Q: Is there any substitute for the tablets Nimusilide as it is feared that it may affect liver. My mother is taking the drug regularly for her acute osteoporosis in her backbone. Please suggest the substitute medicine. She is nearing seventy years of age.

A:Nimesulide (available in India as Nise, Nimulid, Nimind, Nimegesic, Emesulide, Nelsid, Nimbid, Nimotas, Nimuflex, Nixia, Pronim, etc.) has been banned in many countries including Finland, Spain, Turkey and more recently in Bangladesh due to its potentially toxic and sometimes fatal effect on liver. Elderly people and children are more susceptible to its serious side-effects. Nimesulide is not approved for use in United States, Britain, Canada, Australia and a large number of other western countries. Acute osteoporosis (unlike osteoarthritis) needs to be treated because pain-killers are not going to solve the problem. They merely reduce the sensation of pain. For symptomatic relief of pain it is advisable to take simple analgesics such as paracetamol (sold under the trade names of Crocin, Calpol, Pyrexon). If they do not give relief, one can shift to a combination of paracetamol with ibuprofen (brand names: Duoflam, Reducin-A). Only when all these agents do not give adequate relief, should one try a Non-Steroidal Anti-Inflammatory Agent (NSAID) such as diclofenac (sold under the trade name of Dicloran, Doflex etc). In other words, there should be a step-up approach starting with least potent agent to a higher potency drug.