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Home Books Principles & Practice of Pain Medicine, 2e

Chapter 61. Nonsteroidal Anti-Inflammatory Drugs

Lee S. Simon

Nonsteroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory, analgesic, and antipyretic agents. They are used to reduce pain, decrease stiffness, and improve function in patients with osteoarthritis (OA), rheumatoid arthritis (RA), and other forms of arthritis. They are also used for the treatment of pain including headache, dysmenorrhea, and postoperative pain.1–3 Whether their effectiveness is solely due to their anti-inflammatory or analgesic effects or other possible mechanisms is not known.4 There are at least 20 different NSAIDs currently available in the United States (Table 61-1). In addition, cyclooxygenase-2 selective inhibitors (COX-2 inhibitors, e.g., celecoxib, rofecoxib), with similar efficacy but significantly decreased gastrointestinal (GI) and platelet effects, are available.5–8

Table 61-1 Nonsteroidal Anti-Inflammatory Medications
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Table 61-1 Nonsteroidal Anti-Inflammatory Medications
MedicationProprietary (Trade) NameUsual Daily Dose (Adults)Serum Half-Life HoursApproved Use*
Nonselective NSAIDS
Carboxylic Acid Derivatives
Aspirin (acetylsalicylic acid)Multiple2.4–6 g/24h in 4–5 divided doses4–15RA, OA, AS, JCA, ST
Buffered aspirinMultipleSameSameSame
Enteric-coated salicylatesMultipleSameSameSame
SalsalateDisalcid1.5–3.0 g/24h bidSameSame
DiflunisalDolobid0.5–1.5 g/24h bid7–15Same
Choline magnesium trisalicylate†Trilisate1.5–3 g/24h bid-tidRA, OA, pain, JCA
Proponic Acid Derivatives
Ibuprofen†Motrin, Rufen, OTCOTC: 200–400 mg qid2RA, OA, JCA
Rx: 400, 600, 800, maximum: 3200 mg
Naproxen†Naprolan, Anaprox, Naprosyn EC250, 375, 500 mg bid13RA, OA, JCA, ST
FenoprofenNalfon300–600 mg qid3RA, OA
KetoprofenOrudis75 mg tid2RA, OA
FlurbiprofenAnsaid100 mg bid-tid3–9RA, OA
OxaprozinDaypro600–1800 mg/24h40–50RA, OA, pain
TolmetinTolectin400, 600, 800 mg; 800–2400 mg1RA, OA, JCA
Acetic Acid Derivatives
Indomethacin†Indocin, Indocin SR25–50 mg tid or qid3–11RA, OA, G, AS
Indocin SRSR: 75 mg bid; rarely > 150 mg/24h
TolmetinSee above1
SulindacClinoril150, 200 mg bid to tid16RA, OA, AS, ST, G
DiclofenacVoltaren, Arthrotec50 tid, 75 mg bid1–2RA, OA, AS
EtodolacLodine200–300 mg.bid-tid-qid maximum: 1200 mg2–4OA, pain
KetorolacToradol20–40 mg2Pain
Fenamates
MeclofenamateMeclomen50–100 mg tid-qid2–3RA, OA
Mefenamic acidPonstel250 mg qid2RA, OA
Enolic Acid Derivatives
PiroxicamFeldene10, 20 mg q day30–86RA, OA
PhenylbutazoneButazolidin100 mg tid up to 600 mg/24h40–80Gout, AS
MeloxicamMobic7.5–15 mg20OA
Naphthylkanones
NabumetoneRelafen500 mg bid up to 1500 mg/24h19–30RA, OA
COX-2 Selective NSAIDS
CelecoxibCelebrex100, 200 mg bid, 200 mg qd11RA, OA
OA
Rofecoxib†VIOXX12.5, 25 mg qd17OA
50 mg qdAcute pain

*FDA approved.

RA = rheumatoid arthritis; OA = osteoarthritis; AS = ankylosing spondylitis; G = gout; JCA = juvenile chronic arthritis; ST = soft tissue injury.

†Available in liquid form.

NSAIDs are one of the most commonly used classes ...

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