ORIGINAL ARTICLES
Long-Term Tolerability of Nimesulide and Acetaminophen in Nonsteroidal Antiinflammatory Drug-Intolerant Patients

https://doi.org/10.1016/S1081-1206(10)63083-9Get rights and content

Background

Oral challenges are used to identify alternative nonsteroidal antiinflammatory drugs (NSAIDs) for patients who react adversely to drugs of this class, but challenge conditions often differ from those in which the drug will actually be used.

Objective

To determine whether the results of oral challenges with nimesulide or acetaminophen, using cumulative administration of a single therapeutic dose while the patient is in good health, can predict the response to multiple doses of the drug during future illness.

Methods

Follow-up interviews were conducted with 248 NSAID-intolerant subjects who had tolerated oral challenges with nimesulide and/or acetaminophen 1 to 3 years earlier. We analyzed the adverse reaction rate in light of the febrile/nonfebrile nature of the condition treated and the number of doses consumed.

Results

Nimesulide was tolerated by 115/122 (94.2%) of the patients who had tried it; acetaminophen by 71/75 (94.6%). A total of 8/159 (5%) patients had experienced reactions (seven urticarial and one asthmatic) to one or both drugs. Intolerance was unrelated to the nature of the condition treated or the number of doses administered, but all four patients who failed to tolerate acetaminophen and 3/7 of those who reacted to nimesulide had histories of chronic urticaria.

Conclusions

Oral challenges can reliably predict long-term NSAID tolerability in patients with previous adverse reactions to other drugs of this class, except for patients with chronic urticaria.

REFERENCES (32)

  • GA Faich

    Special report. Adverse-drug-reaction monitoring

    N Engl J Med

    (1986)
  • NS Irey

    Adverse drug reactions and death. A review of 827 cases

    JAMA

    (1976)
  • A Szczeklik

    Adverse reactions to aspirin and nonsteroidal anti-inflammatory drugs

    Ann Allergy

    (1987)
  • Hirschberg

    Mitteilung über einen fall von nebenwirkung des aspirin

    Dtsch Med Wochenschr

    (1902)
  • G Marone et al.

    Effects of arachidonic acid and metabolite on antigen-induced histamine release from human basophils in vitro

    J Immunol

    (1979)
  • A Szczeklik et al.

    Relationship of inhibition of prostaglandin biosynthesis by analgesics to asthma attacks in aspirin-sensitive patients

    Br Med J

    (1975)
  • Cited by (50)

    View all citing articles on Scopus
    View full text