yes, strong evidence, a level evidence a · 2019-04-11 · mefenamic acid exempt i i c i carboxylic...

Yes, Strong Evidence, "A" Level Evidence A

Yes, Moderate Evidence, "B" Level Evidence B

Yes, Limited Evidence, "C" Level Evidence C

Yes, Insufficient Evidence (Consensus-based), "I" Level I

No, Strong Evidence, "A" Level Evidence A

No, Moderate Evidence, "B" Level Evidence B

No, Limited Evidence, "C" Level Evidence C

No, Insufficient Evidence (Consensus-based), "I" Level I

No Recommendation NR

No, Other = Not Recommended, Healthesystems recommendations based on

leading sources as well as pharmacy and therapeutics (P&T) decisions

(pharmacy and medical literature, safety, cost)

NO

Yes, Other = Recommended, Healthesystems recommendations based on

leading sources as well as P&T decisions (pharmacy and medical literature,

safety, cost)

YES

multiple recommendations apply (Refer to MDGuidelines for detail) *

ACETIC ACID DERIVATIVES ANTHRANILIC ACID DERVICATIVES CARBOXYLIC ACID DERIVATIVES COX-2 INHIBITORS ENOLIC ACID (OXICAM) DERIVATIVES NAPTHYLALKANONE DERIVATIVES PROPRIONIC ACID DERIVATIVES SALICYLATES MISCELLANEOUS

diclofenac meclofenamate sodium diflunisal celecoxib meloxicam nabumetone esomeprazole/naproxen aspirin bromfenac sodium

diclofenac potassium mefenamic acid salsalate piroxicam famotidine/ibuprofen choline magnesium trisalicylate

diclofenac sodium fenoprofen calcium

diclofenac sodium/misoprostol flurbiprofen

etodolac flurbiprofen sodium

indomethacin ibuprofen

ketorolac tromethamine ketoprofen

sulindac naproxen

tolmetin sodium naproxen sodium

oxaprozin

NSAID SUB-CLASSIFICATIONS

Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic

ACETIC ACID DERIVATIVES

diclofenac

diclofenac potassium Exempt C I I I I A I I I I I I I I I I I I I I I

diclofenac sodium Exempt†

diclofenac sodium/misoprostol Exempt I I I I I I I I I I

etodolac Exempt C I I I I A I I I I I I I I I I I I I I I

indomethacin Exempt C I I I I A I I I I I I I I I I I I I I I

ketorolac tromethamine Exempt† NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

sulindac Exempt C I I I I A I I I I I I I I I I I I I I I

tolmetin sodium Exempt C I I I I A I I I I I I I I I I I I I I

ANTHRANILIC ACID DERVICATIVES

meclofenamate sodium Exempt C I I I I A I I I I I I I I I I I I I I I

mefenamic acid Exempt C I I I I A I I I I I I I I I I I I I I I

CARBOXYLIC ACID DERIVATIVES

diflunisal Exempt C I I I I A I I I I I I I I I I I I I I

salsalate Exempt C I I I I A I I I I I I I I I I I I I I I

COX-2 INHIBITORS

celecoxib Exempt C I I I I A I I I I I I I I I I I I I I I

ENOLIC ACID (OXICAM) DERIVATIVES

meloxicam Exempt C I I I I A I I I I I I I I I I I I I I I

piroxicam Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

NAPTHYLALKANONE DERIVATIVES

nabumetone Exempt C I I I I A I I I I I I I I I I I I I I I

PROPRIONIC ACID DERIVATIVES

esomeprazole/naproxen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

famotidine/ibuprofen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

fenoprofen calcium Exempt C I I I I A I I I I I I I I I I I I I I I

flurbiprofen Exempt C I I I I A I I I I I I I I I I I I I I I

flurbiprofen sodium Exempt

ibuprofen Exempt C I I I I A I I I I I I I I I I I I I I I

ketoprofen Exempt C I I I I A I I I I I I I I I I I I I I I

naproxen Exempt C/NR* I/NR* I I I A I I I I I I I I I I I I I I I

naproxen sodium

oxaprozin Exempt C I I I I A I I I I I I I I I I I I I I I

SALICYLATES

aspirin Exempt I I I I

choline magnesium trisalicylate Exempt C I I I I A I I I I I I I I I I I I I I I

MISCELLANEOUS

bromfenac sodium Exempt

Category

Condition

Phase

Tarsal Tunnel Syndrome

Ankle and Foot Disorders

Achilles Tendinopathy Achilles Tendon Rupture Ankle and Foot Fractures Ankle SprainAnkle Tendinopathy - Tendinopthaty

