see also non-steroidal anti-inflammatory drugs (NSAIDs)

• Structurally & pharmacologically related to tolmetin & indomethacin, however, unlike these pyrolle acetic acid derivatives, it is a cyclic propionic derivative.
• It is the most potent analgesic of the NSAID's & can be used in adults instead of narcotics to avoid the associated dependence problems of the narcotics.

• 30mg IM has onset of action & peak analgesic efficacy comparable to 12mg IM morphine or 100mg IM pethidine but has a longer duration of action.
• 10mg IM is as efficacious as 6mg IM morphine
• doses above 10mg IM or IV do not appear to have additional analgesic benefit but may increase risks¹⁾
• 10mg orally is superior to:
  • paracetamol (acetaminophen) 1000mg + codeine 60mg
  • ibuprofen 400mg

• Rapidly absorbed orally, peak [ ] @ 30min, T1/2 4-6hrs;
• 99% plasma protein bound; Linear P/K after single dose;
• Steady state after 6hrly doses for 1 day;
• Mainly excreted in urine; poorly crosses BBB;

• IM: Short term analgesia Rx (up to 2days) post-op
• Oral: Short term analgesia Rx (up to 7days) post-op

• Obstetric use as PG inhib. effects on uterine contraction & fetal circulation;
• Dehydration or hypovolaemia
• Renal impairment (CRN > 180umol/L)
• Coagulopathy
• Post-op for ops. with high risk of bleeding
• HS to NSAIDs
• Pts with PH nasal polyps, angiooedema or bronchospasm/asthma
• PH Stevens-Johnson synd. or vesicular bullous rash
• Suspected or confirmed intracranial bleeding
• GIT bleeding / PH peptic ulcer
• Concurrent other NSAIDs
• Pregnancy, labour, lactation, children < 16yrs.