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ANTI-INFLAMMATORY DRUGS, NONSTEROIDAL (Systemic)

Some commonly used brand names are:

In the U.S.—

Actron ⁹
Advil ⁷
Advil Caplets ⁷
Advil, Children"s ⁷
Aleve ¹⁴
Anaprox ¹⁴
Anaprox DS ¹⁴
Ansaid ⁶
Bayer Select Ibuprofen Pain Relief Formula Caplets ⁷
Cataflam ¹
Clinoril ¹⁸
Cotylbutazone ¹⁶
Cramp End ⁷
Daypro ¹⁵
Dolgesic ⁷
Dolobid ²
EC-Naprosyn ¹⁴
Excedrin IB ⁷
Excedrin IB Caplets ⁷
Feldene ¹⁷
Genpril ⁷
Genpril Caplets ⁷
Haltran ⁷
Ibifon 600 Caplets ⁷
Ibren ⁷
Ibu ⁷
Ibu-200 ⁷
Ibu-4 ⁷
Ibu-6 ⁷
Ibu-8 ⁷
Ibuprin ⁷
Ibuprohm ⁷
Ibuprohm Caplets ⁷
Ibu-Tab ⁷
Indocin ⁸
Indocin SR ⁸
Lodine ³
Lodine XL ³
Meclomen ¹⁰
Medipren ⁷
Medipren Caplets ⁷
Midol IB ⁷
Mobic ¹²
Motrin ⁷
Motrin Chewables ⁷
Motrin, Children"s ⁷
Motrin, Children"s Oral Drops ⁷
Motrin-IB ⁷
Motrin-IB Caplets ⁷
Motrin, Junior Strength Caplets ⁷
Nalfon ⁴
Nalfon 200 ⁴
Naprelan ¹⁴
Naprosyn ¹⁴
Nuprin ⁷
Nuprin Caplets ⁷
Orudis ⁹
Orudis KT ⁹
Oruvail ⁹
Pamprin-IB ⁷
Ponstel ¹¹
Q-Profen ⁷
Relafen ¹³
Rufen ⁷
Tolectin 200 ²¹
Tolectin 600 ²¹
Tolectin DS ²¹
Trendar ⁷
Voltaren ¹

In Canada—

Actiprofen Caplets ⁷
Advil ⁷
Advil Caplets ⁷
Albert Tiafen ²⁰
Alka Butazolidin ¹⁶
Anaprox ¹⁴
Anaprox DS ¹⁴
Ansaid ⁶
Apo-Diclo ¹
Apo-Diflunisal ²
Apo-Flurbiprofen ⁶
Apo-Ibuprofen ⁷
Apo-Indomethacin ⁸
Apo-Keto ⁹
Apo-Keto-E ⁹
Apo-Napro-Na ¹⁴
Apo-Napro-Na DS ¹⁴
Apo-Naproxen ¹⁴
Apo-Phenylbutazone ¹⁶
Apo-Piroxicam ¹⁷
Apo-Sulin ¹⁸
Apo-Tenoxicam ¹⁹
Butazolidin ¹⁶
Clinoril ¹⁸
Daypro ¹⁵
Dolobid ²
Feldene ¹⁷
Froben ⁶
Froben SR ⁶
Idarac ⁵
Indocid ⁸
Indocid SR ⁸
Medipren Caplets ⁷
Mobiflex ¹⁹
Motrin ⁷
Motrin-IB ⁷
Nalfon ⁴
Naprosyn ¹⁴
Naprosyn-E ¹⁴
Naprosyn-SR ¹⁴
Naxen ¹⁴
Novo-Difenac ¹
Novo-Difenac SR ¹
Novo-Diflunisal ²
Novo-Flurprofen ⁶
Novo-Keto-EC ⁹
Novo-Methacin ⁸
Novo-Naprox ¹⁴
Novo-Naprox Sodium ¹⁴
Novo-Naprox Sodium DS ¹⁴
Novo-Pirocam ¹⁷
Novo-Profen ⁷
Novo-Sundac ¹⁸
Novo-Tenoxicam ¹⁹
Novo-Tolmetin ²¹
Nu-Diclo ¹
Nu-Flurbiprofen ⁶
Nu-Ibuprofen ⁷
Nu-Indo ⁸
Nu-Naprox ¹⁴
Nu-Pirox ¹⁷
Orudis ⁹
Orudis-E ⁹
Orudis-SR ⁹
Oruvail ⁹
PMS-Piroxicam ¹⁷
Ponstan ¹¹
Relafen ¹³
Rhodis ⁹
Rhodis-EC ⁹
Surgam ²⁰
Surgam SR ²⁰
Synflex ¹⁴
Synflex DS ¹⁴
Tolectin 200 ²¹
Tolectin 400 ²¹
Tolectin 600 ²¹
Voltaren ¹
Voltaren Rapide ¹
Voltaren SR ¹

Other commonly used names are: Etodolic acid Indometacin Meclofenamic acid

Note:

For quick reference, the following nonsteroidal anti-inflammatory drugs are numbered to match the corresponding brand names.

