Use as a resource with your neurologist ONLY.
| Class | Medication | Typical Dose | Maximum Dose/24 hr | Highlights | Forms | Half-Life |
|---|---|---|---|---|---|---|
| Acetic Acids | Diclofenac | 50 mg every 8-12 hrs | United States: 150 mg, 200 mg for rheumatoid arthritis Canada: 100 mg |
Diclofenac free acid has different dosing than diclofenac sodium and potassium (seen here). | Tab, cap, gel, inj | 1-2 hrs |
| Etodolac | 200-400 mg every 6-8 hrs | 1000 mg | More COX-2 selective than other NSAIDS except for coxibs, which means greater GI tolerability | Tab, cap, ER tab | 7 hrs | |
| Indomethacin | 25-50 mg every 8-12 hrs | 150 mg 200 mg for rheumatic diseases |
Greater risk of CNS side effects. May be used as a diagnostic tool to identify paroxysmal hemicrania or hemicrania continua (used as a preventive treatment in both). More potent at inhibitng prostaglandins in the kidneys than other NSAIDs. Therefore, higher risk of adverse kidnery effects. |
Cap, ER cap, supp | 4-6 hrs | |
| Sulindac | 150-200 mg every 12 hrs | 400 mg |
Increased risk of nephrolithiasis Higher risk of liver injury |
Tab | 7.8 hrs | |
| Ketorolac |
20 mg after IV or IM, then 10 mg every 4 to 6 hours (tab) 60/30 mg every 6 hrs (IM/IV) Nasal spray: For adult patients <65, ≥110 lbs, and normal kidney function: 1 spray in EACH nostril every 6-8 hours For adult patients ≥65, <110 lbs, or with renal impairment: 1 spray in ONLY ONE nostril every 6-8 hours |
40 mg (tab) 120 mg (IM/IV) 4 doses per day, for up to 5 days (Intanasal) |
Very potent Duration of therapy should not exceed 5 days due to adverse effects risk |
Tab, inj, nasal | 4-6 hrs | |
| Fenamates | Meclofenamate | 50 mg every 4-6 hrs, 100 mg 3x/day for dysmenorrhea |
400 mg | For dysmenorrhea | Cap | 2.5-4 hrs |
| Mefenamic Acid | 250 mg every 6 hrs | 1000 mg | Only for dysmenorrhea | Tab, cap | 2-4 hrs | |
| Naphthylalkanones | Nabumetone | 1000 mg 1-2x/day | 2000 mg | Preferentially inhibits COX-2 | Tab | 24 hrs |
| Oxicams | Piroxicam | 10-20 mg daily | 20 mg |
Due to longer half-life, higher risk of GI adverse effects compared to other NSAIDs Similarly, due to long half-life, good for chronic pain |
Cap | 50 hrs |
| Meloxicam |
7.5-15 mg daily tab/susp 5-10 mg cap |
15 mg tab/susp 10 mg cap |
Safer on GI tract than piroxicam due to preferential COX-2 selectivity Long duration, slower onset so must be careful with repeated use |
Tab, cap, susp | 15-20 hrs | |
| Propionic Acids | Fenoprofen | 200 mg every 4-6 hrs or 400-600 mg every 6-8 hrs |
3200 mg |
Higher risk of photosensitive skin reactions compared to other NSAIDs Nephrotixicity risk |
Tab, cap | 2-4 hrs |
| Flurbiprofen | 50 mg every 6 hrs or 100 mg every 8-12 hrs |
300 mg | May also be in the form of an opthalmic solution to inhibit miosis during cataract surgery | Tab | 4-6 hrs | |
| Ibuprofen | 400 mg every 4-6 hrs 600-800 mg every 6-8 hrs |
3200 mg acute 2400 mg chronic |
May help prevent altitude sickness when taken prophylactically Good alternative to naproxen for migraine relief |
Tab, cap, liq | 2-3 hrs | |
| Ketoprofen | 50 mg every 6 hrs or 75 mg every 8 hrs |
300 mg | Do not uses extended release forumation for acute pain | Cap, ER cap | 2-4 hrs | |
| Naproxen |
250, 500 mg naproxen = 275, 550 mg naproxen sodium 250-500 mg every 12 hrs or |
1250 mg- short-term use 1000 mg- chronic use May increase to 1500 mg during a flare. |
Commonly combined with sumatriptan for acute migraine tx Most well-studied for migraine Drug of choice for those with CVD |
Tab, cap, liq, susp | 12-15 hrs | |
| Oxaprozin | 1200 mg daily | 1800 mg | Slow onset and long half-life | Tab | 50-60 hrs | |
| Salicylates | Aspirin | 325-1000 mg every 4-6 hrs | 4000 mg |
Not routinely used for migraine relief as there are better alternatives Only NSAID that reduces risk of myocardial infarction and ischemic stroke, but not for doses necessary for pain relief Irreversibly inhibits platelet COX-1 activity Increased risk of bleeding with long-term use |
Tab, cap, liq | 2-3 hrs |
| Diflunisal | 500 mg every 8-12 hrs | 1500 mg | Lower GI bleed risk | Tab | 8-12 hrs | |
| Salsalate | 1000 mg every 8-12 hrs or 1500 mg every 12 hrs | 3000 mg | Lower GI bleed risk | Tab | 6-10 hrs | |
| Magnesium salicylate | 1160 mg every 6 hrs | 4640 mg | Lower GI bleed risk | Tab | 2-3 hrs | |
| COX-2 Inhibitors | Celecoxib | 100 mg twice daily or 200 mg once daily | 400 mg |
Less GI toxicity than nonselective NSAIDs Elyxyb oral solution also available specificall for migraine attacks |
Cap, liq | 11 hrs |
