Drug | Usual analgesic dose (oral) | Maximum dose per day | Selected characteristics |
Nonselective NSAIDs* | |||
Acetic acids | |||
Diclofenac¶ | 50 mg every 8 to 12 hours | 150 mg For rheumatoid arthritis, labeling in United States permits up to 200 mg Approved maximum in Canada is 100 mg |
|
Etodolac | 200 to 400 mg every 6 to 8 hours | 1000 mg |
|
Indomethacin | 25 to 50 mg every 8 to 12 hours | 150 mg For rheumatologic conditions, labeling in United States permits up to 200 mg |
|
Sulindac | 150 to 200 mg every 12 hours | 400 mg |
|
Fenamates | |||
Meclofenamate (meclofenamic acid) | 50 mg every 4 to 6 hours or 100 mg 3 times daily up to 6 days for dysmenorrhea | 400 mg |
|
Mefenamic acid | 250 mg every 6 hours or 500 mg 3 times daily | 1000 mg For dysmenorrhea, up to 1500 mg |
|
Nonacidic | |||
Nabumetone | 1000 mg once to twice daily | 2000 mg |
|
Oxicams | |||
MeloxicamΔ | 7.5 to 15 mg once daily (conventional tablet, oral suspension) | 15 mg (conventional tablet, oral suspension) |
|
5 to 10 mg once daily (capsule) | 10 mg (capsule) | ||
Piroxicam | 10 to 20 mg once daily | 20 mg |
|
Propionic acids | |||
Fenoprofen | 200 mg every 4 to 6 hours or 400 to 600 mg every 6 to 8 hours | 3200 mg |
|
Flurbiprofen | 50 mg every 6 hours or 100 mg every 8 to 12 hours | 300 mg | |
IbuprofenΔ | 400 mg every 4 to 6 hours or 600 to 800 mg every 6 to 8 hours | 3200 mg (acute), 2400 mg (chronic) |
|
Ketoprofen | 50 mg every 6 hours or 75 mg every 8 hours | 300 mg | |
Naproxen | Base: 250 to 500 mg every 12 hours or 250 mg every 6 to 8 hours | Base: 1250 mg (acute); 1000 mg (chronic); may increase to 1500 mg during a disease flare |
|
Naproxen sodium: 275 to 550 mg every 12 hours or 275 mg every 6 to 8 hours | Naproxen sodium: 1375 mg (acute); 1100 mg (chronic); may increase to 1650 mg during a disease flare | ||
Oxaprozin | 1200 mg once daily | 1200 mg or 1800 mg depending on body weight (refer to UpToDate Lexidrug monograph) |
|
Salicylate (acetylated) | |||
Aspirin | 325 to 1000 mg every 4 to 6 hours | 4000 mg |
|
Salicylates (nonacetylated) | |||
Diflunisal | 500 mg every 8 to 12 hours | 1500 mg |
|
Magnesium salicylate | 1160 mg every 6 hours | 4640 mg | |
Salsalate | 1000 mg every 8 to 12 hours or 1500 mg every 12 hours | 3000 mg | |
COX-2 selective NSAIDs | |||
Celecoxib | 200 mg daily or 100 mg every 12 hours | 400 mg |
|
Etoricoxib (not available in the United States) | 30 to 60 mg once daily | 60 mg (chronic pain and inflammation) 120 mg (acute pain for up to 8 days) |
|
Non-NSAID analgesic | |||
Acetaminophen (paracetamol)Δ | 325 to 650 mg every 4 to 6 hours or 1000 mg every 6 hours up to 3 times daily | 3000 mg 4000 mg in selected, medically supervised patients Avoid or use a lower total daily dose (maximum 2000 mg) in older adults, patients at increased risk for hepatotoxicity (eg, regular alcohol use, malnourished), or patients with organ dysfunction |
|
NSAIDs are useful for treatment of acute and chronic painful and inflammatory conditions and may reduce opioid requirements. The indications for use of NSAIDs in specific disorders, adverse effects, and toxicities are presented in the relevant UpToDate topics including reviews of NSAID-associated adverse cardiovascular effects, gastroduodenal toxicity, acute kidney injury, etc.
UpToDate contributors generally avoid use of NSAIDs, or use them with particular caution and at reduced doses, in older adults and patients (regardless of age) with existing or increased risk for cardiovascular, GI, or kidney disease. Concurrent gastroprotection (eg, a proton pump inhibitor) may be warranted. For information on gastroprotective strategies, including use of selective COX-2 inhibitors and other options, refer to the UpToDate topic reviews of COX-2 selective NSAIDs and NSAIDs (including aspirin) and primary prevention of gastroduodenal toxicity.
Short- to moderate-acting NSAIDs (eg, naproxen, ibuprofen) are preferred for most patients. Use the lowest effective dose for the shortest duration of time. For chronic inflammatory conditions, a trial of ≥2 weeks is advised to assess full efficacy. For patients who experience an inadequate response to an NSAID of 1 class, it is reasonable to substitute an NSAID of another class.
Dosing in this table is for immediate-release preparations in patients with normal organ (eg, kidney) function. For treatment of acute pain, a loading dose of some NSAIDs may be used; refer to UpToDate Lexidrug monographs.
Drug interactions may be determined by use of the drug interactions program included within UpToDate.AERD: aspirin-exacerbated respiratory disease; CNS: central nervous system; COX-2: cyclooxygenase, isoform 2; GI: gastrointestinal; OTC: over the counter.
* Nonselective NSAIDs reversibly inhibit platelet function, with some exceptions noted above.
¶ Also available as a topical agent.
Δ Also available for parenteral use.Data from: UpToDate Lexidrug. More information available at https://online.lexi.com/.
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