USUAL DOSE.— 300 to 650 mg every 4 hours and up to 1 g four times daily, not to exceed 4 g per day.
Ibuprofen (Motrin)
ACTION AND USE.— Ibuprofen is indicated for the relief of mild to moderate pain, including headaches and menstrual cramps. It is also used as an anti-inflammatory agent in the treatment of arthritis, tendinitis, bursitis, etc. It is not recommended in the third trimester of pregnancy, gastrointestinal bleeding, or renal impairment.
USUAL DOSE.— Do not exceed 2.4 g per day. For mild to moderate pain, give 400 mg every 4 to 6 hours as needed. For anti-inflammatory use, give 300 to 600 mg three or four times daily as needed. It may be taken with food or milk.
Naproxen Sodium (Anaprox)
ACTION AND USE.— Naproxen sodium was developed as an analgesic because it is more rapidly absorbed than naproxen (Naprosyn), a non-steroidal anti-inflammatory with analgesic and antipyretic properties. It is indicated for the relief of mild to moderate pain and for the treatment of primary dysmenorrhea, rheumatoid arthritis, osteoarthritis, tendinitis and bursitis, and acute gout. Its effects are similar to aspirin and indomethacin but with less toxic gastrointestinal side effects; however, it is not indicated for patients with a history of gastrointestinal disease, especially those with a propensity for peptic ulcer disease.
USUAL DOSE.— Two tablets initially then one tablet every 6 to 8 hours as required for mild to moderate pain but not to exceed 5 tablets daily. For long term treatment of arthritis, one tablet twice daily for two to four weeks.
Indomethacin (Indocin)
ACTION AND USE.— Indomethacin is a potent anti-inflammatory agent with antipyretic and analgesic properties. Because it may cause side effects, it should be reserved for cases of chronic rheumatoid arthritis, osteoarthritis, or acute gout.
USUAL DOSE.— 25 to 50 mg two to three times daily not to exceed 200 mg daily.
Tolmetin Sodium (Tolectin)
ACTION AND USE.— Tolmetin sodium has the same indications, contraindications, and uses as indomethacin.
USUAL DOSE.— 400 mg three times daily initially, then adjusted to patient response but not to exceed 2000 mg daily.
Sulindac (Clinoril)
ACTION AND USE.— Sulindac has the same indication, contraindication, and uses as indomethacin and tolmetin sodium but is longer lasting.
USUAL DOSE.— 15o to 200 mg twice daily with food.
Phenylbutazone (Butazolidine)
ACTION AND USE.— Along with its antiinflammatory properties, phenylbutazone is regarded as a potent analgesic for relief of the pain of rheumatoid arthritis and associated condition. Because of its high incidence of toxic side effects, it is recommended only for patients who do not respond to less toxic drugs. It is also used to relieve the symptoms of acute gouty arthritis when less conservative measures are not effective.
USUAL DOSE.— Initially, 300 to 600 mg daily in three or four equally divided doses with food or milk. The dosage is adjusted to the lowest level to receive favorable results. If favorable results are not obtained in 7 to 10 days, treatment with phenylbutazone should be discontinued.
CENTRAL NERVOUS SYSTEM STIMULANTS
Certain drugs stimulate the activity of various portions of the central nervous system (CNS). Chapter 21 of the Manual of the Medical Department (MANMED) is explicit as to the usage of these drugs in the Navy. Primary indications for this class of drugs are narcolepsy, hyperkinesis, and attention deficit disorders in children. Central nervous system stimulants are generally contraindicated in patients with hypertension, arteriosclerosis, symptomatic cardiovascular disorders, agitated states, glaucoma, or history of drug abuse.
