ANSAID
What it isNonselective COX inhibitor; arthritis and ophthalmic prevention of surgical miosis.
Why this oneThe eye-drop formulation preserves dilation during surgery, a niche distinct from its systemic arthritis use.
What limits itSystemic use retains NSAID gastrointestinal, renal, and cardiovascular toxicity and can raise lithium levels.
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Rheumatoid arthritis or osteoarthritis | Adult | 200-300 mg/day divided BID-QID | 200-300 mg/day divided BID-QID | 300 mg/day (single dose ≤100 mg) |
Renal Avoid in advanced renal disease unless benefit outweighs risk; monitor renal function in renal impairment
Hepatic Discontinue if abnormal liver tests persist or worsen
Pregnancy Avoid at about 30 weeks gestation and later (risk of premature closure of fetal ductus arteriosus); limit use 20-30 weeks (risk of oligohydramnios/neonatal renal impairment).
Lactation Poorly excreted into human milk (~0.1 mg/day to infant at maternal 200 mg/day); consider benefits of breastfeeding against clinical need.
⚠ BOXED WARNINGS
Cost, est. cash$10–$300/month
Generic entry1995
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityGI bleeding, kidney injury, hypertension and fluid retention; many agents increase lithium concentrations.

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