NSAID + CYP2C9

Shorter T ½ life

Celecoxib, ibuprofen, flurbiprofen

Therapeutic reach for shorter T1/2: CYP2C9 *1/2

Intermediate metabolizer: initiate w/ approved recc dose

Therapeutic reach for shorter T1/2: CYP2C9 *1/3

intermediate metab: initiate w/ lowest reach dose for shortest duration. consider other risk factors such as age and hepatic impairment. Titrate to clinical effect w/ close monitoring of ADE such as elevated BP or Kidney dysfunction

Therapeutic reach for shorter T1/2: CYP2C9 *2/2

intermediate metab: initiate w/ lowest reach dose for shortest duration. consider other risk factors such as age and hepatic impairment. Titrate to clinical effect w/ close monitoring of ADE such as elevated BP or Kidney dysfunction

Therapeutic reach for shorter T1/2: CYP2C9 *2/3 + 3/3

Poor metabolizer: initiate at 25%-50% of starting dose, or use alternative NSAIDs not metabolized by CYP2C9 (ASA, ketorolac, naproxen, sulindac)

Longer T ½ life

Meloxicam

Therapeutic reach for longer T1/2: CYP2C9 *1/3

Intermediate metal: initiate w/ 50% lowest recc dose w/ close monitoring or use alternative NSAIDs not metabolized by CYP2C9 (ASA, ketorolac, naproxen, sulindac)

Therapeutic reach for longer T1/2: CYP2C9 *2/2

Intermediate metal: initiate w/ 50% lowest recc dose w/ close monitoring or use alternative NSAIDs not metabolized by CYP2C9 (ASA, ketorolac, naproxen, sulindac)

Therapeutic reach for longer T1/2: CYP2C9 *2/3 + *3/3

Poor metal: choose alt NSAID not metal by CYP2C9 or T1/2 shorter

Longest T1/2

Proxicam, tenoxicam

Therapeutic reach for longest T1/2: CYP2C9 1/1 + *2

Initiate therapy at standard lowest dose for shorted duration

Therapeutic reach for longest T1/2: CYP2C9 *1/3 —> 3/3

Intermediate metal: choose alternative NSAID not metab by CYP2C9 or shorter T1/2

NSAID not impacted by CYP2C9

1. Aspirin 

2. Diclofenac

3. Indomethacin

4. Nabumetone

5. Naproxen

6. Ketorolac (short term use 5 d)

7. Sulindac