NSAIDs [Explained]

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Dosage:
Adults:
Arthrotec® 50:
Osteoarthritis: 1 tablet 2-3 times/day
Rheumatoid arthritis: 1 tablet 3-4 times/day
For both regimens, if not tolerated by patient, the dose may be reduced to 1 tablet twice daily

Arthrotec® 75:
Patients who cannot tolerate full daily Arthrotec® 50 regimens: 1 tablet twice daily
Note: The use of these tablets may not be as effective at preventing GI ulceration

Supplied:
Tablet: Diclofenac sodium 50 mg and misoprostol 200 mcg; diclofenac sodium 75 mg and misoprostol 200 mcg

Supplied:
(Cataflam® - fastest onset of action) 50 mg tablet (K+ salt). (Voltaren®) Delayed release (enteric coated tab - Na+ salt): 25 mg, 50 mg, 75 mg. (Voltaren®-XR) Extended release tab: 100 mg

Maximum Daily Dose:  225 mg;  XR: 200 mg

Drug UPDATES: ZORVOLEX® (diclofenac) capsules, for oral use
[Drug information  /  PDF]  
Dosing:  Click (+) next to Dosage and Administration section (drug info link)

Initial U.S. Approval:  2013

Mechanism of Action: ZORVOLEX is an NSAID that exhibits anti-inflammatory, analgesic, and antipyretic activities in animal models. The mechanism of action of ZORVOLEX, like that of other NSAIDs, is not completely understood but may involve inhibition of the cyclooxygenase (COX-1 and COX-2) pathways. Diclofenac's mechanism may also be related to prostaglandin synthetase inhibition.

INDICATIONS AND USAGE:  ZORVOLEX is an NSAID indicated for management of mild to moderate acute pain and osteoarthritis pain

HOW SUPPLIED: Capsules: 18 mg or 35 mg

Drug UPDATES:  Dyloject™ (diclofenac sodium) Injection, for intravenous use
[Drug information  /  PDF]  
Dosing:  Click (+) next to Dosage and Administration section (drug info link)

Initial U.S. Approval:  2014

Mechanism of Action: The active ingredient in Dyloject, diclofenac, is an NSAID that exhibits anti-inflammatory analgesic and antipyretic activities in animal models.
The mechanism of action of Dyloject, like that of other NSAIDs, is not completely understood but may involve inhibition of the cyclooxygenase (COX-1 and COX-2) pathways. Dyloject’s mechanism may also be related to inhibition of prostaglandin synthetase.

INDICATIONS AND USAGE:
Dyloject is an NSAID indicated for use in adults for the:
management of mild to moderate pain.
management of moderate to severe pain alone or in combination with opioid analgesics.

HOW SUPPLIED: Injection, single use vial containing 37.5 mg/mL.

Rheumatoid arthritis, osteoarthritis: Initial: 600-1200 mg/day given in divided doses: 400 mg 2 times/day; 300 mg 2 or 3 times/day; 500 mg 2 times/day; total daily dose should not exceed 1200 mg; for patients weighing <60 kg, total daily dose should not exceed 20 mg/kg/day

Lodine® XL: 400-1000 mg once daily

Supplied:
Capsule (Lodine®): 200 mg, 300 mg
Tablet: 400 mg, 500 mg
Tablet, extended release (Lodine® XL): 400 mg, 500 mg, 600 mg

Maximum Daily Dose::  1200 mg

Moderate to severe rheumatoid arthritis including acute flares of chronic disease.
Moderate to severe ankylosing spondylitis.
Moderate to severe osteoarthritis.
Acute painful shoulder (bursitis and/or tendinitis).
Acute gouty arthritis.

[May cause GI upset, bleeding, ulceration, perforation; take with food or milk to minimize GI upset.]

Dosing (Adults):  25-50 mg/dose 2-3 times/day; maximum dose: 200 mg/day; extended release capsule should be given on a 1-2 times/day schedule; maximum dose for sustained release is 150 mg/day.
Elderly: Refer to Adults dosing; best to start older adults on 25 mg dose given 2-3 times/day

Supplied:
Capsule (Indocin®): 25 mg, 50 mg.
Capsule, sustained release (Indocin® SR): 75 mg.
Injection, powder for reconstitution, as sodium trihydrate (Indocin® I.V.): 1 mg
Suspension, oral (Indocin®): 25 mg/5 mL (237 mL).

Maximum Daily Dose: 200 mg;   SR: 150mg

IM: 60 mg x 1 or 30 mg q6h (maximum daily dose: 120 mg).
 IV: 30 mg x 1 or 30 mg q6h (maximum daily dose: 120 mg).

Oral: 20 mg, followed by 10 mg every 4 to 6 hours (Max 40 mg/day). Oral dosing is intended to be a continuation of IM/IV therapy only.

Dosing (EXCEPTIONS): Elderly (>65 yo - elderly pts have increased incidence of GI bleeding, ulceration, and perforation. Also decreased clearance), Renal insufficiency or weight <50 kg:
IM: 30 mg x1 or 15 mg q6h (maximum daily dose: 60 mg) IV: 15 mg x 1 or 15mg q6h (maximum daily dose: 60 mg) Oral: 10 mg every 4-6 hours (max 40 mg/day).

