The above study on nimesulide and meloxicam by D e M enezes et al. is read with great interest. The authors have justified the use of nimesulide in their study by stating that the drug was only used in the young and for a short period whilst hepatotoxicity appears usually in older patients and those who have been prescribed a long course of the drug. We would like to highlight that the consumption of nimesulide has been associated with fulminant hepatic failure which would lead to liver transplantation or the demise of the patient. Severe liver failure and encephalopathy had also occurred in the young who have taken limited course of nimesulide. Many countries, including Singapore and Ireland, have withdrawn this drug due to safety concerns.
While the benefits of nimesulide are evident, the drastic possibility of fulminant hepatic failure should not be overlooked. Although the risk for severe hepatic damage is low, rates are still higher in nimesulide compared to other NSAIDs and thus not encouraged for generalized use. The potential need of liver transplant or death makes it a controversial alternative, for use in control of post-operative trismus and swelling alone, in third molar removal. There are many other NSAIDs of proven safety profile and efficacy available in the market that can be used, rather than to risk patient safety.