This information applies to the following medicines:
1.	Diclofenac (dye-KLOE-fen-ak)
2.	Diflunisal (dye-FLOO-ni-sal)‡
3.	Etodolac (ee-TOE-doe-lak)†
4.	Fenoprofen (fen-oh-PROE-fen)‡
5.	Floctafenine (flok-ta-FEN-een)*
6.	Flurbiprofen (flure-BI-proe-fen)‡§
7.	Ibuprofen (eye-byoo-PROE-fen)‡§
8.	Indomethacin (in-doe-METH-a-sin)‡
9.	Ketoprofen (kee-toe-PROE-fen)‡
10.	Meclofenamate (me-kloe-FEN-am-ate)†‡
11.	Mefenamic Acid (me-fe-NAM-ik)
12.	Meloxicam (mel-OX-i-cam)‡
13.	Nabumetone (na-BYOO-me-tone)
14.	Naproxen (na-PROX-en)‡
15.	Oxaprozin (ox-a-PROE-zin)
16.	Phenylbutazone (fen-ill-BYOO-ta-zone)‡
17.	Piroxicam (peer-OX-i-kam)‡
18.	Sulindac (sul-IN-dak)‡
19.	Tenoxicam (ten-OX-i-kam)*
20.	Tiaprofenic Acid (tie-a-pro-FEN-ik)*
21.	Tolmetin (TOLE-met-in)‡
* Not commercially available in the U.S.
† Not commercially available in Canada
‡ Generic name product may be available in the U.S.
§ Generic name product may be available in Canada

This information does not apply to aspirin or other salicylates or to ketorolac (e.g., Toradol).

Description

Nonsteroidal anti-inflammatory drugs (also called NSAIDs) are used to relieve some symptoms caused by arthritis (rheumatism), such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will help you only as long as you continue to take it.

Some of these medicines are also used to relieve other kinds of pain or to treat other painful conditions, such as:

gout attacks;
bursitis;
tendinitis;
sprains, strains, or other injuries; or
menstrual cramps.

Ibuprofen and naproxen are also used to reduce fever.

Meclofenamate is also used to reduce the amount of bleeding in some women who have very heavy menstrual periods.

Nonsteroidal anti-inflammatory drugs may also be used to treat other conditions as determined by your doctor.

Any nonsteroidal anti-inflammatory drug can cause side effects, especially when it is used for a long time or in large doses. Some of the side effects are painful or uncomfortable. Others can be more serious, resulting in the need for medical care and sometimes even death. If you will be taking this medicine for more than one or two months or in large amounts, you should discuss with your doctor the good that it can do as well as the risks of taking it. Also, it is a good idea to ask your doctor about other forms of treatment that might help to reduce the amount of this medicine that you take and/or the length of treatment.

One of the nonsteroidal anti-inflammatory drugs, phenylbutazone, is especially likely to cause very serious side effects. These serious side effects are more likely to occur in patients 40 years of age or older than in younger adults, and the risk becomes greater as the patient"s age increases. Before you take phenylbutazone, be sure that you have discussed its use with your doctor. Also, do not use phenylbutazone to treat any painful condition other than the one for which it was prescribed by your doctor .

Although ibuprofen and naproxen may be used instead of aspirin to treat many of the same medical problems, they must not be used by people who are allergic to aspirin.

The 200-mg strength of ibuprofen and the 220-mg strength of naproxen are available without a prescription. However, your health care professional may have special instructions on the proper dose of these medicines for your medical condition.

Other nonsteroidal anti-inflammatory drugs and other strengths of ibuprofen and naproxen are available only with your medical doctor"s or dentist"s prescription. These medicines are available in the following dosage forms:

Oral
Diclofenac
- Tablets (U.S. and Canada)
- Delayed-release tablets (U.S. and Canada)
- Extended-release tablets (Canada)
Diflunisal
- Tablets (U.S. and Canada)
Etodolac
- Capsules (U.S.)
- Tablets (U.S.)
- Extended-release tablets (U.S.)
Fenoprofen
- Capsules (U.S. and Canada)
- Tablets (U.S. and Canada)
Floctafenine
- Tablets (Canada)
Flurbiprofen
- Extended-release capsules (Canada)
- Tablets (U.S. and Canada)
Ibuprofen
- Oral suspension (U.S.)
- Tablets (U.S. and Canada)
- Chewable tablets (U.S.)
Indomethacin
- Capsules (U.S. and Canada)
- Extended-release capsules (U.S. and Canada)
- Oral suspension (U.S.)
Ketoprofen
- Capsules (U.S. and Canada)
- Extended-release capsules (U.S. and Canada)
- Tablets (U.S.)
- Delayed-release tablets (Canada)
- Extended-release tablets (Canada)
Meclofenamate
- Capsules (U.S.)
Mefenamic Acid
- Capsules (U.S. and Canada)
Meloxicam
- Tablets (U.S.)
Nabumetone
- Tablets (U.S. and Canada)
Naproxen
- Oral suspension (U.S. and Canada)
- Tablets (U.S. and Canada)
- Delayed-release tablets (U.S. and Canada)
- Extended-release tablets (U.S. and Canada)
Oxaprozin
- Tablets (U.S. and Canada)
Phenylbutazone
- Capsules (U.S.)
- Tablets (U.S. and Canada)
- Buffered tablets (Canada)
Piroxicam
- Capsules (U.S. and Canada)
Sulindac
- Tablets (U.S. and Canada)
Tenoxicam
- Tablets (Canada)
Tiaprofenic Acid
- Extended-release capsules (Canada)
- Tablets (Canada)
Tolmetin
- Capsules (U.S. and Canada)
- Tablets (U.S. and Canada)

