The compatibility of simultaneous or alternate use of paracetamol and nimesil is the personal experience of the author, who almost died from such a combination.
I was a fool.
Because I didn’t ask in advance whether nimesil and paracetamol could be used together. Because of this, I almost went to another world.
There were several motives for committing terrible drug-induced violence against oneself.
- Firstly, I was in a hurry to get better; I developed some kind of terrible viral bronchitis, which could very well turn out to be a real coronavirus. I couldn’t get sick – I had a small child in my arms and an elderly man who required constant care.
- Secondly, we sell Nimesil in small bags individually, so the instructions had to be studied separately, and I was too lazy to do this. In addition, I have been using Nimesil for quite a long time - it is a fairly good remedy for headaches, or at the first signs of a cold. My throat started to hurt a little, I took the packet, and in the morning you are fine. At least, that's how it worked for me.
Paracetamol is also a proven remedy since childhood. I never thought that taking Nimesil and Paracetamol together would turn me into a zombie.
Composition and dosage forms
Paracetamol is a substance from the non-steroidal non-narcotic group of analgesics with a pronounced antipyretic effect. Available in several pharmaceutical forms:
- tablets for oral administration: contain 200 or 500 mg of the active ingredient, packaged in blisters or packaging without cells;
- capsules: hard shell 500 mg;
- syrup and suspension: sweetish-tasting liquid, contains 2.4% paracetamol (24 mg per 1 ml), packaged in glass bottles of 50 and 100 ml;
- 1.5 percent aqueous solution for infusion: colorless transparent liquid in ampoules of 5 ml;
- rectal suppositories: in a dosage of 50–500 mg, packaged in cell contour plates.
The first day
The cold just keeps on coming. Or maybe it's coronavirus? I sneeze loudly and quickly like a Kalashnikov machine gun, simultaneously making predictions that tomorrow the neighbors will shy away from me when they meet. The city has a special quarantine regime.
Temperature 37. Took 2 tablets of paracetamol at intervals of 4 hours. My head and throat hurt badly. Without a second thought, after 3-4 hours I took a packet of Nimesil, and at night another paracetamol tablet.
At night I felt sharply worse and developed a cough. I couldn’t sleep, except that I dozed for about 40 minutes at the table.
Mechanism of action
The anti-inflammatory effect of the drug is insignificant. Paracetamol mainly acts as an antipyretic and a mild analgesic. A derivative of phenacetin inhibits the production of compounds in the body that are responsible for sensitivity to pain - prostaglandins. At the same time, it affects the thermoregulation centers, reducing high body temperature.
The drug helps with pain syndromes of various origins:
- neuralgia;
- myalgia;
- joint pain;
- algomenorrhea;
- renal colic;
- toothache;
- febrile conditions accompanying acute respiratory viral infections and other infectious lesions.
Paracetamol is quickly absorbed into the blood, does not accumulate in the body, and does not irritate the mucous membranes of the gastrointestinal tract. Metabolized in the liver. It is completely eliminated 4–5 hours after administration. The drug has a symptomatic effect: it relieves acute signs of diseases for a certain time, without affecting their intensity and duration.
Instructions for Nimesil
Undesirable side effects can be minimized by using the minimum effective dose of the drug for the shortest possible short course.
Nimesil® 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, ulceration or perforation of an ulcer increases with increasing doses of NSAIDs in patients with a history of ulcers, especially those complicated by bleeding or perforation, and in elderly patients, so treatment should be started at the lowest possible dose. Patients receiving drugs that reduce blood clotting or suppress platelet aggregation also increase the risk of gastrointestinal bleeding. If gastrointestinal bleeding or ulcers occur in patients taking Nimesil®, treatment with the drug should be discontinued.
Since Nimesil® is partially excreted by the kidneys, its dosage for patients with impaired renal function should be reduced depending on the level of urination.
There is evidence of rare cases of liver reactions. If signs of liver damage appear (itching, yellowing of the skin, nausea, vomiting, abdominal pain, dark urine, increased activity of liver transaminases), you should stop taking the drug and consult your doctor.
