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Arthritis Treatments: NSAIDS

January 12, 2012

Arthritis Treatments: NSAIDS (download)

ARTHRITIS TREATMENTS: NSAIDS

Generic & Class	Brand & Company	Strength(s)	Formulations^a	Usual Dose^b
ACETIC ACIDS DERIVATIVES
diclofenac	Cataflam Novartis	50mg	tabs	Adults: OA: 50mg 2–3 times daily. RA: 50mg 3–4 times daily. AS: 25mg 4 times daily, may add 25mg at bedtime. Children: Not recommended.
	Voltaren Novartis	25mg, 50mg, 75mg	tabs (e-c)	Adults: OA: 50mg 2–3 times daily or 75mg twice daily. RA: 50mg 3–4 times daily or 75mg twice daily. AS: 25mg 4 times daily, with an additional 25mg at bedtime if necessary. Children: Not recommended.
	Voltaren XR Novartis	100mg	ext-rel tabs	Adults: OA: 100mg once daily. RA: 100mg once daily; rarely 100mg twice daily may be used. Children: Not recommended.
etodolac	(various)	200mg, 300mg	caps	Adults: Initially 600mg–1g/day in 2–3 divided doses; usual max 1g/day in divided doses; may increase to 1.2g/day when needed. Children: Not recommended.
		400mg, 500mg	tabs
		400mg, 500mg, 600mg	ext-rel tabs	Adults: 400mg–1g once daily; max 1.2g/day. Children: Not recommended.
indomethacin	Indocin Merck	25mg, 50mg	caps	Adults: Acute gouty arthritis: 50mg 3 times daily until pain tolerable; then rapidly reduce dose to discontinue. Other conditions: initially 25mg 2–3 times daily. Increase if needed at weekly intervals by 25–50mg daily; max 200mg daily. Children: <14 yrs: usually not recommended. ≥2 yrs: 1–2mg/kg/day in divided doses; max 3–4mg/kg/day (or 150–200mg/day whichever less).
	Indocin Merck	50mg	supp
	Indocin Susp Iroko	25mg/5mL	susp
nabumetone	(various)	500mg, 750mg	tabs	Adults: Initially 1g once daily; max 2g/day in 1 or 2 divided doses. Renal insufficiency (CrCl 30–49mL/min): initial max 750mg once daily, may increase to 1.5g/day; (CrCl <30mL/min): initial max 500mg once daily, may increase to 1g/day. Children: Not recommended.
sulindac	Clinoril Merck	150mg, 200mg+	tabs	Adults: 150mg twice daily; max 400mg/day. Acute painful shoulder or gouty arthritis: 200mg twice daily, usually for 7–14 days. Children: Not recommended.
COX-2 INHIBITORS
celecoxib	Celebrex Pfizer	50mg, 100mg, 200mg, 400mg	caps	Adults: ≥18yrs: OA: 200mg once daily or 100mg twice daily. RA: 100–200mg twice daily. AS: 200mg in 1–2 divided doses; if no response after 6 weeks, 400mg once daily may be tried. <50kg: start at lowest recommended dose. Children: <2yrs: not recommended. JRA: ≥2yrs (≥10kg to ≤25kg): 50mg twice daily; (>25kg): 100mg twice daily.
PROPIONIC ACIDS DERIVATIVES
fenoprofen	Nalfon Pedinol	200mg	caps	Adults: 300mg–600mg 3 or 4 times daily. Max: 3.2g/day. Children: <18yrs: not recommended.
flurbiprofen	Ansaid Pfizer	50mg, 100mg	tabs	Adults: 200–300mg/day in 2–4 divided doses; max single dose 100mg. Reduce dosage for renal impairment. Children: Not recommended.
ibuprofen	Motrin Tablets Pfizer	400mg, 600mg, 800mg	tabs	Adults: RA, OA: 400–800mg 3–4 times daily; max 3.2g/day. Children: JRA: 30–40mg/kg per day in 3–4 doses. May use 20mg/kg per day in 3–4 doses for milder disease.
ketoprofen ext-rel	(various)	200mg	ext-rel caps*	Adults: 200mg daily. Children: Not recommended.
naproxen	Anaprox Roche	275mg	tabs	Adults: Arthritis,spondylitis: 275mg or 550mg twice daily. Tendinitis, bursitis: Initially 550mg, then 550mg every 12 hrs or 275mg every 6–8 hrs; max 1.375g (first day), then max 1.1g/day. Acute gout: 825mg once then 275mg every 8 hrs. Children: <2yrs: not recommended. ≥2yrs: use susp form of naproxen.
	Anaprox DS Roche	550mg	tabs	Adults: Arthritis,spondylitis: 275mg or 550mg twice daily. Tendinitis, bursitis: Initially 550mg, then 550mg every 12 hrs or 275mg every 6–8 hrs; max 1.375g (first day), then max 1.1g/day. Acute gout: 825mg once then 275mg every 8 hrs. Children: <2yrs: not recommended. ≥2yrs: use susp form of naproxen.
