Dose: 500mg – 1g, 4–6 hourly. Max dose 4g in 24 hours
Preparations: Tablets/caplets/capsules: 500mg, 1g
Dispersible tablets: 500mg
Oral suspension: 120mg/5ml, 250mg/5ml, 500mg/5ml
Suppositories: 60mg, 125mg, 250mg, 500mg
Injection for IV infusion: 10mg/ml, 50ml (500mg) and 100ml (1g) vials
Reduce dose if severe liver disease, alcohol dependence, malnutrition, low weight (<50kg), frail elderly.
Dose interval should be ≥ 6h if severe renal impairment.
Indications: for analgesia in palliative care, including action as adjuvant analgesic
Assess analgesic response after regular use for one week
Patients considered to be at risk of NSAID induced gastroduodenal ulceration (age over 65 years, past history of peptic ulcer disease, concomitant oral steroids or anticoagulants, serious
comorbidity) should receive a gastro-protective drug such as a proton pump inhibitor.
Use with extreme caution in renal failure. Fluid retention and renal function may all be worsened by NSAIDs. There is little evidence to suggest that any particular NSAID is safer than another in respect of renal toxicity.
NSAIDs may be considered for asthmatic patients unless they have a history of sensitivity.
Usually first line NSAID
Oral: 200-400mg TDS
Tablet: 200mg, 400mg, 600mg
MR tablet: 800mg OD
MR capsule: 300mg BD
Granules: 600mg sachet
Gel for topical use 5% and 10%
Current evidence suggests an increased risk of cardiovascular thrombotic events with NSAIDs.
For those at risk consider naproxen or low dose ibuprofen (1200mg or less/24h)
Oral: 500mg – 1g BD
It appears to be associated with a lower incidence of GI side effects
Oral: 250-500mg BD
Tablet: 250mg, 500mg
It appears to be associated with a lower risk of cardiovascular thrombotic events
Up to 150mg in 24 hours
Can be given via CSCI but not compatible with other drugs
Injection can cause skin necrosis
Tablet: 25mg, 50mg
Modified Release tablets and capsules: 75mg, 100mg
Dispersible tablets: 50mg
Suppositories: 12.5mg, 25mg, 50mg, 100mg
Gel: For topical use
Low GI Risk
Higher cardiac risk
MR = Modified release
EC = enteric coated
In patients who are terminally ill the increased risk of renal, cardiovascular and GI toxicity associated with NSAIDs must be weighed against the potential for improved pain control.
For further guidance on the use of NSAIDs (including alternative parenteral agents) consult your local Specialist Palliative Care Team.
Use the links below for more steps:
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.