEX® should be discontinued.

The drug contains sucrose, this should be taken into account by patients suffering from diabetes (0.15 XE in one sachet) and those on a low-calorie diet. NEMULEX® is not recommended for use in patients with fructose intolerance, sucrose-isomaltase deficiency, or glucose-galactose malabsorption syndrome.

If signs of a “cold” or acute respiratory viral infection occur while using the drug 11EMULEXk, the drug should be discontinued. Nimesulide can change the properties of platelets, so caution must be exercised when using the drug in people with hemorrhagic diathesis, however, the drug does not replace the preventive effect of acetylsalicylic acid in cardiovascular diseases.

Elderly patients are especially susceptible to adverse reactions to NSAIDs, including life-threatening gastrointestinal bleeding and perforation, and decreased renal, liver, and cardiac function. When taking NEMULEX® for this category of patients, proper clinical monitoring is necessary.

There is evidence of rare cases of skin reactions (such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) when taking NSAIDs. including nimesulide. At the first manifestations of a skin rash, damage to the mucous membranes or other signs of an allergic reaction, taking NEMULEX® should be stopped immediately.

Comparison of addiction between Nimesil and Nemulex

Like safety, addiction also involves many factors that must be considered when evaluating a drug.

So, the totality of the values ​​of such parameters as “o syndrome” in Nimesil is quite similar to the similar values ​​in Nemulex. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible. At the same time, Nimesil has a fairly low “syndrome” value, just like Nemulex.

Buy Nemulex granules for suspension 100 mg 2 g No. 30 in pharmacies

Nemulex Buy Nemulex in pharmacies Nemulex in the drug directory DOSAGE FORMS granules for the preparation of suspension for oral administration 100 mg

MANUFACTURERS Sotex PharmFirm (Russia)

GROUP Anti-inflammatory drugs of different groups

COMPOSITION Active substance: nimesulide.

INTERNATIONAL NON-PROPENTED NAME Nimesulide

SYNONYMS Actasulide, Aponil, Koxtral, Mesulide, Nise, Nimegesic, Nimesil, Nimesulide, Nimica, Nimulid, Prolid, Flolid

PHARMACOLOGICAL ACTION Non-steroidal anti-inflammatory drug (NSAID). It has anti-inflammatory, analgesic, antipyretic and antiplatelet effects. Unlike other NSAIDs, it selectively suppresses COX-2 and inhibits the synthesis of prostaglandins at the site of inflammation; has a less pronounced inhibitory effect on COX-1 (less likely to cause side effects associated with inhibition of prostaglandin synthesis in healthy tissues). Absorption when taken orally is high. Eating reduces the rate of absorption without affecting its extent. The maximum concentration in blood plasma is 3.5-6.5 mg/l. Binding to plasma proteins - 95%, to erythrocytes - 2%, to lipoproteins - 1%, to acidic alpha1-glycoprotein 1%. Metabolized in the liver by tissue monooxygenases. The main metabolite, 4-hydroxynimesulide (25%), has similar pharmacological activity, but due to a decrease in molecular size, it is able to quickly diffuse through the hydrophobic COX-2 channel to the active binding site of the methyl group. 4-hydroxynimesulide is a water-soluble compound, the elimination of which does not require glutathione and phase II metabolic conjugation reactions (including sulfation, glucuronidation). 4-hydroxynimesulide undergoes enterohepatic recirculation. The half-life of nimesulide is 1.56-4.95 hours, 4-hydroxynimesulide is 2.89-4.78 hours. 4-hydroxynimesulide is excreted by the kidneys (65%) and bile (35%).

INDICATIONS FOR USE Rheumatoid arthritis; osteoarthritis; arthritis of various etiologies; arthralgia; myalgia; postoperative and post-traumatic pain; bursitis; tendinitis; algodismenorrhea; toothache and headache. The drug is intended for symptomatic therapy, reduces pain and inflammation at the time of use, and does not affect the progression of the disease.