Renal dosing: Do not use in patients with advanced renal impairment. Patients with moderately-elevated serum creatinine should use half the recommended dose, not to exceed 60 mg/day IM/IV.

Maximum Daily Dose:  IV/ IM:120 mg;   oral: 40mg

CLINORIL is indicated for acute or long-term use in the relief of signs and symptoms of the following:

Osteoarthritis
Rheumatoid arthritis**
Ankylosing spondylitis
Acute painful shoulder (Acute subacromial bursitis/supraspinatus tendinitis)
Acute gouty arthritis
** The safety and effectiveness of CLINORIL have not been established in rheumatoid arthritis patients who are designated in the American Rheumatism Association classification as Functional Class IV (incapacitated, largely or wholly bedridden, or confined to wheelchair; little or no self-care).

Dosage:
Adults: 150-200 mg twice daily or 300-400 mg once daily; not to exceed 400 mg/day.
[Should be administered with food or milk.]

Supplied:
Tablet: 150 mg, 200 mg

Maximum Daily Dose :  400 mg

Dosage:
Osteoarthritis and Rheumatoid Arthriti (Adult ): initial, 400 mg orally three times a day for 1-2 weeks. Maintenance: 200 to 600 mg orally three times a day. Maximum: 1800 mg/day.

Supplied: 400 mg capsule. 200, 600 mg tab]

Maximum Daily  Dose :  1800 mg

Administration
Tablet should be swallowed whole; do not crush or chew.
Should be taken with food to decrease GI distress.

Dosage:
Adults: Oral:
Osteoarthritis: 500-750 mg/day in divided doses.
Pain: Initial: 500-1000 mg followed by 250-500 mg every 8-12 hours; maximum daily dose: 1.5 g
 Inflammatory condition: 500-1000 mg/day in 2 divided doses; maximum daily dose: 1.5 g

Dosing adjustment in renal impairment: Clcr<50 mL/minute: Administer 50% of normal dose.

Supplied:
Tablet: 250 mg, 500 mg

Dosing comments in renal impairment: In patients with end-stage renal disease undergoing hemodialysis: 750 mg twice daily with an additional 500 mg after dialysis

Supplied:
Tablet: 500 mg, 750 mg

Supplied:
Suspension: 7.5 mg/5 mL (100 mL)
Tablet: 7.5 mg, 15 mg

Maximum Daily Dose :  15 mg

Dosage:
Adults: 10-20 mg/day once daily; although associated with increase in GI adverse effects, doses >20 mg/day have been used (ie, 30-40 mg/day). May be taken with food to decrease GI adverse effect.
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Dosing adjustment in hepatic impairment: Reduction of dosage is necessary
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Monitoring Parameters
Occult blood loss, hemoglobin, hematocrit, and periodic renal and hepatic function tests; periodic ophthalmologic exams with chronic use
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Supplied:
Capsule: 10 mg, 20 mg

Maximum Daily Dose :  20 mg

Maximum Daily Dose:  2000 mg

Maximum Daily Dose:  300 mg

Carefully consider the potential benefits and risks of MOTRIN tablets and other treatment options before deciding to use MOTRIN. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.

MOTRIN tablets are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis.

MOTRIN tablets are indicated for relief of mild to moderate pain.

MOTRIN tablets are also indicated for the treatment of primary dysmenorrhea.

Controlled clinical trials to establish the safety and effectiveness of MOTRIN tablets in children have not been conducted.

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Dosage:  [Administer with food ]
Oral:
Children:
Antipyretic: 6 months to 12 years: Temperature <102.5°F (39°C): 5 mg/kg/dose; temperature >102.5°F: 10 mg/kg/dose given every 6-8 hours (maximum daily dose: 40 mg/kg/day)

Juvenile rheumatoid arthritis: 30-50 mg/kg/24 hours divided every 8 hours; start at lower end of dosing range and titrate upward (maximum: 2.4 g/day)

Analgesic: 4-10 mg/kg/dose every 6-8 hours

OTC labeling (analgesic, antipyretic):
Children 6 months to 11 years: See table; use of weight to select dose is preferred; doses may be repeated every 6-8 hours (maximum: 4 doses/day)

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Children >/= 12 years: 200 mg every 4-6 hours as needed (maximum: 1200 mg/24 hours)
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Adults:
Inflammatory disease: 400-800 mg/dose 3-4 times/day (maximum dose: 3200 mg/day)

Analgesia/pain/fever/dysmenorrhea: 200-400 mg/dose every 4-6 hours (maximum daily dose: 1.2 g, unless directed by physician)

OTC labeling (analgesic, antipyretic): 200 mg every 4-6 hours as needed (maximum: 1200 mg/24 hours)

