Oral drugs for mild, acute nociceptive pain in adults

Paracetamol should be used first line for mild, acute nociceptive pain because of its favourable safety profile. In adults, use:

1 paracetamol immediate-release 1 g orally, 4-to 6-hourly. Maximum 4 g in 24 hours acute pain, mild (adults) paracetamol

OR

1 paracetamol modified-release 1.33 g orally, 8-hourly. Maximum 4 g in 24 hours. paracetamol

The combination of paracetamol and an NSAID is synergistic, and improved pain relief is achieved compared with either drug alone. If paracetamol alone is unlikely to provide adequate analgesia (eg pain with an inflammatory component), paracetamol and NSAIDs may be used together; however, NSAIDs can cause significant adverse effects and their use is contraindicated in some patients. In adults with mild, acute nociceptive pain, use:

1 paracetamol immediate-release 1 g orally, 4-to 6-hourly. Maximum 4 g in 24 hours paracetamol

OR

1 paracetamol modified-release 1.33 g orally, 8-hourly. Maximum 4 g in 24 hours paracetamol

PLUS ONE OF THE FOLLOWING NSAIDS

1 celecoxib 100 to 200 mg orally, twice daily acute pain, mild (adults) celecoxib

OR

1 ibuprofen 200 to 400 mg orally, 3 times daily¹ acute pain, mild (adults) ibuprofen

OR

1 naproxen 250 to 500 mg orally, twice daily². acute pain, mild (adults) naproxen

An NSAID may be considered as monotherapy for mild, acute nociceptive pain with an inflammatory component. In adults with mild, acute nociceptive pain, use:

1 celecoxib 100 to 200 mg orally, twice daily celecoxib

OR

1 ibuprofen 200 to 400 mg orally, 3 times daily¹ ibuprofen

OR

1 naproxen 250 to 500 mg orally, twice daily². naproxen

If oral administration is not possible (eg the patient cannot take oral medications, or has impaired gastrointestinal absorption), consider an alternative route of administration.

¹ Avoid ibuprofen in patients at increased risk of bleeding or gastrointestinal toxicity. In these patients, celecoxib is preferred. See Nonsteroidal anti-inflammatory drugs (NSAIDs) in pain management for further advice on adverse effects and contraindications. Return

² Avoid naproxen in patients at increased risk of bleeding or gastrointestinal toxicity. In these patients, celecoxib is preferred. See Nonsteroidal anti-inflammatory drugs (NSAIDs) in pain management for further advice on adverse effects and contraindications.Return