Rectal
Diclofenac
- Suppositories (Canada)
Indomethacin
- Suppositories (U.S. and Canada)
Ketoprofen
- Suppositories (Canada)
Naproxen
- Suppositories (Canada)
Piroxicam
- Suppositories (Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your health care professional will make. For the nonsteroidal anti-inflammatory drugs, the following should be considered:

Allergies—Tell your health care professional if you have ever had any unusual or allergic reaction to any of the nonsteroidal anti-inflammatory drugs, or to any of the following medicines:

Aspirin or other salicylates
Ketorolac (e.g., Toradol)
Oxyphenbutazone (e.g., Oxalid, Tandearil)
Suprofen (e.g., Suprol)
Zomepirac (e.g., Zomax)

Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet—Make certain your health care professional knows if you are on any special diet, such as a low-sodium or low-sugar diet. Some of these medicines contain sodium or sugar.

Pregnancy—Studies on birth defects with these medicines have not been done in humans. However, there is a chance that these medicines may cause unwanted effects on the heart or blood flow of the fetus or newborn baby if they are taken regularly during the last few months of pregnancy. Also, studies in animals have shown that these medicines, if taken late in pregnancy, may increase the length of pregnancy, prolong labor, or cause other problems during delivery. If you are pregnant, do not take any of these medicines, including nonprescription (over-the-counter [OTC]) ibuprofen or naproxen, without first discussing its use with your doctor.

Studies in animals have not shown that fenoprofen, floctafenine, flurbiprofen, ibuprofen, ketoprofen, nabumetone, phenylbutazone, piroxicam, tiaprofenic acid, or tolmetin causes birth defects. Diflunisal caused birth defects of the spine and ribs in rabbits, but not in mice or rats. Diclofenac and meclofenamate caused unwanted effects on the formation of bones in animals. Etodolac and oxaprozin caused birth defects in animals. Indomethacin caused slower development of bones and damage to nerves in animals. In some animal studies, sulindac caused unwanted effects on the development of bones and organs. Studies on birth defects with mefenamic acid have not been done in animals.

Even though most of these medicines did not cause birth defects in animals, many of them did cause other harmful or toxic effects on the fetus, usually when they were given in such large amounts that the pregnant animals became sick.

For naproxen: Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding—

For indomethacin : Indomethacin passes into the breast milk and has been reported to cause unwanted effects in nursing babies.
For meclofenamate : Use of meclofenamate by nursing mothers is not recommended, because in animal studies it caused unwanted effects on the newborn"s development.
For nabumetone: Use of nabumetone is not recommended because it may cause unwanted effects in nursing babies
For naproxen: Use of naproxen is not recommended because it may cause unwanted effects in nursing babies
For phenylbutazone : Phenylbutazone passes into the breast milk and may cause unwanted effects, such as blood problems, in nursing babies.
For piroxicam : Studies in animals have shown that piroxicam may decrease the amount of milk.

Although other anti-inflammatory analgesics have not been reported to cause problems in nursing babies, diclofenac, diflunisal, fenoprofen, flurbiprofen, meclofenamate, mefenamic acid, naproxen, piroxicam, and tolmetin pass into the breast milk. It is not known whether etodolac, floctafenine, ibuprofen, ketoprofen, nabumetone, oxaprozin, sulindac, or tiaprofenic acid passes into human breast milk.

Children—

For ibuprofen : Ibuprofen has been tested in children 6 months of age and older. It has not been shown to cause different side effects or problems than it does in adults.
For indomethacin and for tolmetin : Indomethacin and tolmetin have been tested in children 2 years of age and older and have not been shown to cause different side effects or problems than they do in adults.
For naproxen : Studies with naproxen in children 2 years of age and older have shown that skin rash may be more likely to occur.
For oxaprozin : Oxaprozin has been used in children with arthritis. However, there is no specific information comparing use of this medicine in children with use in other age groups.
For phenylbutazone : Use of phenylbutazone in children up to 15 years of age is not recommended.
For other anti-inflammatory analgesics : There is no specific information on the use of other anti-inflammatory analgesics in children.

Most of these medicines, especially indomethacin and phenylbutazone, can cause serious side effects in any patient. Therefore, it is especially important that you discuss with the child"s doctor the good that this medicine may do as well as the risks of using it.

