Background

The nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently used medicines to treat osteoarthritis—the most common form of arthritis—and mild to moderate pain. They cost from about $4 to more than $1,500 a month. This report shows how you could save hundreds of dollars a month or more.

To help you and your doctor choose the right NSAID, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a 27-page report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an NSAID?

Since individual needs vary, use the information in this report to talk with your doctor about the medicine and dose that is right for you, and the possible risks. NSAIDs should be used with caution. All increase the risk of serious side effects, including stomach ulcers, gastrointestinal bleeding, kidney failure, heart attacks, and strokes. Except for low-dose aspirin and naproxen, NSAIDs might not be appropriate for people at risk of heart disease or stroke. Don’t take them for long periods of time without consulting a doctor.

Given those risks, we recommend the following:

  • If you have had a stomach ulcer or bleeding, or are at high risk of either, talk with your doctor about the potential risks of taking NSAIDs and treatment alternatives. The risk of bleeding from NSAID use increases with age.
  • If you have heart disease or are at risk of a heart attack or stroke, talk with your doctor about the potential risks of taking any NSAID.
  • If you have kidney disease or high blood pressure, talk with your doctor about the risks of taking NSAIDs for long periods of time.
  • Take the lowest dose of an NSAID that brings relief and do not take any longer than necessary.
  • NSAIDs can interact with other medicines, including other NSAIDs, such as aspirin, and increase the risk of serious side effects. If your doctor prescribes an NSAID, tell him or her about any other medicines or dietary supplements you are taking, including daily aspirin to reduce your risk of heart attack or stroke.

Treating Osteoarthritis Pain

Options in Treating Osteoarthritis

Health Status and Risks

Options

  • No or low GI risk1
  • No heart or stroke risk

  • GI risk2
  • No or low heart or stroke risk

  • Heart or stroke risk
  • No or low GI risk

  • Heart or stroke risk
  • GI risk2

  • Acetaminophen plus aspirin for heart protection, with a stomach acid reducer
  • Naproxen, with a stomach acid reducer
  • Topicals3
  • Use lowest effective dose of drugs
  • Stay alert for signs of an ulcer: burning stomach pain, blood in stool, or black, tarry stools

1. GI stands for gastrointestinal.
2. Patients with a history of prior bleeding should talk to their doctor before taking an NSAID.
3. Because the topicals result in reduced levels of the NSAID medication in the body, they should theoretically have a reduced risk of heart attack and stroke, but studies are needed to confirm this.

Our Recommendations

NSAIDs block the production of substances in the body called “prostaglandins.” Those chemicals play a role in pain, inflammation, fever, and muscle cramps and aches. At low doses, NSAIDs work mainly as pain relievers. At higher doses, they may also reduce the body’s inflammatory response to tissue damage as well as relieve pain.


Taking effectiveness, safety, and cost into account, we have chosen two NSAIDs as Consumer Reports Best Buy Drugs:

  • Naproxen—generic prescription and over-the-counter
  • Ibuprofen—generic prescription and over-the-counter

These are inexpensive medicines that are as effective as other NSAIDs when used in comparable doses. Naproxen may be a better choice for people who have higher risk of heart attacks or strokes, since the available evidence indicates it does not increase the risk of these conditions. If you are at increased risk of bleeding due to older age, use of aspirin or other
blood thinners, or a history of prior bleeding or ulcers, talk to your doctor before starting an NSAID. Celecoxib (Celebrex) may be an alternative in some situations, or taking an acid blocker to help protect the stomach. Celecoxib is no more effective at relieving pain than ibuprofen or naproxen, but is more expensive, so it is not a top choice for most people. NSAIDs applied to the skin (topical) can be as effective as NSAID tablets or capsules for localized arthritis pain, but it is not yet clear if they cause fewer, serious side effects than oral NSAIDs. Also, they are more expensive.

This report was published in July 2013.

Cost Comparison

Note: If the price box contains a

, that indicates the dose of that drug may be available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

Generic Name and Dose

Brand Name(s) A

Drug Is a
Generic?