Despite the rarity of visual impairment in patients taking nimesulide concomitantly with other NSAIDs, treatment should be stopped immediately. If any visual disturbance occurs, the patient should be examined by an ophthalmologist.
The drug can cause fluid retention in tissues, so patients with high blood pressure and cardiac dysfunction should use Nimesil® with extreme caution.
In patients with renal or heart failure, Nimesil® should be used with caution, as renal function may deteriorate. If the condition worsens, treatment with Nimesil® should be discontinued.
Clinical studies and epidemiological data suggest that NSAIDs, especially at 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.
The drug contains sucrose, this should be taken into account by patients suffering from diabetes mellitus (0.15–0.18 XE per 100 mg of the drug) and those on a low-calorie diet. Nimesil® is not recommended for use in patients with fructose intolerance, glucose-galactose malabsorption or sucrose-isomaltose deficiency.
If signs of a cold or acute respiratory viral infection occur during treatment with Nimesil®, the drug should be discontinued.
Nimesil® should not be used simultaneously with other NSAIDs.
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 particularly susceptible to adverse reactions to NSAIDs, incl. the risk of gastrointestinal bleeding and perforations that threaten the patient’s life, deterioration of kidney, liver and heart function. When taking Nimesil® for this category of patients, proper clinical monitoring is necessary.
There is evidence of the occurrence in rare cases of skin reactions (such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) to nimesulide as well as to other NSAIDs. At the first signs of a skin rash, damage to the mucous membranes or other signs of an allergic reaction, Nimesil® should be stopped.
The effect of the drug on the ability to drive vehicles and operate machinery.
The effect of the drug Nimesil® on the ability to drive vehicles and operate machinery has not been studied, therefore, during treatment with the drug Nimesil®, care should be taken when driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Precautionary measures
Carefully
Arterial hypertension, diabetes mellitus, compensated heart failure, coronary heart disease, cerebrovascular diseases, dyslipidemia/hyperlipidemia, peripheral arterial disease, hemorrhagic diathesis, smoking, creatinine clearance 30-60 ml/min.
History of ulcerative lesions of the gastrointestinal tract; history of infection caused by Helicobacter pylori; elderly age; long-term previous use of NSAIDs; severe somatic diseases.
Concomitant use with the following drugs: anticoagulants (for example, warfarin), antiplatelet agents (for example, acetylsalicylic acid, clopidogrel), oral glucocorticosteroids (for example, prednisolone), selective serotonin reuptake inhibitors (for example, citalopram, fluoxetine, paroxetine, sertraline).
Second day
The cough is becoming more intense. I take mucaltin, lozenges for a sore throat, and also irrigate my cold throat with the drug “Inhalipt”. I took a paracetamol tablet in the morning and at lunchtime.
I would like to lie down, but I need to take pills to my sick grandmother. Without contacting anyone, I jump into the car and drive, feeling like I’m in a fog.
The sore throat went away, but in the evening I had a severe headache again. The cough becomes very intense, and heaviness appears in the chest. I drink a packet of Nimesil again, hoping that the syndrome will be relieved. This helps for a while.
I can't sleep at night. I'm coughing. Whistling breathing. Bronchitis. I suffer, I try sounds of nature, try different positions, but I can’t fall asleep. The pulse on the smart watch shows about 100 beats per minute.
Temperature. The second sleepless night and fever are cruel.
I'm squeezed like a lemon.
Acute toothache in pregnant women
Due to increased levels of acidity in the mouth and lack of nutrients, teeth are more susceptible to decay during pregnancy and lactation. But during such periods, when acute pain appears, it is extremely undesirable to take medications due to their toxic effects on the body of the fetus or child, including developmental defects. An urgent visit to a doctor is necessary to make a diagnosis and choose treatment tactics. To alleviate the painful condition, it is possible to use traditional methods of treatment.
IMPORTANT! St. John's wort herb should not be used due to its negative effect on the fetus and child!