CONTRAINDICATIONS Hypersensitivity; complete or incomplete combination of bronchial asthma, recurrent nasal polyposis or paranasal sinuses and intolerance to acetylsalicylic acid and other NSAIDs (including a history); erosive and ulcerative lesions of the mucous membrane of the stomach and duodenum; active gastrointestinal bleeding; cerebrovascular or other bleeding; inflammatory bowel diseases (Crohn's disease, ulcerative colitis) in the acute phase; hemophilia and other bleeding disorders; decompensated chronic heart failure; liver failure or any active liver disease; history of hepatotoxic reactions when using nimesulide; alcoholism; addiction; severe chronic renal failure (CR

SIDE EFFECTS Allergic reactions: hypersensitivity reactions, anaphylactoid reactions. From the side of the central nervous system: dizziness, feeling of fear, nervousness, nightmares, headache, drowsiness, encephalopathy (Reye's syndrome). From the skin: itching, skin rash, increased sweating, erythema, dermatitis, erythema multiforme exudative, incl. Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome). From the urinary system: edema, dysuria, hematuria, urinary retention, hyperkalemia, renal failure, oliguria, interstitial nephritis. From the digestive system: diarrhea, nausea, vomiting, constipation, flatulence, gastritis, abdominal pain, stomatitis, tarry stools, gastrointestinal bleeding, ulcer and/or perforation of the stomach or duodenum, increased liver transaminases, hepatitis, fulminant hepatitis, jaundice, cholestasis. From the hematopoietic system: anemia, eosinophilia, thrombocytopenia, pancytopenia, purpura, prolongation of bleeding time. From the respiratory system: shortness of breath, exacerbation of bronchial asthma, bronchospasm. From the senses: blurred vision. From the cardiovascular system: arterial hypertension, tachycardia, hemorrhages, hot flashes. Other: general weakness, hypothermia.

INTERACTION There is evidence that nimesulide can reduce the bioavailability of furosemide and compete for binding to plasma proteins of fenofibrate, salicylic acid, and tolbutamides. May replace salicylic acid and furosemide (but not warfarin) in plasma proteins. In the presence of the drug, the free fractions of methotrexate may increase significantly. Taking the drug in therapeutic doses orally for a short period does not change the serum profile of digoxin in patients with mild heart failure. Plasma lithium concentrations increase when lithium and nonmex are taken concomitantly. It is not recommended to take Nemex at the same time as diuretics, which have a damaging effect on renal hemodynamics. May enhance the effect of cyclosporine on the kidneys. When using the drug simultaneously with corticosteroids and serotonin reuptake inhibitors, the risk of gastrointestinal bleeding increases.

METHOD OF APPLICATION AND DOSAGE The drug is taken orally. The contents of 1 sachet of granulate are dissolved in 80-100 ml of water. The recommended dose for adults and adolescents aged 12-18 years is 100 mg (1 sachet) 2 times a day after meals. The maximum daily dose for adults and adolescents aged 12-18 years is 200 mg.

OVERDOSE Symptoms: nausea, vomiting, drowsiness, apathy, gastrointestinal bleeding, increased blood pressure, acute renal failure, respiratory depression. Treatment: Symptomatic and supportive treatment is recommended. There is no specific antidote. Patients admitted to the hospital with symptoms of a drug overdose (within 4 hours after taking it or after taking a high dose) are recommended to lavage the stomach, take activated charcoal (adults - 60-100 mg) and/or an osmotic laxative. Regular monitoring of liver and kidney function is necessary. There is no data on the possibility of removing nimesulide using hemodialysis. Forced diuresis and hemodialysis are ineffective due to the high degree of binding of the drug to proteins.

SPECIAL INSTRUCTIONS To reduce the risk of side effects, it is necessary to use the drug in the minimum effective dose for the shortest duration. If the patient's condition does not improve, treatment should be stopped. It is necessary to stop taking the drug if the temperature rises or flu-like symptoms develop while taking it. If patients taking the drug develop symptoms indicating liver damage (for example, anorexia, nausea, vomiting, abdominal pain, fatigue, dark urine), or increased liver transaminases, the drug should be discontinued. Such patients are not recommended to be prescribed this drug in the future. Gastrointestinal bleeding or ulcer/perforation of the stomach or duodenum can develop at any time while using the drug and is not accompanied by clinically significant symptoms (including pain). If gastrointestinal bleeding or ulcers occur, or if renal function deteriorates, the drug should be discontinued. If the drug is used for more than 2 weeks, monitoring of liver function indicators is necessary. In patients with liver cirrhosis or renal failure, with hypoalbuminemia or hyperbilirubinemia, the binding of nimesulide is reduced. Elderly patients most often develop side effects when taking the drug, incl. gastrointestinal bleeding, perforation, dysfunction of the heart, kidneys and liver. Therefore, regular clinical monitoring of the patient’s condition is recommended. If, when using the drug, undesirable effects from the central nervous system and sensory organs occur, then patients should refrain from driving vehicles and engaging in activities that require increased concentration and speed of psychomotor reactions.

