Q: I am 38 years old and suffering from ankylosing spondylitis for the last 15 years. Due to pain in the spine and hip joints I have to take NSAIDs daily. I often take nimesulide 100-200 mg and sometimes take etorycoxib(60-90 mg) and valdecoxib(10-20 mg). Since I take them regularly. Sometimes one type for 2 months and the next month another one for 2/3 months. I am worried about the side effects like gastric ulcer, kidney damage, also heart attacks. But I am confused because sometimes I hear that this medicine is better than another one and the next month I hear that the other is better. I take antacids with the NSAID. Sometimes I take famotidine for 2 weeks or Ranitidine for safety. Please suggest me which drug is better for long term use and how do I plan my intake for long term use?

A:Nimesulide was discovered in America but is not permitted to be sold there. It is also not permitted to be sold in Britain, Australia, Canada and over 150 other countries. In Finland, two patients have died due to liver failure caused by Nimesulide. Such discarded and dangerous drugs are sold in India due to lax rules and corrupt practices in prescription generation. A patient like you who has already suffered from jaundice can take Nimesulide only at grave risk. Both Rofecoxib and Valdecoxib have been banned in western countries due to adverse effects on heart. Etoricoxib is not yet cleared for sale in the United States. There is now consensus that older, conventional NSAIDs such as diclofenac that have been in use for decades are safer. I think that you should take a diclofenac with slow release long acting paracetamol product such as Fenaplus. To avoid gastro-intestinal irritation while on long term use you can concurrently take omeprazole such as Ocid 20 mg along with Fenaplus.