Suggested nonsteroidal anti-inflammatory drug (NSAID) doses in primary dysmenorrhea

Drug	Initial dose	Subsequent dose, as needed	Maximum dose per day in short-term use (≤3 days)
Propionic (phenylpropionic) acids
Ibuprofen*	400 to 600 mg	400 to 600 mg every 4 to 6 hours	2400 mg
Ibuprofen*	800 mg	800 mg every 8 hours	2400 mg
Naproxen base*	500 mg	250 mg every 6 to 8 hours	1250 mg
Naproxen sodium*	550 mg	275 every 6 to 8 hours	1375 mg
Fenoprofen	200 mg	200 mg every 4 to 6 hours	3200 mg
Ketoprofen	50 mg	25 to 50 mg every 6 to 8 hours	300 mg
Fenamates
Mefenamic acid	500 mg	250 mg every 6 hours	1000 mg
Meclofenamate	100 mg	50 mg every 4 to 6 hours	400 mg
Acetic acids
Indomethacin	25 mg	25 mg three times daily	150 mg
Tolmetin	400 mg	400 mg three times daily	1800 mg
Diclofenac	75 to 100 mg	50 mg three times daily	150 mg (100 mg beginning on day 2 in some countries)
Etodolac	400 mg	200 to 400 mg every 6 to 8 hours (immediate release)	1000 mg (immediate release)
Salicylates (nonacetylated)
Diflunisal^¶	1000 mg	500 mg twice daily	1500 mg
Oxicams
Meloxicam^Δ	7.5 mg	7.5 mg once daily	15 mg
Piroxicam^◊	20 mg	10 to 20 mg once daily	20 mg

NSAIDs are taken at the first onset of menses and continued for 1 to 3 days or usual duration of painful symptoms. Patients with severe symptoms may begin taking an NSAID 1 to 2 days prior to onset of menses. All doses shown are for oral administration in adult or adolescent women. Patients should be well hydrated and without significant kidney disease (CrCl >60 mL/minute).
Avoid NSAID use in women with a history of gastrointestinal bleeding, coagulopathy, ischemic heart disease, stroke, heart failure, liver disease, or aspirin-sensitive asthma.
Use with caution or avoid in patients receiving co-medication with anticoagulants, systemic glucocorticoids, lithium, loop diuretics, and other interacting drugs. Specific interactions may be checked by using the Lexi-Interact program included with UpToDate.

* Available without a prescription in the United States and other countries. Naproxen sodium is more rapidly absorbed than naproxen base.
¶ Minimal or no effect on platelet functioning and generally tolerated by adults with asthma at daily dose of ≤1000 mg.
Δ Relatively COX-2 selective and minimal effect on platelet functioning at daily dose of 7.5 mg. Rarely associated with serious cutaneous allergic reactions (eg, Stevens-Johnson syndrome).
◊ Risk of serious gastrointestinal complications may be elevated in doses ≥20 mg per day; consider concurrent pharmacologic gastroprotection. Rarely associated with serious cutaneous allergic reactions (eg, Stevens-Johnson syndrome).

Prepared with data from:

Anon. Drugs for pain. Treatment guidelines from the Medical Letter; 2013. 11:31.
Majoribanks J, Proctor M, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea (review). Cochrane Database Systematic Rev (2010). 20:1.

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Suggested nonsteroidal anti-inflammatory drug (NSAID) doses in primary dysmenorrhea