The Kerala government and public health experts are struggling to come to terms with the alarming number of deaths that are being attributed to chikungunya.
Experts point at Nimesulide for chikungunya deaths
THIRUVANANTHAPURAM: Under a deluge of epidemics, the Kerala government and public health experts are struggling to come to terms with the alarming number of deaths that are being attributed to chikungunya. With experts continuing to insist that chikungunya is not a killer fever the needle of suspicion is turned on a controversial drug, nimesulide, which is sold over the counter (OTC).
While the official toll is just above hundred, an average of ten people are believed to have succumbed to the fever every day in the last one month.
"There is no scientific data to prove that chikungunya could be a cause of death. Still people die of fever in Kerala. It's a fact that many of the victims had chikungunya. It has come to our notice that many medical shops sell drugs like nimesulide for people who complain of joint pain. Hence the suspicion that nimesulide is contributing to the deaths," Dr Bharat Chandran, a cardiac specialist in Thiruvananthapuram, said.
Nimesulide, a non-steroid anti-inflammatory drug (NSAID), was in the dock in 2003 after the Delhi High Court ordered an enquiry into allegations that the drug was responsible for many child deaths around Delhi. The Drugs Controller General, who gave a clean chit to the drug, has banned many of its combinations. The drug, normally prescribed for arthritis, gives instant relief from joint pain, a common symptom of chikungunya.
"Nimesulide is definitely dangerous. It is found to have fatal reactions. It affects liver, kidneys and blood vessels. Misuse or overuse of the drug could be fatal," Dr Chandran said. Recommended oral use of nimesulide in adults and adolescents is 200 mg per day.
The doctor added that the drug has 5-10 percent risk ratio, which could assume fatal proportions when administered in an epidemic. The authorities, however, say that nimesulide has been approved by the Drugs Controller General.
"The fixed dose combination of nimesulide with paracetamol/muscle relaxants, is like other similar combinations of NSAIDs for short-time use and is considered rational, and may be permitted to continue to be marketed," the Drugs Controller of India's letter to the state counterpart dated October 22, 2003, reads.
"Drugs Technical Advisory Board, the apex body of drugs controllers in India, has conducted studies on nimesulide and recommended it for rational use. Our job is to enforce the rules. Those who oppose the use of the drug have not submitted any evidence to support their argument," State Drugs Controller (in charge) MP George said. The Drugs Controller's Office had banned the sale of nimesulide drops, fearing overuse in kids.
Though nimesulide is marketed in about 50 countries including India, the drug was never allowed in the United States, the United Kingdom, Canada and Australia. Irish Medicine Board on May 15 and Singapore Health Science Authority on June 15 suspended nimesulide with immediate use.
The drug is available in a variety of trademarks like Aulin, Ainex, Donulide, Edrigyl, Eskaflam, Heugan, Mesulid, Nexen, Nimed, Nimedex, Nisulid, Scaflam, Scaflan.
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