STORAGE CONDITIONS Store out of reach of children, in a dry place, protected from light, at a temperature not exceeding 25 C.

Comparison of side effects of Nimesil and Nemulex

Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.

Nimesil has more side effects than Nemulex. This implies that the frequency of their occurrence is low in Nimesil and low in Nemulex. Frequency of manifestation is an indicator of how many cases of an undesirable effect from treatment are possible and registered. The undesirable effect on the body, the strength of influence and the toxic effect of drugs are different: how quickly the body recovers after taking it and whether it recovers at all. When using Nimesil, the body's ability to recover faster is higher than that of Nemulex.

What is the difference?

Nemulex (instructions) is produced in granules for the preparation of a suspension by Romanian pharmaceuticals, and is produced in Russia. The sachets contain 2 g of granules; packed in 4, 10 or 30 pieces per pack.

Nimesil (instructions) is produced in Italy;
it is also produced in bags of granules (2 g each), 9 or 30 bags per pack. Comparative table of compositions

Nemulex and Nimesil contain nimesulide in the same amount. A comparison of drugs by auxiliary components shows that, although their difference is not significant, it exists. Various components are used as emulsifiers and a base for the powder. Perhaps because of this, there is some difference in the pharmacokinetics of the drugs:

1. Nemulex reaches its maximum concentration in the systemic circulation after 1.5–2.5 hours, and Nimesil slightly later, after 2–3 hours.
2. The half-life of Nemulex is 3–5 hours, Nimesil is 3–6 hours.
3. Nimesulide is excreted by the kidneys. In Nimesil, the amount of nimesulide metabolite excreted by the kidneys is 50%; Nemulex has 65%. The rest comes out with bile.

Changes in the concentration of the active drug substance in organs and tissues over time occur with slight differences.

The same components are added to give the granules flavor.

Nemulex granules are slightly larger than Nimesil, so they take longer to dissolve in water.

Comparison of granules

Conclusion

If you need to provide a quick anti-inflammatory and analgesic effect using a drug from the NSAID group, doctors often prescribe Nemulex or Nimesil, which contain the same active substance and have a similar effect. The release form is also the same: powders for dissolution in water. The differences in pharmacokinetics are very minor and do not affect the therapeutic effect of the drugs. Therefore, which of these drugs is better depends on the patient’s preferences and the availability of the drug in the pharmacy.

The cost of drugs can be

Comparison of ease of use of Nimesil and Nemulex

This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.

The ease of use of Nimesil is approximately the same as Nemulex. However, they are not convenient enough to use.

The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.

Last update date: 2020-12-13 10:32:08

How do they work?

When injury, infection, or degenerative changes occur in the spine and joints, tissue cells are damaged. When cell membranes are destroyed, phospholipids are released. They break down into fatty acids, among which is arachidonic acid. Further, under the action of the enzyme COX-2 (cyclooxygenase type 2), arachidonic acid is converted into biologically active substances, including prostaglandins. They organize the inflammatory response.

Inflammation is accompanied by swelling and pain. To relieve inflammation, you need to reduce prostaglandin production. Drugs from the NSAID group block (inhibit) the work of cyclooxygenase, and without it prostaglandin is not formed.

Nimesulide is a selective (selective) COX-2 inhibitor. That is, the active substance of both drugs acts selectively, affecting predominantly this type of enzyme. This is important because it is COX-2 that is triggered in response to damage, causing an inflammatory response. There is also the enzyme COX-1: it is formed normally in the body and is needed for the synthesis of those prostaglandins that are involved in normal physiological reactions. Non-selective inhibitors, such as acetylsalicylic acid or ketorolac, act on COX-1 and COX-2; at the same time, the number of side effects associated with suppression of prostaglandin production in the gastric mucosa and kidneys increases.

So, Nemulex and Nimesil have the same effect. It is based on reducing the synthesis of prostaglandins - the main participants in inflammation, pain and fever.