Frequency of Dose (per Day) B

Average Cost for
Month’s Supply C

Celecoxib 100 mg capsule

Celebrex

No

Two

$219

Celecoxib 200 mg capsule

Celebrex

No

One

$181

Celecoxib 400 mg capsule

Celebrex

No

One

$282

Diclofenac 25 mg capsule

Zipsor

No

Four

$412

Diclofenac 50 mg tablet

Generic

Yes

Three

$46

Diclofenac 25 mg delayed-release tablet

Generic

Yes

Three

$110

Diclofenac 50 mg delayed-release tablet

Generic

Yes

Three

$109

Diclofenac 75 mg delayed-release tablet

Generic

Yes

Two

$100

Diclofenac 100 mg extended-release tablet

Generic

Yes

Two

$24

Diclofenac 1% topical gel

Voltaren gel

No

Maximum dose of 32 grams per day

$196

Diclofenac 1.3% topical patch

Flector patch

No

Two patches

$478 per each area

Diclofenac 1.5% topical solution

Pennsaid solution

No

40 drops per knee, four times per day

$220 per area

Diflunisal 500 mg tablet

Generic

Yes

Two

$96

Etodolac 200 mg tablet

Generic

Yes

Three

$82

Etodolac 300 mg tablet

Generic

Yes

Two

$92

Etodolac 400 mg capsule

Generic

Yes

Two

$82

Etodolac 500 mg capsule

Generic

Yes

Two

$81

Etodolac 400 mg extended-release tablet

Generic

Yes

One

$41

Etodolac 500 mg extended-release tablet

Generic

Yes

One

$44

Etodolac 600 mg extended-release tablet

Generic

Yes

One

$81

Fenoprofen 400 mg capsule

Nalfon

No

Three

$250

Fenoprofen 600 mg tablet

Generic

Yes

Three

$169

Flurbiprofen 50 mg tablet

Generic

Yes

Three

$65

Flurbiprofen 100 mg tablet

Generic

Yes

Two

$91

Ibuprofen 200 mg tablet

AdvilD

OTCE

Six

$18

Ibuprofen 200 mg tablet

MotrinD

OTCE

Six

$21

Ibuprofen 200 mg tablet

GenericD

OTCE

Six

$11

Ibuprofen 200 mg liquid-filled capsule

Advil LiquigelD

OTCE

Six

$31

Ibuprofen 200 mg liquid-filled capsule

GenericD

OTCE

Six

$24

Ibuprofen 400 mg tablet

Generic

Yes

Four

$15

Ibuprofen 600 mg tablet

Generic

Yes

Four

$19

Ibuprofen 800 mg tablet

Generic

Yes

Three

$18

Indomethacin 25 mg capsule

Generic

Yes

Three

$21

Indomethacin 50 mg capsule

Generic

Yes

Two

$35

Indomethacin 75 mg extended-release capsule

Generic

Yes

One

$88

Ketoprofen 50 mg capsule

Generic

Yes

Three

$119

Ketoprofen 75 mg capsule

Generic

Yes

Three

$128

Ketoprofen 200 mg extended-release capsule

Generic

Yes

One

$211

Meclofenamate 100 mg capsule

Generic

Yes

Three

$608

Mefenamic acid 250 mg capsule

Generic

Yes

Four

$1,588

Meloxicam 7.5 mg tablet

Mobic

No

One

$187

Meloxicam 7.5 mg tablet

Generic

Yes

One

$95

Meloxicam 15 mg tablet

Mobic

No

One

$288

Meloxicam 15 mg tablet

Generic

Yes

One

$147

Nabumetone 500 mg tablet

Generic

Yes

Two

$35

Nabumetone 750 mg tablet

Generic

Yes

Two

$42

Naproxen 220 mg tablet

AleveD

OTCE

Three

$13

Naproxen 220 mg tablet

GenericD

OTCE

Three

$10

Naproxen 250 mg tablet

Generic

Yes

Two

$45

Naproxen 275 mg tablet

Generic

Yes

Two

$52

Naproxen 375 mg tablet

Generic

Yes

Two

$61

Naproxen 500 mg tablet

Generic

Yes

Two

$70

Naproxen 375 mg delayed-release tablet

Generic

Yes

One

$59

Naproxen 500 mg delayed-release tablet

Generic

Yes

Two

$71

Naproxen 550 mg tablet

Generic

Yes

Two

$39

Naproxen 375 mg extended-release tablet

Naprelan

No

One

$310

Naproxen 500 mg extended-release tablet

Naprelan

No

One

$308

Naproxen 750 mg extended-release tablet

Naprelan

No

One

$307

Oxaprozin 600 mg tablet

Generic

Yes

Two

$104

Piroxicam 10 mg capsule

Generic

Yes

One

$71

Piroxicam 20 mg capsule

Generic

Yes

One

$126

Salsalate 500 mg tablet

Generic

Yes

Six

$135

Salsalate 750 mg tablet

Generic

Yes

Four

$118

Sulindac 150 mg tablet

Generic

Yes

Two

$52

Sulindac 200 mg tablet

Generic

Yes

Two

$65

A. “Generic” means this is a generic drug, as noted in column four as well.

B. As commonly recommended or prescribed. Many NSAIDs must be taken multiple times per day. Convenience of dosing might be a factor for some patients. If switching from one NSAID to another, talk with your doctor about equivalency of dosing between the different NSAIDs. They come in a wide variety of recommended doses.

C. Monthly cost reflects national average retail prices for March 2013, rounded to the nearest dollar. Data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

D. This is a nonprescription medicine. Generic versions or store brand might be less expensive. Prices for these medications were obtained by Consumer Reports secret shoppers from five major chain pharmacies (CVS, Rite Aid, Target, Walgreens, and Walmart) and local supermarkets across the U.S. in January 2013. The prices from the various stores were averaged to yield per-pill prices, which were then converted into a monthly price based on the maximum recommended number of pills per day.

E. OTC stands for over-the-counter, meaning it is a nonprescription drug.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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