Older adults—Certain side effects, such as confusion, swelling of the face, feet, or lower legs, or sudden decrease in the amount of urine, may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of nonsteroidal anti-inflammatory drugs. Also, elderly people are more likely than younger adults to get very sick if these medicines cause stomach problems. With phenylbutazone, blood problems may also be more likely to occur in the elderly.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a nonsteroidal anti-inflammatory drug, it is especially important that your health care professional know if you are taking any of the following:

Alcohol or
Corticosteroids taken orally (cortisone-like medicine) or
Corticotropin (e.g., HP Acthar) or
Potassium supplements (e.g., K-Dur, Slow-K)—May increase the risk of serious stomach problems such as ulcers and bleeding

Anticoagulants (blood thinners) or
Cefamandole (e.g., Mandol) or
Cefoperazone (e.g., Cefobid) or
Cefotetan (e.g., Cefotan) or
Heparin or
Plicamycin (e.g., Mithracin) or
Valproic acid—The chance of bleeding may be increased

Aspirin—The chance of serious side effects may be increased if aspirin is used together with a nonsteroidal anti-inflammatory drug on a regular basis

Ciprofloxacin (e.g., Cipro) or
Enoxacin (e.g., Penetrex) or
Itraconazole (e.g., Sporanox) or
Ketoconazole (e.g., Nizoral) or
Lomefloxacin (e.g., Maxaquin) or
Norfloxacin (e.g., Noroxin) or
Ofloxacin (e.g., Floxin) or
Tetracyclines, oral—The buffered form of phenylbutazone (e.g., Alka Butazolidin) may keep these medicines from working properly if the 2 medicines are taken too close together

Cyclosporine (e.g., Sandimmune) or
Digitalis glycosides (heart medicine) or
Lithium (e.g., Lithane) or
Methotrexate (e.g., Mexate) or
Phenytoin (e.g., Dilantin)—Higher blood levels of these medicines and an increased chance of side effects may occur

Penicillamine (e.g., Cuprimine)—The chance of serious side effects may be increased, especially with phenylbutazone (e.g., Cotylbutazone)

Probenecid (e.g., Benemid)—Higher blood levels of the nonsteroidal anti-inflammatory drug and an increased chance of side effects may occur

Triamterene (e.g., Dyrenium)—The chance of kidney problems may be increased, especially with indomethacin

Zidovudine (e.g., AZT, Retrovir)—The chance of serious side effects may be increased, especially with indomethacin

Other medical problems—The presence of other medical problems may affect the use of nonsteroidal anti-inflammatory drugs. Make sure you tell your doctor if you have any other medical problems, especially:

Alcohol abuse or
Bleeding problems or
Colitis, Crohn"s disease, diverticulitis, stomach ulcer, or other stomach or intestinal problems or
Diabetes mellitus (sugar diabetes) or
Hemorrhoids or
Hepatitis or other liver disease or
Kidney disease (or history of) or
Rectal irritation or bleeding, recent, or
Stomach or colon irritation or bleeding, recent, or
Systemic lupus erythematosus (SLE) or
Tobacco use (or recent history of)—The chance of side effects may be increased

Anemia or
Asthma or
Epilepsy or
Fluid retention (swelling of feet or lower legs) or
Heart disease or
High blood pressure or
Kidney stones (or history of) or
Low platelet count or
Low white blood cell count or
Mental illness or
Parkinson"s disease or
Polymyalgia rheumatica or
Porphyria or
Temporal arteritis—Some nonsteroidal anti-inflammatory drugs may make these conditions worse

Ulcers, sores, or white spots in mouth—Ulcers, sores, or white spots in the mouth sometimes mean that the medicine is causing serious side effects; if these sores or spots are already present before you start taking the medicine, it will be harder for you and your doctor to recognize that these side effects might be occurring

Proper Use of This Medicine

For patients taking a capsule, tablet (including caplet), or liquid form of this medicine:

Take tablet or capsule forms of these medicines with a full glass (8 ounces) of water . Also, do not lie down for about 15 to 30 minutes after taking the medicine. This helps to prevent irritation that may lead to trouble in swallowing.
To lessen stomach upset, these medicines should be taken with food or an antacid. This is especially important when you are taking indomethacin, mefenamic acid, phenylbutazone, or piroxicam, which should always be taken with food or an antacid. Taking the extended-release tablet dosage form of flurbiprofen or naproxen and taking nabumetone with food may also help the medicine be absorbed into your body more quickly. However, your doctor may want you to take the first 1 or 2 doses of other nonsteroidal anti-inflammatory drugs 30 minutes before meals or 2 hours after meals. This helps the medicine start working a little faster when you first begin to take it. However, after the first few doses, take the medicine with food or an antacid.
It is not necessary to take delayed-release (enteric-coated) tablets with food or an antacid, because the enteric coating helps protect your stomach from the irritating effects of the medicine. Also, it is not necessary to take ketoprofen extended-release capsules (e.g., Oruvail) with food or an antacid, because the medicine inside the capsules is enteric coated.
If you will be taking your medicine together with an antacid, one that contains magnesium and aluminum hydroxides (e.g., Maalox) may be the best kind of antacid to use, unless your doctor has directed you to use another antacid. However, do not mix the liquid form of ibuprofen, indomethacin, or naproxen together with an antacid, or any other liquid, before taking it. To do so may cause the medicine to break down. If stomach upset (indigestion, nausea, vomiting, stomach pain, or diarrhea) continues or if you have any questions about how you should be taking this medicine, check with your health care professional.
Some of these medicines must be swallowed whole. Tablets should not be crushed, chewed, or broken, and capsules should not be emptied out, before you take the medicine. These include delayed-release (enteric-coated) or extended-release tablets or capsules, diflunisal tablets (e.g., Dolobid), and phenylbutazone tablets (e.g., Butazolidin). If you are not sure whether you are taking a delayed-release or extended-release form of your medicine, check with your pharmacist.

