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Medical Forum / General / Dentistry / September 2006Nimesulide substitutes
Nimesulide is legal in my country. My wife has a tooth problem & the doctor has prescribed a capusle containing Nimesulide-100mg & Serratiopeptidase-15mg to be taken just once a day for 6 days. She has taken one dose till now. Just now, I found out that nimesulide is banned in many countries because of liver & kidney problems. I went back & talked to the doctor, but she said that there were controversies regarding Nimesulide but it isn't more dangerous than any other NSAIDs. However, I am still scared because my wife has taken ibuprofen, paracetamol, diflocenac etc in the last month. Is there any other safer tablet I can substitute for Nimesulide - my wife doesn't seem to have much fever. I think the doctor has given it mainly for reducing inflammation & pain. My wife has swollen cheeks from dental surgery few weeks back - she isn't visiting the dentist any more - this is from a regular physician. What do people recommend as a substitute & what dosage? I am travelling & in unfamiliar territory & hence do not have a choice of changing too many doctors now. Is diflocenac a good safe substitute for reducing dental inflamation - what should be equivalent dosage? Is there a diff between diflocenac sodium or diflocenac pottasium? Also what is Serratiopeptidase? > Nimesulide is legal in my country. > [quoted text clipped - 33 lines] > > Also what is Serratiopeptidase? What kind of tooth problem? Steve > What kind of tooth problem? Inflammation & pain more than 2 weeks after wistom tooth surgery. There is slight swellin of cheek remaining & pain in the throat & ear, because of some fluid apparently. Dear Anonymous, Nimesulide is legal in my home country also. I used it several times (myself included) and I believe it's one of the most effective painkillers. It should be safe for short courses, but of course all medication has side effects. If you want to play it completely safe, you cannot get anything safer than paracetamol, on the other hand it sucks for dental pain because it doesn't have any anti-inflammatory effect. I would stay away from diclofenac as it can be really heavy on the stomach. Ibuprofen at 400-60 mg is quite effectivfe for dental pain. Serropeptidase is an enzyme sometimes prescribed for arthritis sufferers. I haven't really heard of it being used as a common painkiller, but it does have anti-inflammatory action. Regards, George > Dear Anonymous, > > Nimesulide is legal in my home country also. I used it several times > (myself included) and I believe it's one of the most effective > painkillers. It should be safe for short courses, but of course all > medication has side effects. Are you a doctor, George? How many doys is short course & how much dosage per day. > If you want to play it completely safe, > you cannot get anything safer than paracetamol, on the other hand it > sucks for dental pain because it doesn't have any anti-inflammatory > effect. I would stay away from diclofenac as it can be really heavy on > the stomach. Ibuprofen at 400-60 mg is quite effectivfe for dental > pain. Will try that, because she has taken ibuprofen many times before. As per some reports, I read, Nimesulide carries slightly more risk than ibuprofen. > Serropeptidase is an enzyme sometimes prescribed for arthritis > sufferers. I haven't really heard of it being used as a common > painkiller, but it does have anti-inflammatory action. > Are you a doctor, George? > How many doys is short course & how much dosage per day. I'm a dentist. Short course is hard to define absolutely. It's generally any course of medication intended to treat an acute problem (eg pain after wisdom tooth removal) rather than a chronic problem (eg arthritis, when the patient is on painkillers for life). 100-200mg 2-3 times per day is a good theurapeutic dose. > > If you want to play it completely safe, > > you cannot get anything safer than paracetamol, on the other hand it [quoted text clipped - 6 lines] > As per some reports, I read, Nimesulide carries slightly more > risk than ibuprofen. Since I moved countries and nimesulide doesn't exist in the UK, I've been relying on ibuprofen and it's an ok drug. But in the end all NSAIDs will affect the kidneys to some extent. Take care, George >> Are you a doctor, George? >> How many doys is short course & how much dosage per day. [quoted text clipped - 5 lines] > patient is on painkillers for life). 