other than AchillesCharcot Joint Foot Neuroma - Morton's Neuroma Foot Ulceration

Forefoot and Midfoot Franctures -

Tarsal, metatarsal, PhalangealHammer Toe

Hindoot Fractures - Calcaneous

TalusMidtarsus Sprain Paronchyia Plantar Heel Pain - Plantar Faciitis

† = Ophthalmic form Exempt; Oral form Non-Exempt

Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic


diclofenac

diclofenac potassium Exempt I I I I I


diclofenac sodium/misoprostol Exempt A A A A

etodolac Exempt I I I I I

indomethacin Exempt I I I I I

ketorolac tromethamine Exempt† NO NO NO NO NO

sulindac Exempt I I I I I

tolmetin sodium Exempt I I I I I


meclofenamate sodium Exempt I I I I I

mefenamic acid Exempt I I I I I


diflunisal Exempt I I I I I

salsalate Exempt I I I I I

COX-2 INHIBITORS

celecoxib Exempt I I I I I


meloxicam Exempt I I I I I

piroxicam Non-Exempt NO NO NO NO NO


nabumetone Exempt I I I I I


esomeprazole/naproxen Non-Exempt NO NO NO

famotidine/ibuprofen Non-Exempt NO NO NO NO

fenoprofen calcium Exempt I I I I I

flurbiprofen Exempt I I I I I


ibuprofen Exempt I I I I I

ketoprofen Exempt I I I I I

naproxen Exempt I* I* I I* I*

naproxen sodium

oxaprozin Exempt I I I I I

SALICYLATES

aspirin Exempt A A A A

choline magnesium trisalicylate Exempt I I I I I

MISCELLANEOUS


Category

Condition

Phase


Cervical and Thoracic Spine Disorders

Cervicogenic Headache Cervicothoracic Pain Neuropathic Pain Peri-operative management Radicular Pain Syndromes Wiplash-associated injury

Chronic

Persistent Pain

Complex Regional

Pain Syndrome

Fibromyalgia -

Tender pointsNeuropathic

Chronic Chronic Chronic Chronic


diclofenac

diclofenac potassium Exempt NR NR NR NR

diclofenac sodium Exempt† NR NR NR NR

diclofenac sodium/misoprostol Exempt NO NO NO NO

etodolac Exempt I I C I

indomethacin Exempt I I C I

ketorolac tromethamine Exempt† NO NO NO NO

sulindac Exempt I I C I

tolmetin sodium Exempt I I C I


meclofenamate sodium Exempt I I C I

mefenamic acid Exempt I I C I


diflunisal Exempt I I C I

salsalate Exempt I I C I

COX-2 INHIBITORS

celecoxib Exempt I I C I


meloxicam Exempt I I C I

piroxicam Non-Exempt NO NO NO NO


nabumetone Exempt I I C I


esomeprazole/naproxen Non-Exempt NO NO NO NO


fenoprofen calcium Exempt I I C I

flurbiprofen Exempt I I C I


ibuprofen Exempt I I C I

ketoprofen Exempt I I C I

naproxen Exempt I I C I

naproxen sodium

oxaprozin Exempt I I C I

SALICYLATES

aspirin Exempt NO NO NO

choline magnesium trisalicylate Exempt I I C I

MISCELLANEOUS


Chronic PainCategory

Condition

Phase


Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic


diclofenac

diclofenac potassium Exempt I I I I I B/I* B I I NR NR I* I I* I I* I


diclofenac sodium/misoprostol Exempt I I

etodolac Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

indomethacin Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

ketorolac tromethamine Exempt† NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

