| Ibuprofen |
COX-1 = COX-2 |
2–4 hrs |
~30 min |
200–800 mg q6–8h (max 3200 mg/day) |
Hepatic / Renal |
Fast-acting, OTC, well-tolerated short-term |
Avoid high doses chronically; nephrotoxic with ACEi/diuretics; affects platelet function |
| Naproxen |
COX-1 > COX-2 |
12–17 hrs |
~1 hr |
250–500 mg BID (max 1000 mg/day) |
Hepatic / Renal |
Long half-life allows BID dosing |
Lower CV risk; watch renal/GI toxicity |
| Diclofenac |
COX-2 > COX-1 |
~2 hrs |
~20–30 min |
50 mg TID (max 150 mg/day) |
Hepatic / Renal |
Multiple forms (topical, oral, patch); potent anti-inflammatory |
High CV & hepatic risk; caution in CVD and liver disease |
| Indomethacin |
COX-1 > COX-2 |
4–5 hrs |
~30–60 min |
25–50 mg TID (max 200 mg/day) |
Hepatic / Renal |
Strong for gout flares |
High CNS side effects (headache, dizziness, confusion), especially in elderly |
| Ketorolac |
COX-1 > COX-2 |
4–6 hrs |
~30 min |
PO: 10 mg q4–6h (max 5 days) |
Hepatic / Renal |
Very potent; good for post-op pain, often used IV/IM |
Severe GI and renal toxicity limits use to 5 days max |
| Meloxicam |
COX-2 > COX-1 |
15–20 hrs |
~1–2 hrs |
7.5–15 mg once daily |
Hepatic / Renal |
Once-daily dosing, less GI upset |
Safer GI profile than most non-selective NSAIDs |
| Celecoxib |
COX-2 selective |
~11 hrs |
~1 hr |
100–200 mg BID (max 400 mg/day) |
CYP2C9 hepatic metabolism |
Lower GI risk; no effect on platelet aggregation |
↑CV risk; caution with sulfa allergy |
| Piroxicam |
COX-1 = COX-2 |
45–50 hrs |
~3 hrs |
10–20 mg once daily |
Hepatic / Renal |
Longest acting NSAID, good for chronic arthritis |
Not recommended for elderly due to long half-life and high GI risk |
| Etodolac |
COX-2 > COX-1 |
6–8 hrs |
~30–60 min |
200–400 mg BID |
Hepatic / Renal |
Better GI profile than others |
Adjust in renal impairment |
| Sulindac |
Prodrug (non-selective) |
7–8 hrs |
Delayed (~1–2 hrs) |
150–200 mg BID |
Hepatic (active metabolite) / Renal |
Prodrug: activated in liver; less GI irritation in theory |
Still has renal risk; avoid in CKD |
