Friday, March 13, 2009

A case report on nimesulide and its relation with angina

Salman, M. T.Rahman, S. Z. and Khan, R. A. (2003A case report on nimesulide and its relation with angina. In: International Workshop on Adverse Drug-Reaction Monitoring & 3rd Annual Conference Society of Pharmacovigilance, India11-13 Dec 2003Agra, India.

Even though there might be several cases of NSAIDs induced angina that are not been reported, we could find a definite case of Nimesulide induced angina in Aligarh. A 65 year old female patient was a known case of diabetes mellitis for 17 years and angina pectoris for 10 years for which she was maintained on drugs. She sustained injury after falling down and was found to have Colle’s fracture for which she was advised POP and Tab Nimesulide twice daily alongwith ongoing treatment. On 3rd day, she felt chest pain (angina) for which she used Tab sorbitrate 3-4 times a day but no improvement was noticed. Then she consulted her family physician. On examination, no abnormality was found except that ECG showed changes of ischemia and extra systoles. She was diagnosed as a case of Unstable Angina and advised to stop the suspected drug Nimesulide but continue to take previous treatment. She then showed improvement in angina. As an alternative Tab Brufen (Ibuprofen) 400 mg thrice daily was advised. The patient afterwards complained no problem. In this case, the unstable angina appears to be due to coronary spasm and not due to clot because on withdrawing the suspected drug there was rapid relief. The spasm seems to be related to inherent properties of Nimesulide and not due to prostaglandin inhibition as Brufen did not cause the same symptoms. Alternatively, it may be due to an imbalance between COX 1 and COX 2 activities due to preferencial COX 2 inhibition. Moreover, the inhibition of prostaglandin synthesis may adversely affect cardiovascular homeostasis.

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