sulindac Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

tolmetin sodium Exempt I I I I I B/I* B I I NR NR I* I I* I I* I


meclofenamate sodium Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

mefenamic acid Exempt I I I I I B/I* B I I NR NR I* I I* I I* I


diflunisal Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

salsalate Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

COX-2 INHIBITORS

celecoxib Exempt I I I I I B/I* B I I NR NR I* I I* I I* I


meloxicam Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

piroxicam Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO


nabumetone Exempt I I I I B/I* B I I NR NR I* I I* I I* I


esomeprazole/naproxen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

famotidine/ibuprofen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

fenoprofen calcium Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

flurbiprofen Exempt I I I I I B/I* B I I NR NR I* I I* I I* I


ibuprofen Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

ketoprofen Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

naproxen Exempt I I I I I I/C* B/C* I* I* NR NR I*/NR I/NR I*/NR I/NR I*/NR I/NR

naproxen sodium

oxaprozin Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

SALICYLATES

aspirin Exempt A A I I

choline magnesium trisalicylate Exempt I I I I I B/I* B I I NR NR I* I I* I I* I

MISCELLANEOUS


Ulnar Neuropathy at the Elbow

Elbow Disorders

Biceps and Triceps Tendinosis Elbow Contusion Elbow Dislocation Elbow Fracture Elbow Sprain Lateral Epicondylalgia Medial Epicondylalgia Olecranon Bursitis Pronator Syndrome

Category

Condition

Phase


Radial Nerve Entrapment

Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic


diclofenac

diclofenac potassium Exempt

diclofenac sodium Exempt† B B B B I B C C I C

diclofenac sodium/misoprostol Exempt

etodolac Exempt

indomethacin Exempt

ketorolac tromethamine Exempt† B B B B I B C C I C

sulindac Exempt

tolmetin sodium Exempt


meclofenamate sodium Exempt

mefenamic acid Exempt


diflunisal Exempt

salsalate Exempt

COX-2 INHIBITORS

celecoxib Exempt


meloxicam Exempt

piroxicam Non-Exempt


nabumetone Exempt


esomeprazole/naproxen Non-Exempt

famotidine/ibuprofen Non-Exempt

fenoprofen calcium Exempt

flurbiprofen Exempt

flurbiprofen sodium Exempt B B B B I B C C I C

ibuprofen Exempt

ketoprofen Exempt

naproxen Exempt

naproxen sodium

oxaprozin Exempt

SALICYLATES

aspirin Exempt

choline magnesium trisalicylate Exempt

MISCELLANEOUS

bromfenac sodium Exempt B B B B I B C C I C

Category

Condition

Phase


Eye

Allergic Disorders Atopic and Vernal Keratoconjunctivitis Blepharoconjunctivitis Chemical BurnsForeign Bodies, Rust Rings, Corneal

AbrasionsPterygium Thermal Burns Traumatic Injuries

Viral, Bacterial, Fungal Infections /

Corneal Ulcers

Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic


diclofenac

diclofenac potassium Exempt B C C I C C C C I I I I C NR NR I I I NR NR C


diclofenac sodium/misoprostol Exempt C C

etodolac Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

indomethacin Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

ketorolac tromethamine Exempt† NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

sulindac Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

tolmetin sodium Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C


meclofenamate sodium Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

mefenamic acid Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C


diflunisal Exempt B C I I C I C C C C I I I I C NR NR I I I NR NR C

salsalate Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

COX-2 INHIBITORS

celecoxib Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C


meloxicam Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

piroxicam Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO


nabumetone Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C


esomeprazole/naproxen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

famotidine/ibuprofen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

fenoprofen calcium Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

flurbiprofen Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C


ibuprofen Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

ketoprofen Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

naproxen Exempt B C I I I I C I C/I* C C/I* C I I I I C NR NR I I I NR NR C

naproxen sodium

oxaprozin Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

SALICYLATES

aspirin Exempt NO I C NO A A I I NO I C I NO NR C

choline magnesium trisalicylate Exempt B C I I I I C I C C C C I I I I C NR NR I I I NR NR C

MISCELLANEOUS


Wrist SprainsNon-specific Hand/Wrist/ Forearm

Pain

Category

Condition Hand/Wrist/ Forearm Lacerations Human / Animal Bites Kienbock DiseaseMiddle and Proximal Phalangeal

and Metacarpal FracturesScaphoid Fracture

Phase


Radial Nerve Entrapment

Hand, Wrist, And Forearm Disorders

Carpal Tunnel Syndrome Compartment Syndrome Crush Inury Distal Forearm FracturesDistal Phalanx Fractures and

