First line in treating osteoarthritis.
Dose: 325-650 mg every 4-6 hours, with a maximum of 4000 mg/day
6 doses of 650 mg is just below 4000 mg
Patients with liver disease
Chronic alcohol users
Second line in treating osteoarthritis.
Examples of NSAIDs and doses
1200 – 3200 mg/day in 3-4 divided doses, with a max dose of 3200 mg/day
4 doses of 800 mg reaches the maximum dose of 3200 mg.
Naproxen sodium (Aleve®)
275 – 550 mg twice a day, with a max dose of 1375 mg/day
2 doses of 550 mg reaches just below the max dose of 1375mg/day. (5 doses of 275 mg equates to 1375 mg. However, note that naproxen should only be taken twice a day.)
100 mg twice daily or 200 mg daily, with a max dose of 200 mg/day.
Usually used in combination with other medication.
Can be used alone for mild pain.
Diclofenac (Solaraze®, Voltaren Gel®)
Lower extremity – use 4g four times daily
Upper extremity – use 2g four times daily
Apply four times daily, takes 2 weeks to work
Considered a supplement
Not for patients allergic to oysters, crab shells, and shell fish.
Dose: 500 mg three times daily
Should be taken for at least 1 month before improvement occurs.
(Rare) Not for patients allergic to shark and cow cartilage.
Dose: 400 mg three times daily
Should be taken for at least 1 month to see results.
Intra-articular Corticosteroid Injections
For painful flares of osteoarthritis of the knees of hips.
Dose is based on size of joints.
Breakdown of cartilage or bone with long term use
Do not inject more than 3 or 4 times in 1 year.
A maximum of 1 injection every 3 months.
Only for the knees.
Drugs & Doses:
Hyalgan® – weekly injection of 2 mL for 5 weeks.
Supartz® – weekly injection of 2 mL for 5 weeks.
Synvisc® – weekly injection of 2 mL for 3 weeks.
Orthovisc® – weekly injection of 2 mL for 3 weeks.
Tramadol – add on to NSAID
Tetracycline/Doxycycline – delays loss to narrowing of joint spaces