| Drug | Labeled Indications | Dosing | Dose Adjustments for Special Populations | |
|---|---|---|---|---|
| Oral drugs | Acetaminophen | Fever; pain | Pain: 650–1,000 mg up to 4 g/day | Pediatric patients (peds): 10–15 mg/kg/dose up to 5 doses/day |
| Aspirin | Arthritis; cerebrovascular accident; transient ischemia; coronary artery bypass graft; disorder of joint of spine; fever; juvenile rheumatoid arthritis; myocardial infarction; prophylaxis; osteoarthritis; pain; percutaneous coronary intervention; pleurisy; systemic lupus erythematosus; rheumatoid arthritis; stable angina, chronic; unstable angina | OA and RA: 3g/day divided into 4 to 6 doses | Peds: 40–130 mg/kg/day, depending upon condition | |
| Celecoxib (Celebrex) | Ankylosing spondylitis; familial adenomatous polyposis; syndrome osteoarthritis; pain; primary dysmenorrhea; rheumatoid arthritis; juvenile rheumatoid arthritis | OA: 200 mg/day; RA: 200–400 mg/day | Renal impairment: reduce dose by 50%; elderly patients weighing < 50 kg: initiate at lowest dose | |
| Diclofenac | Ankylosing spondylitis; extraction of cataract; inflammatory disorder of eye; light intolerance; pain in eye; refractive keratoplasty; osteoarthritis; pain; rheumatoid arthritis | OA: delayed release, 100–150 mg/day in 2 to 3 doses; extended release, 100–200 mg/day; RA: delayed release, 100–200 mg/day in 3 to 4 doses; extended release, 75–225 mg/day | Renal impairment: initiate with lowest recommended dose, then monitor closely | |
| Diflunisal | Osteoarthritis; pain, mild to moderate; rheumatoid arthritis | OA and RA: 500–1000 mg/day in 2 equally divided doses; maximum dose, 1,500 mg/day | Renal impairment and elderly: initiate with lowest dose possible, then monitor closely | |
| Etodolac | Juvenile rheumatoid arthritis; osteoarthritis; pain, acute; rheumatoid arthritis | OA and RA initial treatment: immediate release, 300 mg 2–3×/day or 400–500 mg 2×/day; OA and RA maintenance: immediate release, 600–1,000 mg/day 2–4×/day with a maximum dose of 1,200 mg/day; extended release, 400–1,000 mg/day | Juvenile rheumatoid arthritis weighing 20 to 30 kg: extended release, 400 mg 1×/day; JRA weighing 31 to 45 kg: extended release, 600 mg 1×/day; JRA weighing 46 to 60 kg: extended release, 800 mg 1×/day; JRA, extended release, weighing >60 kg: extended release, 1,000 mg 1×/day | |
| Fenoprofen | Migraine; osteoarthritis; pain, mild to moderate; rheumatoid arthritis | OA and RA: 300–600 mg, 3 to 4×/day; maximum daily dose, 3,200 mg | Elderly: smaller dose recommended, 300 mg 3×/day; renal impairment: no dose adjustment necessary | |
| Flurbiprofen | Constricted pupil, intraoperative prophylaxis; osteoarthritis; rheumatoid arthritis | OA and RA: 200–300 mg/day in 2 to 4 divided doses; maximum dose, 300 mg/day | Renal impairment, liver disease, and geriatric patients: initiate with lowest recommended dose, then monitor closely | |
| Ibuprofen | Fever; juvenile rheumatoid arthritis; osteoarthritis; pain, minor; pain, mild to moderate; primary dysmenorrhea; rheumatoid arthritis | OA and RA: 1200–3200 mg/day in 3 to 4 divided doses | Renal impairment: initiate with lowest recommended dose, then monitor closely | |
| Indomethacin | Ankylosing spondylitis; bursitis of shoulder–pain, acute; gouty arthritis, acute; osteoarthritis; tendonitis of shoulder—pain, acute; patent ductus arteriosus; rheumatoid arthritis | OA and RA: immediate release, 25–50 mg 2 to 3×/day or a maximum dose of 100 mg 2×/day; sustained release product, 75 mg 1 to 2×/day | Severe renal impairment (CrCL < 15 mL/min), liver disease (Child-Pugh Class III), elderly, and peds: initiate with lowest recommended dose, then monitor closely | |
| Ketoprofen | Fever; osteoarthritis; pain, minor; pain, mild to moderate; rheumatoid arthritis | OA and RA: immediate release, 150–300 mg/day in 3 to 4 divided doses; extended release, 100–200 mg 1×/day | Mild renal impairment (CrCL > 25 mL/min): maximum, 150 mg/day; moderate renal impairment (CrCL < 25 mL/min): maximum, 100 mg/day; geriatric (>75 years): initiate with doses of 75–150 mg/day; liver disease and serum albumin < 3.5 g/dL: maximum initial dose, 100 mg/day | |
