Diclofenac sodium (Voltaren®)
Diclofenac potassium (Voltaren Rapide®)
Diclofenac sodium/misoprostol (Arthrotec®)
Etodolac (Ultradol™)
Indomethacin sodium (Indocid®)
Piroxicam (Feldene™)
Nabumetone (Relafen™)
Ibuprofen (Advil®, MOTRIN®)
Ketoprofen (Orudis® SR)
Naproxen (Naprosyn®)
Acetylsalicylic acid (Aspirin®)

General comments
Regardless of the rheumatic disease, NSAIDs are useful for pain management and inflammation control. While they reduce the inflammation they do not eliminate established inflammation. They should be used at the lowest dosage to achieve therapeutic effect.

It is important to remember that if pain is incompletely controlled by NSAIDs, the addition of TYLENOL* (acetaminophen) may be useful. Try never to combine NSAIDs to achieve greater pain or anti-inflammatory effect, as this will increase the risk of toxicity, especially GI bleed.

Control of pain in osteoarthritis (OA) is usually achieved with TYLENOL* (acetaminophen) or opioids. The use of NSAIDs remains an option for additional pain relief. This is because OA is not usually associated with a significant inflammatory process, as well as the increased NSAID risk for GI toxicity in this older age group.

Major toxicities associated with NSAIDs occur in the GI tract, central nervous system, hematopoietic system, kidneys, skin and liver.

If GI bleed risk factors are present, NSAIDs should be used with a cytoprotective agent.

May be associated with loss of blood pressure control if the patient has pre-existing hypertension.

May be associated with deterioration in renal function if the patient has pre-existing renal disease.

In the presence of heart or renal failure, NSAIDs should be avoided. The recent concerns with COXIBs and cardiorenal toxicity are now leading to further review of such toxicities with traditional NSAIDs.

Indications

• Regional pain syndromes
• Degenerative joint disease (OA)
• Gout
• Pseudogout
• RA
• Seronegative arthritis

Dosage used in clinical practice
75 to 150 mg/day po (in bid or tid divided doses)

Dosage according to CPS

• OA:
  • Starting and maintenance dose: 75 mg/day in 3 divided doses
  • Maximum recommended daily dose: 150 mg
• RA:
  • Starting dose: 75 to 150 mg/day in 3 divided doses
  • Maintenance dose: 75 to 100 mg/day in 3 divided doses

Dosage used in clinical practice
50 to 150 mg day/po (in bid or tid divided doses)

Dosage according to CPS
50 mg every 6 to 8 hours to a maximum of 150 mg/day

Dosage used in clinical practice
1 to 3 tabs day/po

Dosage according to CPS

• Arthrotec 50: 1 tablet 2 or 3 times/day
• Arthrotec 75: 1 tablet twice a day

Dosage used in clinical practice
400 to 600 mg/day po (in bid divided doses)

Dosage according to CPS

• No dosage provided in the CPS

Dosage used in clinical practice

• 50 to 150 mg/day po (in bid or tid divided doses)
• 1 to 3/day suppos. (most commonly used as a single h.s. dose)

Dosage according to CPS

• Total amount of drug absorbed from the rectal suppository is expected to be similar to the capsule
• Suggest the total daily dose administered rectally not exceed 200 mg

Dosage used in clinical practice
10 to 20 mg/day po (single dose)

Dosage according to CPS

• No dosage provided in the CPS

Dosage used in clinical practice
1,000 to 2,000 mg/day po (single or bid doses)

Dosage according to CPS

• Starting dose: 1,000 mg/day
• Dosage can be increased to 1,500 mg or 2,000 mg/day given either as a single dose or two divided doses

Dosage used in clinical practice
1.2 to 2.4 g/day po (prn or in divided doses)

Dosage according to CPS

• Advil®:
  • 1-2 tablets, caplets, gel caplets or liqui-gels or 1 extra strength caplet or liqui-gel every 4 hours as needed but not to exceed 6 tablets, caplets, gel caplets or liquid-gels in 24 hours
• MOTRIN®:
  • Mild-to-moderate pain:
    • Motrin IB: 200 mg: 1 to 2 tablets, caplets or gelcaps as required every 4 hours, not to exceed 1,200 mg in 24 hours
    • Extra Strength Motrin IB: 300 mg: 1 tablet as required every 4 to 6 hours, not to exceed 1,200 mg in 24 hours
    • Super Strength Motrin IB: 400 mg: 1 tablet as required every 4 to 6 hours, not to exceed 1,200 mg in 24 hours

Dosage used in clinical practice
150 to 200 mg/day po (in bid or tid divided doses)

Dosage according to CPS

• 150 to 200 mg/day in 3 or 4 divided doses
• Usual maintenance dose: 100 mg bid
• Total daily dose of ketoprofen capsules, tablets and suppositories should not exceed 200 mg/day

Dosage used in clinical practice
500 to 1,500 mg/day po (in bid or tid divided doses)

Dosage according to CPS

• 500 mg/day in divided doses
• Dosage can be increased to 750 to 1,000 mg/day

Dosage used in clinical practice
Dosage varies depending on analgesic (low dose) vs anti-inflammatory (high dosage) needs but should not exceed 3.6 g/day.

Dosage according to CPS

• Analgesic: 1 to 2 tablets (325 to 650 mg) every 4 hours po; not to exceed total daily dose of 2.4 g
• Anti-inflammatory: 3 tablets (975 mg) 4 to 6 times/day; up to 30 tablets may be required for optimal anti-inflammatory effect