100-200mg 2-3 times per day is a > good theurapeutic dose. She has taken some pain killers in the last 3 months (mostly Ibuprofen, Diclofenac & Paracetamol). Not very heavy dosages, but pain killers every few days, because of variety of unrelated problems - a sprain, then a headache, a sprain again & then this tooth. That's why I am a little worried. Anyway, she had a surgery for one lower wisdom tooth almost 2.5 weeks back - the dentists say she healed well, but the pain which started on day 5 never fully went away. After 2 weeks, she developed more problems - Mouth developed something which seemed like an oral thrush - She had a lot of pain while swallowing & ear ache. Pain mostly only in the night & a lot. Finally, I went to a General Physician instead of the dental surgeon. The GP said, the clot has formed, but there is still fluid & there is inflammation. The GP gave her Nimesulide (100 mg only once in the night), Betadine Gargle(Povidone Iodine 1%) thrice a day & some probiotics. Almost immediatelly, the improvement was radical. I am assuming, it's the Betadine which is the biggest factor, because she had some probiotics, though much cheaper ones even before she went to the Doc & she has also had the NSAID's before. How can the Gargle give so much improvement almost immediatelly? >>> If you want to play it completely safe, >>> you cannot get anything safer than paracetamol, on the other hand it [quoted text clipped - 10 lines] > been relying on ibuprofen and it's an ok drug. But in the end all > NSAIDs will affect the kidneys to some extent. > Almost immediatelly, the improvement was radical. > I am assuming, it's the Betadine which is the biggest factor, > because she had some probiotics, though much cheaper ones even > before she went to the Doc & she has also had the NSAID's before. > > How can the Gargle give so much improvement almost immediatelly? Beats me. It's probably the antibiotics rather than the mouthwash that did the job. In my experience physicians prescribe much more aggresssive antibiotic regimens than dentists (this is not always good - I had a couple of patients with toothaches and a busted stomach). Or maybe she was bound to get better even without any medication? Guess we'll never know! I'm glad your wife feels better now. Regards, George >> Almost immediatelly, the improvement was radical. >> I am assuming, it's the Betadine which is the biggest factor, [quoted text clipped - 4 lines] > > Beats me. It's probably the antibiotics She hasn't been prescribed any antibiotics after the first 10 days. > rather than the mouthwash that > did the job. In my experience physicians prescribe much more [quoted text clipped - 4 lines] > > I'm glad your wife feels better now. Not good again. Was very good for 1 day after the mouthwash/ nimesulide & probiotics. But some ear pain & teeth pain again today. Wits end now. > Dear Anonymous, > > If you want to play it completely safe, > you cannot get anything safer than paracetamol, on the other hand it > sucks for dental pain because it doesn't have any anti-inflammatory > effect. _____________________ Even paracetamol can easily produce problems. From the Wikipedia: "Paracetamol has a narrow therapeutic index - the therapeutic dose is close to the toxic dose. Additionally, paracetamol is contained in many preparations (both over-the-counter and prescription only medications). This means that, despite being one of the safest analgesics available at recommended doses, there is a large potential for overdose and toxicity. "Without timely treatment, paracetamol overdose can lead to liver failure and death within days. "Because of the wide over-the-counter availability of the drug, it is sometimes used in suicide attempts by those unaware of the prolonged timecourse and high morbidity associated with paracetamol-induced toxicity. "In the UK, sales of over-the-counter Paracetamol in pharmacies are restricted to packs of 32 tablets per customer per occasion (only 16 tablets in non-pharmacy stores). In Ireland, the limits are 24 and 12 tablets respectively." - dentaldoc > Even paracetamol can easily produce problems. I think easily is an overstatement here.Paracetamol has very few common side-effects and is the painkiller of choice for pregnant women - this alone should demonstrate its safety. If it has one problem is that the difference between the effective and the toxic dose is not great, so one should strictly adhere to his doctor's instructions when taking paracetamol. Overdose is certainly much more life-threatening than say aspirins. Regards, George >> Even paracetamol can easily produce problems. > [quoted text clipped - 5 lines] > instructions when taking paracetamol. > Overdose is certainly much more life-threatening than say aspirins. What is the toxic dose for paracetamol? Anyway, news about the wife is that the doc has increased nimesulide/serrawhatever to 100 mg/15 m twice a day & added a pseudopedrine - the pseduapedrine has helped some with the ear & she is feeling better. Doc says there seems to be no infection but if it's not ok by Monday he will give another course of antibiotic. |
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