Aligarh Muslim University, Aligarh India

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Aligarh Muslim University, Aligarh (India)
A case Report on Nimesulide and its Relation with
Angina   M. Tariq Salman, S.Z. Rahman and R. A.
Khan   Department of Pharmacology Jawaharlal
Nehru Medical College A.M.U., Aligarh
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Introduction Nimuslide (4-nitro-2 phenoxymethane
sulphonamide) available in Indian market since
1997 No report indicates its superior efficacy as
anti pyretic or anti-inflammatory compared to
other NSAIDs Many life threatening ADRs with
Nimesulide reported e.g. Hepatotoxicity, GI
toxicity, potentiation of seizures, potentiaion
of colitis in passive cigarette smokers No
rationale for selecting Nimesulide as the first
drug of choice for fever, pain or inflammation
Not used in US, Finland, Spain, Portugal and
Isrel Never licensed for use in Canada, Britain
and Australia
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Case Report 65 yrs., female Average built, 152
cm., 45 kg Past History Diabetes mellitus
17 yrs. Angina pectoris 10
yrs. Hypertension (170/100 mm.) 10 yrs.
Maintained on - Tab. Daonil
(Glibenclamide) 5 mg OD Tab. Glyciphage
(Metformin) 0.5 G BD Tab. Disprin ¼ tab
OD Tab. Metoprolol 50 mg BD Isapghol husk
/ Tab. Bisacodyl 5 mg HS
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Patient developed Colles fracture (fall on out
stretched hand) Advised POP cast, finger
exercises Tab. Nimesulide 100 mg B.D. Patient
felt chest pain on 3rd day of Nimesulide Used
Tab. Sorbitrate (Isosorbide dinitrate) 5 mg
subling. SOS afterward 3 times a day as per
advise of treating physician But No improvement
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Examination Anxious tired Pallor, icterus,
cyanosis, lymphadenopathy, pedal edema
absent JVP not raised B.P. 170 / 100 mm. Hg
RR 20 / min. Pulse 84 / min., regular, good
volume with occasional extra beats Chest B/L
equal air entry, normal vesicular breathing No
added sounds Heart sounds - normal, no murmur
Abdomen No distended veins, Soft, no
organomegaly/palpable lump/fluid thrill or
shifting dullness, Bowel sounds - normal ECG
- Changes of Ischemia extrasystoles, no
infarction
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Management Diagnosis Diabetes mellitus,
Hypertension Unstable Angina Advice
Stop Nimesulide (suspected drug)
Tab. Brufen (Ibuprofen) 400 mg TDS
Old treatment continued (DM, HT, CAD) Result
Marked improvement in chest pain
No ADR (Complaint) with tab. Brufen
Rechallenge Not attempted
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Conclusion Adverse reaction (?) Coronary Artery
Insufficiency (CAI) Suspected drug
Nimesulide Evaluation Naranjo ADR
Probability Scale 3 Possible relationship
WHO Causality categories
Possible link CAI appears to be due to coronary
spasm not due to clot Withdrawl of Nimesulide
caused rapid relief from chest pain PG
inhibition may adversely affect CVS
homeostasis CAI seems to be related to inherent
properties of Nimesulide Not due to PG
inhibition as Ibuprofen didnt cause any symptom
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Coronary spasm may be due to imbalance between
COX-1 and COX-2 activity because of preferential
COX-2 inhibition Literature review suggests
cardiovascular events associated with other
selective COX-2 inhibitors (rofecoxib,
celecoxib) Commonly reported ADR Arrhythmias,
B.P., CHF, MI, CVA Further pharmacoepidemiological
research needed Quantify risk of angina
attributable to Nimesulide Identify patients
susceptible to its adverse CVS effects
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Thank you