LONG-TERM TOLERABILITY OF NIMESULIDE AND ACETAMINOPHEN IN NONSTEROIDAL ANTIINFLAMMATORY DRUG-INTOLERANT PATIENTS

Background: Oral challenges are used to identify alternative nonsteroi dal antiinflammatory drugs (NSAIDs) for patients who react adversely t o drugs of this class, but challenge conditions often differ from thos e in which the drug will actually be used. Objective: To determine whe ther 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 c hallenges with nimesulide and/or acetaminophen 1 to 3 years earlier. W e analyzed the adverse reaction rate in light of the febrile/nonfebril e nature of the condition treated and the number of doses consumed. Re sults: 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%) p atients 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 pa tients who failed to tolerate acetaminophen and 3/7 of those who react ed to nimesulide had histories of chronic urticaria. Conclusions: Oral challenges can reliably predict long-term NSAID tolerability in patie nts with previous adverse reactions to other drugs of this class, exce pt for patients with chronic urticaria.