Subunual Hematoma - Tuft FractureExtensor Compartment Tenosyovitis Flexor Tendon Entrapment Ganglion Cyst Hand Arm Vibration Syndrome Hand/Finger Osteoarthrosis

Triangular Fibrocartilage Complex

TearsUlnar Nerve Entrapment

Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic


diclofenac

diclofenac potassium Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*


diclofenac sodium/misoprostol Exempt A A

etodolac Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

indomethacin Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

ketorolac tromethamine Exempt† NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

sulindac Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

tolmetin sodium Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*


meclofenamate sodium Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

mefenamic acid Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*


diflunisal Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

salsalate Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

COX-2 INHIBITORS

celecoxib Exempt I I I I I I I A I I I I I A/C A I NR NR I I B/I


meloxicam Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

piroxicam Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO


nabumetone Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*


esomeprazole/naproxen Non-Exempt NO NO

famotidine/ibuprofen Non-Exempt NO NO

fenoprofen calcium Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

flurbiprofen Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*


ibuprofen Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

ketoprofen Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

naproxen Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

naproxen sodium

oxaprozin Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

SALICYLATES

aspirin Exempt A A A/B

choline magnesium trisalicylate Exempt I I I I I I I I I I I I I A/C* A I NR NR I I B/I*

MISCELLANEOUS


Lower Abdominal Strains Meralgia Paresthetica Osteonecrosis - Avascular NecrosisPeri-Operative Management of the

Hip and Groin

Category

Condition

Phase


Hip and Groin Disorders

Bilateral Osteoarthrosis - Hip joint

DiseaseEpididymo-Orchitis

Femoro-acetabular Impingement -

Hip Impingement and Labral Tears

Gluteus Medius Tendinosis and

Tears - Rotator Cuff of the Hip

Greater Trochanteric Bursitis -

Greater Trochanteric Pain Syndrome

Groin Strains - Adductor-related

Groin Pain Hamstring and Hip Flexor Strains Hip and Groin Pain Hip Fracture Hip Osteoarthrosis



diclofenac

diclofenac potassium Exempt I I NR NR I A/C* I I I I I I I I I I I


diclofenac sodium/misoprostol Exempt I A/C* I

etodolac Exempt I I NR NR I A/C* I I I I I I I I I I I

indomethacin Exempt I I NR NR I A/C* I I I I I I I I I I I

ketorolac tromethamine Exempt† NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

sulindac Exempt I I NR NR I A/C* I I I I I I I I I I I

tolmetin sodium Exempt I I NR NR I A/C* I I I I I I I I I I I


meclofenamate sodium Exempt I I NR NR I A/C* I I I I I I I I I I I

mefenamic acid Exempt I I NR NR I A/C* I I I I I I I I I I I


diflunisal Exempt I I NR NR I A/C* I I I I I I I I I I I

salsalate Exempt I I NR NR I A/C* I I I I I I I I I I I

COX-2 INHIBITORS

celecoxib Exempt I I NR NR I A/C* I I I I I I I I I I I


meloxicam Exempt I I NR NR I A/C* I I I I I I I I I I I

piroxicam Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO


nabumetone Exempt I I NR NR I A/C* I I I I I I I I I I I


esomeprazole/naproxen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

famotidine/ibuprofen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

fenoprofen calcium Exempt I I NR NR I A/C* I I I I I I I I I I I

flurbiprofen Exempt I I NR NR I A/C* I I I I I I I I I I I


ibuprofen Exempt I I NR NR NO I A/C* I I I I I I I I I I I

ketoprofen Exempt I I NR NR I A/C* I I I I I I I I I I I

naproxen Exempt I I NR NR I A/C* I I I I I I I I I I I

naproxen sodium

oxaprozin Exempt I I NR NR I A/C* I I I I I I I I I I I

SALICYLATES

aspirin Exempt C C B/C

choline magnesium trisalicylate Exempt I I NR NR I A/C* I I I I I I I I I I

MISCELLANEOUS


Sprains and Tears of the Cruciate

Ligament

Knee Disorders

Iliotibial Band Syndrome Knee Bursitis Knee FractureKnee Osteoarthrosis (incl.