| Ketorolac | Extraction of cataract— inflammatory disorder of eye; light intolerance—pain in eye—refractive keratoplasty; pain, acute— moderate to severe; seasonal allergic conjunctivitis | Pain, acute — moderate to severe (<65 years of age): initiate with 20 mg, followed by 10 mg, every 4 to 6 hours; maximum, 40 mg/day | Peds: lowest effective dose for shortest possible duration; >65 years of age or weight <50 kg or renal impairment: 10 mg every 4 to 6 hours as needed; maximum, 40 mg/day | |
| Meclofenamate sodium | Dysmenorrhea; menorrhagia; osteoarthritis; pain; rheumatoid arthritis | OA and RA: 200– 400 mg/day in 3 to 4 equally divided doses; maximum, 400 mg/day | Elderly and renal impairment: lowest effective dose for shortest possible duration | |
| Mefenamic acid | Dysmenorrhea; pain | Pain (children >14 years and adults): initiate with 500 mg, followed by 250 mg every 6 hours; use beyond 1 week is not recommended | Renal impairment: do not use; peds: use not studied | |
| Meloxicam | Juvenile rheumatoid arthritis, polyarticular– pauciarticular juvenile rheumatoid arthritis; osteoarthritis; rheumatoid arthritis | OA and RA: 7.5 mg 1×/day; maximum, 15 mg 1×/day | Elderly, renal impairment, liver disease (Child-Pugh Class III): initiate with lowest recommended dose, then monitor closely | |
| Nabumetone | Osteoarthritis; rheumatoid arthritis | OA and RA: initial treatment, 1,000 mg/day in a single dose; maintenance, 1,000–2,000 mg 1×/day or in 2 equally divided doses | Renal impairment and liver disease: monitor closely and reduce dose if necessary | |
| Naproxen | Ankylosing spondylitis; bursitis; fever; gout, acute; juvenile rheumatoid arthritis; osteoarthritis; pain; pain, minor; primary dysmenorrhea; rheumatoid arthritis; tendinitis | OA and RA: 250–500 mg 2×/day, maximum, 1,500 mg/day ≤ 6 months; over-the-counter, ≤10 days | JRA: 10 mg/kg/day in 2 equally divided doses; renal impairment and liver disease: monitor closely and reduce dose if necessary | |
| Oxaprozin | Juvenile rheumatoid arthritis; osteoarthritis; rheumatoid arthritis | OA and RA: 1,200 mg 1×/day; maximum, 1,800 mg/day or 26 mg/kg/day | JRA, 22 to 31 kg: 600 mg 1×/day; JRA, 32 to 54 kg: 900 mg 1×/day; JRA, >55 kg: 1,200 mg 1×/day; renal impairment or weight <50 kg: initiate with 600 mg 1×/day, then monitor closely | |
| Piroxicam | Osteoarthritis; rheumatoid arthritis | OA and RA: 20 mg/day 1×/day or 2 equally divided doses | Renal impairment or liver disease: monitor closely and reduce dose if necessary | |
| Salsalate | Inflammatory disorder of musculoskeletal system, rheumatic; osteoarthritis; rheumatoid arthritis | OA and RA: 3,000 mg/day in 2 to 3 equally divided doses | Elderly: lower doses may be required; peds: safety and efficacy not established | |
| Sulindac | Bursitis of shoulder—pain, acute; gouty arthritis, acute; osteoarthritis; tendonitis of shoulder— pain, acute; rheumatoid arthritis | OA and RA: 150 mg 2×/day; maximum 400 mg/day | Renal impairment and liver disease: monitor closely and reduce dose if necessary | |
| Tolmetin | Juvenile rheumatoid arthritis; osteoarthritis; rheumatoid arthritis | OA and RA: initial treatment, 400 mg 3×/day for 1 to 2 weeks; maintenance, 200–600 mg 3×/day; maximum, 1,800 mg/day | Renal impairment: initiate with lowest recommended dose, then monitor closely and reduce dose if necessary; juvenile rheumatoid arthritis, ≥2 years, initial treatment: 20 mg/kg/day divided into 3 to 4 doses; juvenile rheumatoid arthritis, ≥ 2 years, maintenance: 15–30 mg/kg/day divided into 3 to 4 doses | |
| Topical drugs | Diclofenac epolamine (Flector; one patch equals 180 mg in an aqueous base) | Acute pain from minor strains, sprains, and contusions | 1 patch to most painful area 2×/day | Patients with fluid retention or heart failure: use with caution |
| Diclofenac sodium (Voltaren; 1% gel) | Osteoarthritis of joints amenable to topical treatment, such as knees and hands | Maximum, 32 g/day, over all affected joints; maximum, 16 g/day, to any single joint of lower extremities; maximum, 8 g/day to any single joint of upper extremities | Patients with fluid retention or heart failure: use with caution | |
| Diclofenac sodium (Pennsaid) | Osteoarthritis of knee | 40 drops on each painful knee, 4×/day | Patients with fluid retention or heart failure: use with caution | |
| Capsaicin | Arthritis; diabetic neuropathy; postherpetic neuralgia | Arthritis: apply thin film 3 to 5×/day | Peds (>2 years): apply thin film 3 to 4×/day | |
From: Introduction
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