2.1. Therapy Limits
The duration of therapy derived for NSAIDs may be long-term and indefinite when prescribed for chronic indications; however, the lowest effective dosages for the shortest possible time should be utilized. NSAIDs should be prescribed cautiously, if at all, to patients at high risk for gastrointestinal complications and patients with known cardiovascular disease. High-risk patients include those with a history of peptic ulcer disease or gastrointestinal bleeding, those with concurrent prescriptions for anticoagulants or corticosteroids, those prescribed high NSAID doses, those with a history of alcohol use and/or smoking, and the elderly. High-risk patients unable to discontinue or reduce NSAID use may benefit from adjunctive therapy with gastroprotective agents such as misoprostol, a histamine-2 receptor antagonist, or proton pump inhibitors.
Treatment duration is limited for mefenamic acid to minimize the occurrence of adverse events. Mefenamic acid should be prescribed for no longer than seven days for pain management and no longer than three days for dysmenorrhea to reduce the incidence of gastrointestinal and cardiovascular adverse events associated with the use of this drug30.
Treatment duration of ketorolac should not exceed 5 total days due to increased risk of adverse events such as risk of gastric ulceration, bleeding, and perforation37.
Diclofenac powder for oral solution is indicated as a single 50 mg dose to treat acute migraine headache. Safety and efficacy of a second dose for an attack have not been established5. Diclofenac sodium 3% topical gel should be used for 60 to 90 days, although complete healing may take an additional 30 days post-cessation of therapy52.