For patients using a suppository form of this medicine:

If the suppository is too soft to insert, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
To insert the suppository: First remove the foil wrapper and moisten the suppository with cold water. Lie down on your side and use your finger to push the suppository well up into the rectum.
Indomethacin suppositories should be kept inside the rectum for at least one hour so that all of the medicine can be absorbed by your body. This helps the medicine work better.

For patients taking nonprescription (over-the-counter [OTC]) ibuprofen or naproxen :

This medicine comes with a patient information sheet. Read it carefully. If you have any questions about this information, check with your health care professional.

For safe and effective use of this medicine, do not take more of it, do not take it more often, and do not take it for a longer time than ordered by your health care professional or directed on the nonprescription (over-the-counter [OTC]) package label . Taking too much of any of these medicines may increase the chance of unwanted effects, especially in elderly patients.

When used for severe or continuing arthritis, a nonsteroidal anti-inflammatory drug must be taken regularly as ordered by your doctor in order for it to help you. These medicines usually begin to work within one week, but in severe cases up to two weeks or even longer may pass before you begin to feel better. Also, several weeks may pass before you feel the full effects of the medicine.

For patients taking mefenamic acid :

Always take mefenamic acid with food or antacids .
Do not take mefenamic acid for more than 7 days at a time unless otherwise directed by your doctor. To do so may increase the chance of side effects, especially in elderly patients.

For patients taking phenylbutazone :

Phenylbutazone is intended to treat your current medical problem only. Do not take it for any other aches or pains . Also, phenylbutazone should be used for the shortest time possible because of the chance of serious side effects, especially in patients who are 40 years of age or older.

Dosing—The dose of these medicines will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of suspension that you take, or the number of suppositories that you use, depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the medicine .

People with arthritis usually need to take more of a nonsteroidal anti-inflammatory drug during a flare-up than they do between flare-ups of arthritis symptoms. Therefore, your dose may need to be increased or decreased as your condition changes.

For diclofenac
For tablet dosage form:
- For relieving pain or menstrual cramps:
  - Adults—50 milligrams (mg) three times a day as needed. Your doctor may direct you to take 100 mg for the first dose only.
  - Children—Use and dose must be determined by your doctor.
- For rheumatoid arthritis:
  - Adults—At first, 50 mg three or four times a day. Your doctor may increase the dose, if necessary, up to a total of 225 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
- For osteoarthritis:
  - Adults—At first, 50 mg two or three times a day. Usually, no more than a total of 150 mg a day should be taken. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
- For spondylitis (lower back pain):
  - Adults—At first, 25 mg four or five times a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
For delayed-release tablet dosage form:
- For rheumatoid arthritis:
  - Adults—At first, 50 mg three or four times a day. Your doctor may increase the dose, if necessary, up to a total of 225 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
- For osteoarthritis:
  - Adults—At first, 50 mg two or three times a day. Usually, no more than a total of 150 mg a day should be taken. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
- For spondylitis (lower back pain):
  - Adults—At first, 25 mg four or five times a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
For extended-release tablet dosage form:
- For rheumatoid arthritis, osteoarthritis, or spondylitis:
  - Adults—Usually 75 or 100 mg once a day, in the morning or evening. Some people may need 75 mg twice a day, in the morning and evening. Take the medicine at the same time every day.
  - Children—Use and dose must be determined by your doctor.
For rectal dosage form (suppositories):
- For rheumatoid arthritis, osteoarthritis, or spondylitis:
  - Adults—One 50-mg or 100-mg suppository, inserted into the rectum. The suppository is usually used only at night by people who take tablets during the day. Usually, no more than a total of 150 mg of diclofenac should be used in a day from all dosage forms combined.
  - Children—Use and dose must be determined by your doctor.

For diflunisal
For oral dosage form (tablets):
- For pain:
  - Adults—1000 milligrams (mg) for the first dose, then 500 mg every eight to twelve hours as needed. Some people may need only 500 mg for the first dose, then 250 mg every eight to twelve hours as needed. Usually, no more than a total of 1500 mg a day should be taken.
  - Children—Dose must be determined by your doctor.
- For rheumatoid arthritis or osteoarthritis:
  - Adults—At first, 250 or 500 mg twice a day. Your doctor may increase the dose, if necessary, up to a total of 1500 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Dose must be determined by your doctor.

