Table: Acetaminophen, aspirin, and useful NSAIDs and COX inhibitors

Medication (Proprietary)Comments2Usual Dose for Adults Based on WeightCost1
Acetaminophen (Ofirmev)≥ 50 kg: 1000 mg IV q6-8hPer unit: $24.00 per vial of 1000 mg
30 days: $2880.00
Acetaminophen or paracetamol3 (Tylenol, Datril, etc)– 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 from combination analgesics, cold remedies, and sleep aids.		≥ 50 kg: 325-500 mg po q4h OR 500-1000 mg po q6h, up to 2000-4000 mg/d
< 50 kg: 10-15 mg/kg q4h po; 15-20 mg/kg q4h rectally, up to 2000-3000 mg/d		Per unit: $0.02/500 mg (po) OTC; $0.43/650 (rectal) OTC
30 days: $3.60 (po); $77.40 (rectal)
Aspirin4– Available also in enteric-coated oral form that is more slowly absorbed but better tolerated.≥ 50 kg: 325-650 mg po q4h
< 50 kg: 10-15 mg/kg q4h po; 15-20 mg/kg q4h rectally		Per unit: $0.02/325 mg OTC; $1.46/300 mg (rectal) OTC
30 days: $7.20 (po); $525.60 (rectal)
Celecoxib3 (Celebrex)– COX-2 inhibitor.
– No antiplatelet effects.
– Lower doses for elderly who weigh < 50 kg.
– Lower incidence of endoscopic GI ulceration than NSAIDs.
– Not known if true lower incidence of GI bleeding.
– Celecoxib is contraindicated in sulfonamide allergy.		≥ 50 kg: 200 mg po od (OA); 100-200 mg po bid (RA)
< 50 kg: 100 mg po od OR bid		Per unit: $4.37/100 mg; $7.57/200 mg
30 days: $227.10 OA; $454.20 RA
Diclofenac (Flector)– Apply patch to most painful area.
– Diclofenac 1% gel is available over the counter.		≥ 50 kg: 1.3% topical patch applied bidPer unit: $14.92/patch
30 days: $895.20
Diclofenac (Voltaren, Cataflam, others)– May impose higher risk of hepatotoxicity.
– Enteric-coated product; slow onset.
– Topical formulations may result in fewer side effects than oral formulations.		≥ 50 kg: 50-75 mg po bid OR tid; 1% gel 2-4g qidPer unit: $0.95/50 mg; $1.14/75 mg; $0.52/g gel
30 days: $85.50; $102.60; $249.60 gel
Diclofenac sustained release (Voltaren-XR, others)≥ 50 kg: 100-200 mg po odPer unit: $2.70/100 mg
30 days: $162.00
Etodolac (Lodine, others)≥ 50 kg: 200-400 mg po q6-8hPer unit: $1.32/400 mg
30 days: $158.40
Ibuprofen (Caldolor)≥ 50 kg: 400-800 mg IV q6hPer unit: $26.08/800 mg vial
30 days: $3129.60
Ibuprofen (Motrin, Advil, Rufen, others)– Relatively well tolerated and inexpensive.≥ 50 kg: 400-800 mg po q6h
< 50 kg: 10 mg/kg po q6-8h		Per unit: $0.05/600 mg Rx; $0.02/200 mg OTC
30 days: $6.00; $3.60
Indomethacin (Indocin, Indometh, others)– Higher incidence of dose-related toxic effects, especially GI and bone marrow effects.≥ 50 kg: 25-50 mg po bid-qidPer unit: $0.38/25 mg; $0.64/50 mg
30 days: $45.60; $76.80
Ketorolac tromethamine– Short-term use (< 5 days) only; otherwise, increased risk of GI side effects.≥ 50 kg: 10 mg po q4-6h to a max of 40 mg/d poPer unit: $2.16/10 mg
30 days: Not recommended
Ketorolac tromethamine5– IM or IV NSAID as alternative to opioid.
– Lower doses for elderly.
– Short-term use (< 5 days) only.		≥ 50 kg: 60 mg IM or 30 mg IV initially, then 30 mg q6h IM or IVPer unit: $1.19/30 mg
30 days: Not recommended
Magnesium salicylate (various)≥ 50 kg: 325-650 mg po q6hPer unit: $0.25/325 mg OTC
30 days: $60.00
Meloxicam (Mobic)– Intermediate COX-2/COX-1 ratio similar to diclofenac.≥ 50 kg: 7.5 mg po q12hPer unit: $2.78/7.5 mg
30 days: $166.80
Nabumetone (Relafen)– May be less ulcerogenic than ibuprofen, but overall side effects may not be less.≥ 50 kg: 500-1000 mg po od (max dose 2000 mg/d)Per unit: $0.78/500 mg; $0.82/750 mg
30 days: $46.80; $49.20
Naproxen (Naprosyn, Anaprox, Aleve [OTC], others)– Generally well-tolerated.
– Lower doses for elderly. 		≥ 50 kg: 250-500 mg po q6-8h
< 50 kg: 5 mg/kg q8h		Per unit: $1.26/500 mg Rx; $0.04/220 mg OTC
30 days: $151.20; $3.60 OTC