60 mg IM or 30 mg IV initially, then 30 mg every 6 hours IM or IV
Intramuscular or intravenous NSAID as alternative to opioid. Lower doses for elderly. Short-term use (
Magnesium salicylate (various)
467—934 mg every 6 hours
$0.23/467 mg OTC
50-100 mg every 6 hours
Diarrhea more common.
Mefenamic acid (Ponstel)
250 mg every 6 hours
500-1000 mg once daily (max dose 2000 mg/d)
$1.38/500 mg; $1.63/750 mg
May be less ulcerogenic than ibuprofen, but overall side effects may not be less.
Naproxen (Naprosyn, Anaprox, Aleve [OTC], others)
250-500 mg every 6-8 hours
5 mg/kg every 8 hours
$1.29/500 mg Rx; $0.08/220 mg OTC
$154.80; $7.20 OTC
Generally well tolerated. Lower doses for elderly.
Oxaprozin (Daypro, others)
600-1200 mg once daily
Similar to ibuprofen. May cause rash, pruritus, photosensitivity.
Piroxicam (Feldene, others)
20 mg daily
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.
325-650 mg every 3-4 hours
$0.08/650 mg OTC
Sulindac (Clinoril, others)
150-200 mg twice daily
$0.98/150 mg; $1.21/200 mg
May cause higher rate of gastrointestinal bleeding. May have less nephrotoxic potential.
200-600 mg four times daily
$0.75/200 mg; $3.22/600 mg
Perhaps more side effects than others, including anaphylactic reactions.
‘Acetaminophen and NSAID dosages for adults weighing
2Average wholesale price (AWP, for AB-rated generic when available) for quantity listed. Source: Red Book Online, 2012, Thomson Reuters (Healthcare) Inc. AWP may not accurately represent the actual pharmacy cost because wide contractual variations exist among institutions.
3The adverse effects of headache, tinnitus, dizziness, confusion, rashes, anorexia, nausea, vomiting, gastrointestinal bleeding, diarrhea, nephrotoxicity, visual disturbances, etc, can occur with any of these drugs. Tolerance and efficacy are subject to great individual variations among patients. Note: All NSAIDs can increase serum lithium levels.
4Acetaminophen and celecoxib lack antiplatelet effects.