For etodolac
For oral dosage forms (capsules or tablets):
- For pain:
  - Adults—400 milligrams (mg) for the first dose, then 200 to 400 mg every six to eight hours as needed. Usually, no more than a total of 1200 mg a day should be taken.
  - Children—Use and dose must be determined by your doctor.
- For osteoarthritis:
  - Adults—At first, 400 mg two or three times a day or 300 mg three or four times a day. Usually, no more than a total of 1200 mg a day should be taken. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
For extended-release tablet dosage form:
- For rheumatoid arthritis, osteoarthritis, or spondylitis:
  - Adults—Usually 400 to 1000 mg once a day. Take the medicine at the same time every day.
  - Children—Use and dose must be determined by your doctor.

For fenoprofen
For oral dosage forms (capsules or tablets):
- For pain:
  - Adults—200 milligrams (mg) every four to six hours as needed.
  - Children—Use and dose must be determined by your doctor.
- For arthritis:
  - Adults—At first, 300 to 600 mg three or four times a day. Your doctor may increase the dose, if necessary, up to a total of 3200 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.

For floctafenine
For oral dosage form (tablets):
- For pain:
  - Adults—200 to 400 milligrams (mg) every six to eight hours, as needed. Usually, no more than 1200 mg a day should be taken.
  - Children—Use is not recommended.

For flurbiprofen
For oral tablet dosage form:
- For menstrual cramps:
  - Adults—50 milligrams (mg) four times a day.
  - Children—Use and dose must be determined by your doctor.
- For bursitis, tendinitis, or athletic injuries:
  - Adults—50 mg every four to six hours as needed.
  - Children—Use and dose must be determined by your doctor.
- For rheumatoid arthritis or osteoarthritis:
  - Adults—At first, 200 to 300 mg a day, divided into smaller amounts that are taken two to four times a day. Usually, no more than a total of 300 mg a day should be taken. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
- For spondylitis (lower back pain):
  - Adults—At first, 50 mg four times a day. Your doctor may increase the dose, if necessary, up to a total of 300 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
For extended-release capsule dosage form:
- For arthritis:
  - Adults—200 mg once a day, in the evening. Take the medicine at the same time every day.
  - Children—Use and dose must be determined by your doctor.

For ibuprofen
For oral dosage forms (oral suspension, tablets, chewable tablets):
- For pain or menstrual cramps:
  - Adults and teenagers—200 to 400 milligrams (mg) every four to six hours as needed. If you are taking the medicine without a prescription from your health care professional, do not take more than a total of 1200 mg (six 200-mg tablets) a day.
  - Children up to 12 years of age—Use and dose must be determined by your doctor.
- For fever:
  - Adults and teenagers—200 to 400 mg every four to six hours as needed. If you are taking the medicine without a prescription from your health care professional, do not take more than a total of 1200 mg (six 200-mg tablets) a day.
  - Children 6 months to 12 years of age—The medicine should be used only with a prescription from your doctor. The dose is based on body weight and on the body temperature. For fevers lower than 102.5 °F (39.2 °C) the dose is 5 mg per kilogram (kg) (about 2.2 mg per pound) of body weight. For higher fevers the dose is 10 mg per kg (about 4.5 mg per pound) of body weight.
  - Infants younger than 6 months of age—Use and dose must be determined by your doctor.
- For arthritis:
  - Adults and teenagers—At first, a total of 1200 to 3200 mg a day, divided into smaller amounts that are taken three or four times a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children 6 months to 12 years of age—The dose is based on body weight. At first, a total of 30 to 40 mg per kg (about 13.6 to 18 mg per pound) of body weight a day, divided into smaller amounts that are taken three or four times a day. Your doctor may increase the dose, if necessary, up to a total of 50 mg per kg (about 21 mg per pound) of body weight a day. After your condition improves your doctor may direct you to take a lower dose.
  - Infants younger than 6 months of age—Use and dose must be determined by your doctor.

For indomethacin
For capsule or oral suspension dosage forms:
- For arthritis:
  - Adults—At first, 25 or 50 milligrams (mg) two to four times a day. Your doctor may increase the dose, if necessary, up to a total of 200 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—The dose is based on body weight. At first, 1.5 to 2.5 mg per kilogram (kg) (about 0.7 to 1.1 mg per pound) of body weight a day, divided into smaller amounts that are taken three or four times a day. Your doctor may increase the dose, if necessary, up to a total of 4 mg per kg (about 1.8 mg per pound) of body weight or 200 mg a day, whichever is less. After your condition improves your doctor may direct you to take a lower dose.
- For gout:
  - Adults—100 mg for the first dose, then 50 mg three times a day. After the pain is relieved, your doctor may direct you to take a lower dose for a while before stopping treatment completely.
  - Children—Use and dose must be determined by your doctor.
- For bursitis or tendinitis:
  - Adults—25 mg three or four times a day or 50 mg three times a day.
  - Children—Use and dose must be determined by your doctor.
For extended-release capsule dosage form:
- For arthritis:
  - Adults—75 mg once a day, in the morning or evening. Some people may need to take 75 mg twice a day, in the morning and evening. Take the medicine at the same time each day.
  - Children—Dose must be determined by your doctor.
For rectal suppository dosage form:
- For arthritis, bursitis, tendinitis, or gout:
  - Adults—One 50-mg suppository, inserted into the rectum up to four times a day.
  - Children—One 50-mg suppository, inserted into the rectum up to four times a day. The suppository dosage form is too strong for small children. However, the suppositories may be used for large or heavy children if they need doses as large as 50 mg.