	Naprelan Victory	375mg, 500mg, 750mg	controlled-rel tabs	Adults: RA, OA, or AS: 750mg–1g once daily; max 1.5g once daily. Acute tendonitis or bursitis: 1g once daily, or 1.5g once daily for a limited period; max 1g/day thereafter. Gout: 1–1.5g once daily for 1 day then 1g once daily until attack subsides. Children: Not recommended.
	Naprosyn Roche	250mg, 375mg, 500mg	tabs	Adults: Arthritis, spondylitis: 250–500mg twice daily; max 1.5g/day (up to 6 months). Tendinitis, bursitis: 500mg once, then 500mg twice daily or 250mg every 6–8 hrs; max (first day) 1.25g, then max 1g/day. Acute gout: 750mg once, then 250mg every 8 hrs. Children: <2yrs: not recommended. ≥2yrs: JRA: 5mg/kg twice daily. Other uses: Doses of 2.5–5mg/kg/dose, max 15mg/kg/day have been used.
	Naprosyn Roche	125mg/5mL	susp
	EC-Naprosyn Roche	375mg, 500mg	tabs (e-c)	Adults: 375–500mg twice daily. Children: <2yrs: not recommended. ≥2yrs: use susp form.
oxaprozin	Daypro Pfizer	600mg	scored caplets	Adults: RA (≥16 years) or OA: 1.2 g once daily; max 1.8 g or 26 mg/kg daily, whichever is less, in divided doses. Low body weight, milder disease, or on dialysis: initially 600 mg once daily; max 1.2g daily. Children: <6 years: not recommended. JRA: 6–16 years (22–31 kg): 600 mg once daily; (32–54 kg): 900 mg once daily; (≥55 kg): 1.2 g once daily.
Combination Therapy
ibuprofen + famotidine	Duexis^c Horizon	800mg/26.6mg	tabs	Adults: RA, OA: 800mg/26.6mg three times daily. Use lowest effective dose for the shortest duration. Children: Not recommended.
OXICAMS DERIVATIVES
meloxicam	Mobic Boehringer Ingelheim	7.5mg, 15mg	tabs	Adults: ≥18yrs: 7.5mg once daily; max 15mg once daily. Children: <2yrs: not recommended. JRA: ≥2yrs: 0.125mg/kg (max 7.5mg) once daily.
meloxicam	Mobic Boehringer Ingelheim	7.5mg/5mL	susp
piroxicam	Feldene Pfizer	10mg, 20mg	caps	Adults: 20mg daily; may give in 2 divided doses. Children: Not recommended.
SALICYLATES
aspirin	Bayer Bayer	325mg	tabs, caplets, gelcaps	Adults: RA, arthritis and pleurisy of SLE: initially 3g daily in divided doses; target plasma salicylate level 150–300micrograms/mL. OA: up to 3g/day in divided doses. Spondyloarthropathies: up to 4g/day in divided doses. Children: JRA: initially 90–130mg/kg per day in divided doses; target plasma salicylate level 150–300micrograms/mL.
	Ecotrin GlaxoSmithKline	81mg, 325mg, 500mg	tabs (e-c)
	Extra Strength Bayer Bayer	500mg	caplets, gelcaps
	Zorprin Par	800mg	tabs^d
choline magnesium trisalicylate	(various)	500mg, 750mg, 1g	scored tabs	Adults: 3g daily at bedtime or in 2 divided doses. Elderly: 750mg three times daily. Children: <12kg: not recommended. 12–37kg: 50mg/kg/day. >37kg: 2.25g/day. Both in 2 divided doses.
choline magnesium trisalicylate	(various)	500mg/5mL	soln
diflunisal	(various)	250mg, 500mg	tabs	Adults: 250–500mg twice daily; max 1.5g/day. Children: Not recommended.
salsalate	(various)	500mg, 750mg	scored tabs	Adults: 3g daily in divided doses. Children: Not recommended.
salsalate	(various)	500mg	caps
NOTES
^a cap = capsules; tabs = tablets; e-c = enteric coated; ext-rel = extended-release; supp = suppositories; susp = suspension; + = scored ^b OA: OA = Osteoarthritis; RA = Rheumatoid arthritis; AS = Ankylosing spondylitis; JRA = Juvenile rheumatoid arthritis ^c Duexis is a fixed-combination tablet of ibuprofen and famotidine indicated for the relief of signs/symptoms of RA and OA and to decrease the risk of developing upper gastrointestinal ulcers (eg, gastric and/or duodenal ulcer), in patients who are taking ibuprofen for those indications. ^d pH dependent release Not an inclusive list. Some of the products listed above have additional indications. See Alphabetical and Section indexes. (Rev. 1/2012)

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