Adverse effects: Abnormal LFTs common, allergic reactions are rare
Cautions: Abnormal liver function
Comments: Often combined with codeine (analgesia) or metoclopramide (for Migraine). IV preparation has more rapid onset but no other benefits and is more expensive.
Dose: Most commonly used preparations are 500mg tablets or 665mg slow-release tablets
Indications: Mild-to-moderate pain, fever, especially due to inflammation including dysmenorrhoea, metastatic bone pain, renal colic, migraine, pericarditis. Inflammatory arthritides including acute gout
Adverse effects: Nausea, gastritis and peptic ulceration, bleeding (can be asymptomatic), diarrhoea, headache, dizziness, renal impairment with sodium and fluid retention and worsening hypertension
Cautions: GI haemorrhage, renal impairment, severe hepatic disease, heart failure. Associated with increased risk of cardiovascular events. Elderly have an increased risk of serious adverse effects.