| Drug (Brand name) Rx or OTC |
Usual Starting Dose |
Maximum Daily Dose |
Comments |
Cost/day* |
|
| Acetaminophen (Tylenol, others) OTC |
650 mg q4–6 hours |
4000 mg |
1000 mg is more effective than 650 mg in some patients |
<$1.00 |
| Aspirin (various) OTC |
650 mg q4–6 hours |
4000 mg |
May not be tolerated as well as some newer NSAIDs. |
<$1.00 |
| Diflunisal (Dolobid) Rx |
1000 mg x1 then 500 mg q12 hours |
1500 mg |
Derived from salicylic acid. Little antipyretic activity |
$2.80 |
| Nonacetylated Salicylates |
|
|
|
|
| Choline magnesium trisalicylate (Trilisate, others) Rx |
1500 mg x1 then 1000 mg q12 hours |
3000 mg |
Effective anti-inflammatory drugs, but less effective analgesics than aspirin. Have minimal antiplatelet effect and do not alter bleeding time. Aspirin cross-sensitivity less likely to occur. |
$3.00 |
| Salsalate (Disalcid, others) Rx |
1500 mg x1 then 1000 mg q12 hours |
3000 mg |
$2.50 |
| Other NSAIDs: Propionic Acid |
|
|
|
|
| Fenoprofen (Nalfon, others) Rx |
200 mg q4–6 hours |
1200 mg |
90% eliminated by the kidney. |
$3.40 |
| Flurbiprofen (Ansaid, others) Rx |
50 mg q8–12 hours |
300 mg |
At high doses, monitor closely for side effects. |
$1.00 |
| Ibuprofen (Rx: Motrin, others; OTC: Advil, Nuprin, others) |
400 mg q4–6 hours; OTC use: 200–400 mg q4–6 hours |
2400 mg; OTC 1200 mg |
200 mg  650 mg aspirin or APAP. 400 mg codeine/APAP |
$1.60 |
| Ketoprofen (Rx: Orudis, others; OTC: Actron, Orudis-KT) |
25–50 mg q6–8 hours; OTC use: 12.5–25 mg q4–6 hours |
300 mg; OTC 75 mg |
12.5 mg 200 mg ibuprofen; 50 mg superior to codeine/APAP |
$3.60 |
| Naproxen (Naprosyn, others) Rx |
500 mg x1 then 500 mg q12 hours or 250 mg q6–8 hours |
1250 mg first day then 1000 mg |
250 mg 650 mg aspirin with longer duration. 95% eliminated by the kidney. |
<$1.00 |
| Naproxen sodium (Rx: Anaprox, others; OTC: Aleve, others) |
550 mg x1 then 550 mg q12 hours or 275 mg q6–8 hours; OTC use: 220–440 mg x1 then 220 mg q8–12 hours |
1375 mg first day then 1100 mg; OTC 660 mg |
275 mg 650 mg aspirin with longer duration; OTC 440 mg 400 mg ibuprofen. 95% eliminated by the kidney. Naproxen sodium may have less dyspepsia than naproxen |
<$1.00 |
| Oxaprozin (Daypro) Rx |
600–1200 mg qd |
1800 mg |
Long serum half-life (42–50 hours) |
$1.66 |
| Other NSAIDs: Acetic Acid |
|
|
|
|
| Diclofenac potassium (Cataflam, others) Rx |
50 mg q8 hours or 75 mg bid |
150 mg |
May have less dyspepsia than the sodium salt. |
$1.10 |
| Diclofenac sodium (Voltaren, others; extended-release: Voltaren XR, others) Rx |
50 mg q8 hours or 75 mg bid; extended-release 100 mg qd |
150 mg; for Voltaren XR 100 mg |
Also available with misoprostol 200 µg (Arthrotec 50 mg, 75 mg) to decrease GI toxicity. |
$1.00 |
| Etodolac (Lodine, others; extended-release: Lodine XL) Rx |
200–400 mg q6–8 hours; Lodine XL 400 mg qd |
1200 mg; for Lodine XL 1000 mg |
200 mg 650 mg aspirin or APAP |
$2.70 |
| Indomethacin (Indocin, other; sustained release: Indocin SR, others) Rx |
25 mg q8–12 hours; sustained release 75 mg qd |
200 mg; for Indocin SR 75 mg bid |
Higher incidence of side effects. Also available in oral suspension. |
<$1.00 |
| Ketorolac (Toradol) |
10 mg q4–6 hours |
40 mg |
91% eliminated by the kidney. Use lower dose if >65 years or <50kg. Do not use >5 days |
$3.70 |
| Sulindac (Clinoril, others) Rx |
150–200 mg bid |
400 mg |
Have few cases reporting less drug interaction with lithium |
<$1.00 |
| Tolmetin (Tolectin, others;) Rx |
200–600 tid |
1800 mg |
100% eliminated by the kidney. |
$1.65 |
| Other NSAIDs: Fenamates |
|
|
|
|
| Meclofenamate (various) Rx |
50–100 mg q4–6 hours |
400 mg |
Comparable with aspirin. Commonly used for dysmenorrhea. Diarrhea is common |
$1.10 |
| Mefenamic acid (Ponstel) Rx |
500 mg x1 then 250 mg q6 hours |
1250 mg |
Effective in dysmenorrhea. Do not use >1 week |
$5.20 |
| Other NSAIDs: Naphthylalkanone |
|
|
|
|
| Nabumetone (Relafen) Rx |
1000 mg qd |
2000 mg |
Can be given either qd or bid |
$2.40 |
| Other NSAIDs: Oxicam |
|
|
|
|
| Meloxicam (Mobic) Rx |
7.5 mg qd |
15 mg |
Dose-dependent COX-2/COX-1 inhibition |
$2.00 |
| Piroxicam (Feldene, others) Rx |
20 mg qd |
20 mg |
Long serum half-life (50 hours). High incidence of side effects, especially in the elderly. |
<$1.00 |
| COX-2 Inhibitors |
|
|
|
|
| Celecoxib (Celebrex) Rx |
Acute pain: 400–600 mg first day, then 200 mg bid |
400 mg |
Contraindicated in sulfa allergy |
$4.70 |
| Valdecoxib (Bextra) Rx |
Dysmenorrhea: 20 mg bid |
40 mg |
Approved for osteoarthritis/rheumatoid arthritis and dysmenorrhea only |
$5.40 |
| Injectable NSAIDs |
|
|
|
|
| Ketorolac IV/IM (Toradol) Rx |
<65 years: 60 mg x1 then 30 mg q6 hours;  65 years: 30 mg x1 then 15 mg q6 hours |
120 mg |
91% eliminated by the kidney. Use lower dose if >65 or <50kg. Do not use >5 days |
$7.99 ea dose |