For ketoprofen
For capsule, tablet, or delayed-release tablet dosage forms:
- For pain or menstrual cramps:
  - Adults—25 to 50 milligrams (mg) every six to eight hours as needed. Some people may need to take as much as 75 mg every six to eight hours. Doses larger than 75 mg are not likely to give better relief.
  - Over-the-counter medication—12.5 mg every 4 to 6 hours.
  - Children—Use and dose must be determined by your doctor.
- For arthritis:
  - Adults—At first, 50 mg four times a day or 75 mg three times a day. Your doctor may increase the dose, if necessary, up to a total of 300 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
For extended-release capsule or extended-release tablet dosage forms:
- For arthritis:
  - Adults—150 or 200 mg once a day, in the morning or evening. Take the medicine at the same time every day.
  - Children—Use and dose must be determined by your doctor.
For rectal suppository dosage form:
- For arthritis:
  - Adults—50 or 100 mg twice a day, inserted into the rectum, in the morning and evening. Sometimes, the suppository is used only at night by people who take an oral dosage form (capsules or delayed-release tablets) during the day. Usually, no more than a total of 300 mg of ketoprofen should be used in a day from all dosage forms combined.
  - Children—Use and dose must be determined by your doctor.

For meclofenamate
For oral dosage form (capsules):
- For arthritis:
  - Adults and teenagers 14 years of age and older—At first, 50 milligrams (mg) four times a day. Your doctor may increase the dose, if necessary, up to a total of 400 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children up to 14 years of age—Use and dose must be determined by your doctor.
- For pain:
  - Adults and teenagers 14 years of age and older—50 mg every four to six hours. Some people may need as much as 100 mg every four to six hours.
  - Children up to 14 years of age—Use and dose must be determined by your doctor.
- For menstrual cramps and heavy menstrual bleeding:
  - Adults and teenagers 14 years of age and older—100 mg three times a day for up to six days.
  - Children up to 14 years of age—Use and dose must be determined by your doctor.

For mefenamic acid
For oral dosage form (capsules):
- For pain and for menstrual cramps:
  - Adults and teenagers 14 years of age and older—500 milligrams (mg) for the first dose, then 250 mg every six hours as needed for up to seven days.
  - Children up to 14 years of age—Use and dose must be determined by your doctor.

For meloxicam
For oral dosage form (tablets):
- For osteoarthritis:
  - Adults—7.5 milligrams (mg) daily in a single dose.

For nabumetone
For oral dosage form (tablets):
- For arthritis:
  - Adults—At first, 1000 milligrams (mg) once a day, in the morning or evening, or 500 mg twice a day, in the morning and evening. Your doctor may increase the dose, if necessary, up to a total of 2000 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.

For naproxen
For naproxen (e.g., Naprosyn) tablet and oral suspension dosage forms:
- For rheumatoid arthritis, osteoarthritis, and spondylitis (lower back pain):
  - Adults—At first, 250, 375, or 500 milligrams (mg) two times a day, in the morning and evening. Your doctor may increase the dose, if necessary, up to a total of 1500 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—The dose is based on body weight. At first, 5 mg per kilogram (kg) (about 2.25 mg per pound) of body weight twice a day. After your condition improves your doctor may direct you to take a lower dose.
- For bursitis, tendinitis, menstrual cramps, and other kinds of pain:
  - Adults—500 mg for the first dose, then 250 mg every six to eight hours as needed.
  - Children—Use and dose must be determined by your doctor.
- For gout:
  - Adults—750 mg for the first dose, then 250 mg every eight hours until the attack is relieved.
  - Children—Use and dose must be determined by your doctor.
For naproxen delayed-release tablet (e.g., EC-Naprosyn) dosage form:
- For rheumatoid arthritis, osteoarthritis, and spondylitis (lower back pain) :
  - Adults—At first, 375 or 500 milligrams (mg) two times a day, in the morning and evening. Your doctor may increase the dose, if necessary, up to a total of 1500 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—The delayed-release tablets are too strong for use in children.
For naproxen extended-release tablet (e.g., Naprelan) dosage form:
- For arthritis and pain:
  - Adults—750 to 1000 mg once a day, in the morning or evening.
  - Children—The extended-release tablets are too strong for use in children.
For naproxen (e.g., Naprosyn) rectal suppository dosage form:
- For arthritis:
  - Adults—One 500-mg suppository, inserted into the rectum at bedtime. The suppository is usually used only at night by people who take an oral dosage form (tablets, oral suspension, or delayed-release tablets) during the day. Usually, no more than a total of 1500 mg of naproxen should be used in a day from all dosage forms combined.
  - Children—The suppositories are too strong for use in children.
For naproxen sodium (e.g., Aleve, Anaprox) tablet dosage form:
- For arthritis:
  - Adults—At first, 275 or 550 mg two times a day, in the morning and evening, or 275 mg in the morning and 550 mg in the evening. Your doctor may increase the dose, if necessary, up to a total of 1650 mg a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Naproxen sodium tablets are too strong for most children. Naproxen (e.g., Naprosyn) tablets or oral suspension are usually used for children.
- For bursitis and tendinitis:
  - Adults—550 mg for the first dose, then 275 mg every six to eight hours as needed.
  - Children—Use and dose must be determined by your doctor. Naproxen sodium tablets are too strong for most children.
- For gout:
  - Adults—825 mg for the first dose, then 275 mg every eight hours until the attack is relieved.
  - Children—Use and dose must be determined by your doctor. Naproxen sodium tablets are too strong for most children.
- For pain, fever, and menstrual cramps:
  - Adults and children 12 years of age or older—For nonprescription (over-the-counter [OTC]) use: 220 mg (one tablet) every eight to twelve hours as needed. Some people may get better relief if they take 440 mg (two tablets) for the first dose, then 220 mg twelve hours later on the first day only. If you are taking this medicine without a prescription from your health care professional, do not take more than three 220-mg tablets a day. If you are older than 65 years of age, do not take more than two 220-mg tablets a day. Your health care professional may direct you to take larger doses.
  - Children up to 12 years of age—Use and dose must be determined by your doctor.

