Acute kidney injury
Nonsteroidal anti-inflammatory drug
Visual analog scale
Table 14.1.1 NSAID and Acetaminophen Dosing |Favorite Table|Download (.pdf)
Table 14.1.1 NSAID and Acetaminophen Dosing
Nonselective NSAIDs (COX-1 and 2 inhibitors)
325–1,000 mg PO Q 4–6 h
- Though data are limited, it appears other NSAIDs may interfere with the antiplatelet effects of aspirin (J Clin Pharm. 2008;48:117; J Am Coll Cardiol. 2004;43:985.); administer NSAIDs 2 h after aspirin
- IV ketorolac should be limited to 5 days of therapy due to risk of AKI (Ann Int Med. 1997;126:193)
- NSAIDs are one of the most commonly implicated drugs leading to hospitalization due to an adverse effect (Br J Clin Pharmacol. 2007;63:136), see Table 14.1.2
- In patients requiring an NSAID: consider naproxen if high CV risk, consider a COX-2 inhibitor if high GI risk; consider adding a PPI to naproxen if high CV and GI risk (Aliment Pharmacol Ther. 2009;29:481)
50 mg PO Q 8 h
200–400 mg PO Q 6–8 h
200 mg PO Q 4–6 h
200–400 mg PO Q 4–6 h
25–50 mg PO Q 6–8 h
15–30 mg IV Q 6 h
250 mg PO Q 6–8 h, or
500 mg PO Q 12 h
Selective NSAIDs (COX-2 inhibitors)
200 mg PO Q 12 h
- Meloxicam and nabumetone lose COX-2 selectivity at higher doses; more GI bleeds observed with 15 mg vs. 7.5 mg meloxicam (Am J Med. 2004;117:100)
- Cross-sensitivity to celecoxib in sulfonamide allergic patients appears low (Drug Safety. 2003;26:187)
7.5–15 mg PO QD
1,000–2,000 mg PO QD
325–1,000 mg PO Q 4–6 h
- Historically, the maximum daily dose of acetaminophen has been 4 g/day (2 g in liver disease); in 2011 the FDA suggested lowering this limit to 2.6 g/day and to avoid acetaminophen in patients with liver disease over concerns for increasing incidence of overdose
Table 14.1.2 NSAID Adverse Effects |Favorite Table|Download (.pdf)
Table 14.1.2 NSAID Adverse Effects
- Heart failure exacerbation
- Increased risk of MI in patients with CAD
- ACC/AHA recommends avoiding NSAIDs when possible in patients with heart failure (Circulation. 2009;119(14):e391) or post-MI (J Am Coll Cardiol. 2007;50:e1)
- Naproxen appears to have lower risk of MI (Aliment Pharmacol Ther. 2009;29:481)
- Increased hospitalizations for heart failure associated with NSAIDs (Arch Intern Med. 2009;169:141) likely secondary to fluid retention and systemic vasoconstriction
- Short- and long-term NSAIDs are associated with slight increased risk of MI and death in patients with a history ...
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