Acute toothache in children
The cause of acute toothache in a child can be simply a reaction to sweet, sour, cold and hot foods, or pulpitis or caries. An urgent visit to a doctor is necessary. To alleviate the condition, you can give your child Paracetamol or Ibuprofen in a dosage corresponding to the age norm, or children's Nurofen. Taking other painkillers is highly undesirable due to the large number of side effects.
Acute toothache worsens at night
Treatment of acute toothache at home
It is undesirable to self-medicate and use traditional medicine methods to relieve even severe tooth pain, since they do more harm than good. The use of some techniques may cause complications. A striking example is the appearance of an abscess and phlegmon after the use of heat (“warming up” a sore spot) during an inflammatory process.
The best way out of the situation is to visit the dentist as soon as possible; as a last resort, take medication to relieve pain and then consult a doctor.
Some traditional methods that can be used:
- applying a cold compress to the cheek or a piece of ice to the sore tooth for a short time will somewhat reduce the pain (cold will constrict the blood vessels and slow down the rate of spread of inflammation). Be careful: do not allow cold to come into contact with the skin, especially for a long time, to avoid frostbite;
- rinsing with a solution of 3% hydrogen peroxide and water effectively fights pathogenic microflora and helps remove plaque, softening it. For the same purpose, rinsing with a solution of chlorhexidine and miramistin is effective;
- An alcohol compress on the tooth cavity somewhat reduces pain for a short time due to its analgesic effect and disinfection. Place a piece of cotton wool soaked in alcohol or vodka inside the carious cavity;
- rinsing with a solution of soda (1 tsp per glass of water) and/or salt (1 tsp per glass of water) reduces swelling and nerve compression by reducing osmotic pressure in the tissues. Effective for discomfort caused by eating. Rinse for 5-10 minutes;
- rinsing with infusion of chamomile and sage reduces inflammation and swelling of the gums. 2 tbsp. pour 1 cup of boiling water over the herbs and leave for 15-20 minutes. Rinse with warm infusion 4-6 times a day.
Is it possible to tolerate toothache?
In case of short-term acute pain caused by sour or sweet food getting into the caries cavity, which goes away after rinsing and the irritant stops acting, a visit to the dentist can be postponed for a couple of days. This pain is typical for shallow caries and enamel erosion.
But it happens that the tooth hurts, and then it stops and the person does not seek medical help. In fact, the disease that provoked the appearance of unpleasant sensations becomes chronic, and the cessation of pain may indicate the death of the pulp, the transition of the pathological process beyond the boundaries of the tooth (asymptomatic process). Often the tooth subsequently has to be removed, and the inflammatory process spreads to other organs and tissues; in complex and advanced situations, conservative treatment is ineffective and surgical intervention is no longer possible.
Temporary relief of acute toothache is not a sign of recovery
Complications
By postponing an appointment with the dentist, you risk getting serious complications instead of one bad tooth:
- pulp necrosis – death and destruction of connective tissue cells filling the tooth cavity;
- periodontitis – after the death of the pulp, the process spreads beyond the tooth and inflammation of the tissues of the pulp chamber begins;
- abscess - a purulent process of the soft tissues of the oral cavity or the body of the jaw;
- phlegmon is a diffuse purulent process that spreads through the intercellular spaces of the soft tissues of the face, neck and chest.
When exactly do you need to see a doctor urgently?
A dental consultation is required if you have:
- pain does not go away within 24 hours (within 2 days if the pain appeared after removal, implantation, or surgical procedures);
- if pain of any intensity in the jaw is accompanied by fever and/or general malaise;
- an independent examination of the oral cavity revealed a gingival hood (redness, swelling of the gums) or purulent inflammation;
- the intensity of the pain syndrome gradually increases;
- bleeding gums and soreness.
Darkening of the tooth indicates destruction of its structure from the inside. Only a specialist can judge the true extent of the damage. The dental clinic “Yulistom” accepts patients seven days a week by appointment, and in case of acute toothache, emergency care is provided on the day of the call, we will accept you without a queue.