For oxaprozin
For oral dosage form (tablets):
- For arthritis:
  - Adults—At first, 600 milligrams (mg) once or twice a day, or 1200 mg once a day. Some people may need a larger amount for the first dose only. Your doctor may increase the dose, if necessary, up to 1800 mg a day. This large dose should always be divided into smaller amounts that are taken two or three times a day. After your condition improves your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.

For phenylbutazone
For oral dosage forms (capsules, tablets, and buffered tablets):
- For severe arthritis:
  - Adults and teenagers 15 years of age and older—At first, 100 milligrams (mg) three or four times a day. Some people may need a higher dose of 200 mg three times a day. After your condition improves your doctor may direct you to take a lower dose for a while before stopping treatment completely. This medicine should not be taken for longer than a few weeks.
  - Children up to 15 years of age—Use is not recommended.
- For gout:
  - Adults—400 mg for the first dose, then 100 mg every four hours for one week or less.
  - Children up to 15 years of age—Use is not recommended.

For piroxicam
For oral dosage form (capsules):
- For arthritis:
  - Adults—20 milligrams (mg) once a day or 10 mg twice a day.
  - Children—Dose must be determined by your doctor.
- For menstrual cramps:
  - Adults—40 mg once a day for one day only, then 20 mg once a day if needed.
  - Children—Dose must be determined by your doctor.
For rectal dosage form (suppositories):
- For arthritis:
  - Adults—20 mg once a day or 10 mg twice a day.
  - Children—Dose must be determined by your doctor.

For sulindac
For oral dosage form (tablets):
- For arthritis:
  - Adults—At first, 150 or 200 milligrams (mg) twice a day. After your condition improves, your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
- For gout, bursitis, or tendinitis:
  - Adults—At first, 200 mg twice a day. After the pain is relieved, your doctor may direct you to take a lower dose for a while before treatment is stopped completely.
  - Children—Use and dose must be determined by your doctor.

For tenoxicam
For oral dosage form (tablets):
- For arthritis:
  - Adults and teenagers 16 years of age and older—At first, 20 milligrams (mg) once a day, at the same time each day. For some people, a smaller dose of 10 mg (one-half tablet) a day may be enough.
  - Children and teenagers up to 16 years of age—Dose must be determined by your doctor.

For tiaprofenic acid
For oral tablet dosage form:
- For arthritis:
  - Adults—At first, 200 milligrams (mg) three times a day or 300 mg twice a day. After your condition improves, your doctor may direct you to take a lower dose.
  - Children—Use and dose must be determined by your doctor.
For extended-release capsule dosage form:
- For arthritis:
  - Adults—600 mg (two capsules) once a day, at the same time each day.
  - Children—Use and dose must be determined by your doctor.

For tolmetin
For oral dosage forms (capsules or tablets):
- For arthritis:
  - Adults—At first, 400 milligrams (mg) three times a day. Your doctor may increase the dose, if necessary, up to a total of 1800 mg a day. After your condition improves, your doctor may direct you to take a lower dose.
  - Children 2 years of age and older—The dose is based on body weight. At first, 20 mg per kilogram (kg) (about 9 mg per pound) of body weight a day, divided into smaller amounts that are taken three or four times a day. Your doctor may increase the dose, if necessary, up to 30 mg per kg (about 13.5 mg per pound) of body weight a day. After your condition improves, your doctor may direct you to take a lower dose.
  - Children up to 2 years of age—Dose must be determined by your doctor.

Missed dose—If your health care professional has ordered you to take this medicine according to a regular schedule, and you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. (For long-acting medicines or extended-release dosage forms that are only taken once or twice a day, take the missed dose only if you remember within an hour or two after the dose should have been taken. If you do not remember until later, skip the missed dose and go back to your regular dosing schedule.) Do not double doses.

Storage—To store this medicine:

Keep out of the reach of children.