Dosing adjustment/comments in severe hepatic impairment: Avoid use

Supplied:
Caplet: 200 mg
Capsule, liqui-gel: 200 mg
Gelcap: Advil®: 200 mg
Suspension, oral: 100 mg/5 mL (5 mL, 120 mL, 480 mL)
Suspension, oral drops: 40 mg/mL (15 mL)
Tablet: 200 mg, 400 mg, 600 mg, 800 mg
     Advil® Junior: 100 mg
Tablet, chewable: 50 mg, 100 mg

Mild to moderate pain: Capsule: 25-50 mg every 6-8 hours up to a maximum of 300 mg/day

OTC labeling: 12.5 mg every 4-6 hours, up to a maximum of 6 tablets/24 hours
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Elderly: Initial dose should be decreased in patients >75 years; use caution when dosage changes are made
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Dosage adjustment in renal impairment:
Mild impairment: Maximum dose: 150 mg/day
Severe impairment: Maximum dose: 100 mg/day
Dosage adjustment in hepatic impairment and serum albumin <3.5 g/dL: Maximum dose: 100 mg/day.

Supplied:
Capsule: 50 mg, 75 mg
Capsule, extended release (Oruvail®): 100 mg, 150 mg, 200 mg
Tablet (Orudis® KT): 12.5 mg

Mild-to-moderate pain, dysmenorrhea, acute tendonitis, bursitis: Initial: 500 mg x 1, then 250 mg every 6 to 8 hours. (Controlled release tablet): 375 to 1000 mg orally once daily.

Supplied:  Tablet: 250 mg, 375 mg, 500 mg. Caplet/Gelcap: 220 mg (Na+ salt - equivalent to 200mg tablet - OTC). Suspension: 125 mg/5 ml.
Tablet (sodium salt) Anaprox ®: 220mg, 275 mg, 550mg. Tablet (controlled release - Na+ salt): 421.5 mg, 550 mg. Tablet (delayed release) - EC-Naprosyn®: 375 mg, 500 mg.

Maximum Daily Dose:  1375 mg max

For relief of the signs and symptoms of osteoarthritis
For relief of the signs and symptoms of rheumatoid arthritis
For relief of the signs and symptoms of juvenile rheumatoid arthritis
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Dosage:
Adults:
Osteoarthritis: 600-1200 mg once daily; patients should be titrated to lowest dose possible; patients with low body weight should start with 600 mg daily

Rheumatoid arthritis: 1200 mg once daily; a one-time loading dose of up to 1800 mg/day or 26 mg/kg (whichever is lower) may be given

Maximum daily dose: 1800 mg or 26 mg/kg (whichever is lower) in divided doses
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Dosing adjustment in renal impairment: 600 mg once daily; dose may be increased to 1200 mg with close monitoring
Dosing adjustment in hepatic impairment: Use caution in patients with severe dysfunction
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Supplied:
Tablet: 600 mg

Osteoarthritis (OA)
Celebrex is indicated for relief of the signs and symptoms of OA

Rheumatoid Arthritis (RA)
Celebrex is indicated for relief of the signs and symptoms of RA

Juvenile Rheumatoid Arthritis (JRA)
Celebrex is indicated for relief of the signs and symptoms of JRA in patients 2 years and older

Ankylosing Spondylitis (AS)
Celebrex is indicated for the relief of signs and symptoms of AS

Acute Pain (AP)
Celebrex is indicated for the management of AP in adults

Primary Dysmenorrhea (PD)
Celebrex is indicated for the treatment of PD

Familial Adenomatous Polyposis (FAP)
Celebrex is indicated to reduce the number of adenomatous colorectal polyps in FAP, as an adjunct to usual care (e.g., endoscopic surveillance, surgery). It is not known whether there is a clinical benefit from a reduction in the number of colorectal polyps in FAP patients. It is also not known whether the effects of Celebrex treatment will persist after Celebrex is discontinued. The efficacy and safety of Celebrex treatment in patients with FAP beyond six months have not been studied.

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Dosage:
Adults: Oral:
Acute pain or primary dysmenorrhea: Initial dose: 400 mg, followed by an additional 200 mg if needed on day 1; maintenance dose: 200 mg twice daily as needed

Osteoarthritis: 200 mg/day as a single dose or in divided dose twice daily

Rheumatoid arthritis: 100-200 mg twice daily
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Elderly: No specific adjustment is recommended. However, the AUC in elderly patients may be increased by 50% as compared to younger subjects. Use the lowest recommended dose in patients weighing <50 kg.
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Dosing adjustment in renal impairment: No specific dosage adjustment is recommended; not recommended in patients with advanced renal disease

Dosing adjustment in hepatic impairment: Reduced dosage is recommended (AUC may be increased by 40% to 180%); decrease dose by 50% in patients with moderate hepatic impairment (Child-Pugh Class II)
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Supplied:
Capsule: 100 mg, 200 mg, 400 mg

Osteoarthritis: 12.5 mg once daily; may be increased to a maximum of 25 mg once daily
Acute pain: 50 mg orally once daily.

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Supplied:
Tablet: 12.5 mg, 25 mg, 50 mg