Acetaminophen (Ofirmev) | 1000 mg intravenously every 6–8 hours | | $56.84 per vial of 1000 mg | $6820.80 | |
Acetaminophen or paracetamol4 (Tylenol, Datril, etc) | 325–500 mg orally every 4 hours or 500–1000 mg orally every 6 hours, up to 2000–4000 mg/day | 10–15 mg/kg every 4 hours orally; 15–20 mg/kg every 4 hours rectally, up to 2000–3000 mg/day | $0.02/500 mg (oral) OTC; $0.43/650 mg (rectal) OTC | $3.60 (oral); $77.40 (rectal) | Not an NSAID because it lacks peripheral anti-inflammatory effects. Equivalent to aspirin as analgesic and antipyretic agent. Limit dose to 4000 mg/day in acute pain, and to 3000 mg/day in chronic pain. Limit doses to 2000 mg/day in older patients and those with liver disease. Be mindful of multiple sources of acetaminophen as in combination analgesics, cold remedies, and sleep aids. |
Aspirin5 | 325–650 mg orally every 4 hours | 10–15 mg/kg every 4 hours orally; 15–20 mg/kg every 4 hours rectally | $0.01/325 mg OTC; $1.51/600 mg (rectal) OTC | $3.60 (oral); $271.80 (rectal) | Available also in enteric-coated oral form that is more slowly absorbed but better tolerated. |
Celecoxib4 (Celebrex) | 200 mg orally once daily (osteoarthritis); 100–200 mg orally twice daily (RA) | 100 mg orally once or twice daily | $4.62/100 mg; $7.58/200 mg | $227.40 OA; $454.80 RA | Cyclooxygenase-2 inhibitor. No antiplatelet effects. Lower doses for elderly who weigh < 50 kg. Lower incidence of endoscopic gastrointestinal ulceration than NSAIDs. Not known if true lower incidence of gastrointestinal bleeding. Celecoxib is contraindicated in sulfonamide allergy. |
Diclofenac (Flector) | 1.3% topical patch applied twice daily | | $14.92/patch | $895.20 | Apply patch to most painful area. |
Diclofenac (Voltaren, Cataflam, others) | 50–75 mg orally two or three times daily; 1% gel 2–4 g four times daily | | $0.95/50 mg; $1.14/75 mg; $0.52/g gel | $85.50; $102.60; $249.60 gel | May impose higher risk of hepatotoxicity. Enteric-coated product; slow onset. Topical formulations may result in fewer side effects than oral formulations. |
Diclofenac sustained release (Voltaren-XR, others) | 100–200 mg orally once daily | | $2.70/100 mg | $162.00 | |
Etodolac (Lodine, others) | 200–400 mg orally every 6–8 hours | | $1.32/400 mg | $158.40 | |
Fenoprofen calcium (Nalfon, others) | 300–600 mg orally every 6 hours | | $3.44/600 mg | $412.80 | Perhaps more side effects than others, including tubulointerstitial nephritis. |
Ibuprofen (Caldolor) | 400–800 mg intravenously every 6 hours | | $24.56/800 mg vial | $2947.20 | |
Ibuprofen (Motrin, Advil, Rufen, others) | 400–800 mg orally every 6 hours | 10 mg/kg orally every 6–8 hours | $0.27/600 mg Rx; $0.02/200 mg OTC | $37.40; $3.60 | Relatively well tolerated and inexpensive. |
Indomethacin (Indocin, Indometh, others) | 25–50 mg orally two to four times daily | | $0.38/25 mg; $0.64/50 mg | $45.60; $76.80 | Higher incidence of dose-related toxic effects, especially gastrointestinal and bone marrow effects. |
Ketoprofen (Orudis, Oruvail, others) | 25–75 mg orally every 6–8 hours (max 300 mg/day) | | $1.12/50 mg Rx; $1.24/75 mg Rx | $134.40; $148.80 | Lower doses for elderly. |
Ketorolac tromethamine | 10 mg orally every 4–6 hours to a maximum of 40 mg/day orally | | $2.16/10 mg | Not recommended | Short-term use (< 5 days) only; otherwise, increased risk of gastrointestinal side effects. |
Ketorolac tromethamine6 | 60 mg intramuscularly or 30 mg intravenously initially, then 30 mg every 6 hours intramuscularly or intravenously | | $1.04/30 mg | Not recommended | Intramuscular or intravenous NSAID as alternative to opioid. Lower doses for elderly. Short-term use (< 5 days) only. |
Magnesium salicylate (various) | 325–650 mg orally every 6 hours | | $0.25/325 mg OTC | $60.00 | |
Meclofenamate sodium7 (Meclomen) | 50–100 mg orally every 6 hours | | $7.74/100 mg | $928.80 | Diarrhea more common. |
Meloxicam (Mobic) | 7.5 mg orally every 12 hours | | $3.16/7.5 mg | $189.60 | Intermediate COX-2/COX-1 ratio similar to diclofenac. |
Nabumetone (Relafen) | 500–1000 mg orally once daily (max dose 2000 mg/day) | | $1.30/500 mg; $1.53/750 mg | $78.00; $91.80 | May be less ulcerogenic than ibuprofen, but overall side effects may not be less. |
Naproxen (Naprosyn, Anaprox, Aleve [OTC], others) | 250–500 mg orally every 6–8 hours | 5 mg/kg every 8 hours | $1.29/500 mg Rx; $0.04/220 mg OTC | $154.80; $3.60 OTC | Generally well tolerated. Lower doses for elderly. |
Piroxicam (Feldene, others) | 20 mg orally once daily | | $4.87/20 mg | $146.10 | Not recommended in the elderly due to high adverse drug reaction rate. Single daily dose convenient. Long half-life. May cause higher rate of gastrointestinal bleeding and dermatologic side effects. |
Sulindac (Clinoril, others) | 150–200 mg orally twice daily | | $0.98/150 mg; $1.21/200 mg | $58.80; $72.60 | May cause higher rate of gastrointestinal bleeding. May have less nephrotoxic potential. |