Degenerative Joint Disease)Knee Pain Meniscal Tears Patellar Tendinopathy

Perioperative Management of the

Knee - including Knee Arthropathy

Quadriceps, Gastrocnemius, and

Soleus Strains

Category

Condition

Phase


Sprains and Tears of the Collateral

Ligaments

Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic


diclofenac

diclofenac potassium Exempt A/I A/I B A A


diclofenac sodium/misoprostol Exempt A A B A A

etodolac Exempt A/I A/I B A A

indomethacin Exempt A/I A/I B A A

ketorolac tromethamine Exempt† NO NO NO NO NO

sulindac Exempt A/I A/I B A A

tolmetin sodium Exempt A/I A/I B A A


meclofenamate sodium Exempt A/I A/I B A A

mefenamic acid Exempt A/I A/I B A A


diflunisal Exempt A/I A/I B A A

salsalate Exempt A/I A/I B A A

COX-2 INHIBITORS

celecoxib Exempt A/I A/I B A A


meloxicam Exempt A/I A/I B A A

piroxicam Non-Exempt NO NO NO NO NO


nabumetone Exempt A/I A/I B A A


esomeprazole/naproxen Non-Exempt NO NO NO NO


fenoprofen calcium Exempt A/I A/I B A A

flurbiprofen Exempt A/I A/I B A A


ibuprofen Exempt A/I A/I B A A

ketoprofen Exempt A/I A/I B A A

naproxen Exempt A/I/NR* A/I/NR* B A/NR* A/NR* NR NR NR NR

naproxen sodium

oxaprozin Exempt A/I A/I B A A

SALICYLATES

aspirin Exempt A A

choline magnesium trisalicylate Exempt A/I A/I B A A

MISCELLANEOUS


Category

Condition

Phase


Low Back Disorders

Facet Degenerative Joint Disease Low Back Peri-operative Management of Low

Back Pain

Radicular Pain Syndromes - Including

SciaticaSacroiliitis Spinal Fractures Spinal Stenosis Spondylolisthesis



diclofenac

diclofenac potassium Exempt I I I C I I I I C A A I I C A A I I


diclofenac sodium/misoprostol Exempt C A A A A I I

etodolac Exempt I I I C I I I I C A A I I C A A I I

indomethacin Exempt I I I C I I I I C A A I I C A A I I

ketorolac tromethamine Exempt† NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

sulindac Exempt I I I C I I I I C A A I I C A A I I

tolmetin sodium Exempt I I I C I I I I C A A I I C A A I I


meclofenamate sodium Exempt I I C I I I I C A A I I C A A I

mefenamic acid Exempt I I C I I I I C A A I I C A A I


diflunisal Exempt I I I C I I I I C A A I I C A A I I

salsalate Exempt I I I C I I I I C A A I I C A A I I

COX-2 INHIBITORS

celecoxib Exempt I I I C I I I I C A A I I C A A I I


meloxicam Exempt I I I C I I I I C A A I I C A A I I

piroxicam Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO


nabumetone Exempt I I I C I I I I C A A I I C A A I I


esomeprazole/naproxen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

famotidine/ibuprofen Non-Exempt NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO

fenoprofen calcium Exempt I I I C I I I I C A A I I C A A I I

flurbiprofen Exempt I I I C I I I C A A I I C A A I I


ibuprofen Exempt I I I C I I I I C A A I I C A A I I

ketoprofen Exempt I I I C I I I I C A A I I C A A I I

naproxen Exempt I I I C I I I I C A A I I C A A I/NR* I/NR*

naproxen sodium

oxaprozin Exempt I I I C I I I I C A A I I C A A I I

SALICYLATES

aspirin Exempt I I I I I I I I C I I I I

choline magnesium trisalicylate Exempt I I I C I I I I C A A I I C A A I I

MISCELLANEOUS


Trigger Points and Myofascial Pain

Shoulder

Acromioclavicular Sprains or Disolocations Adhesive Capsulitis - Frozen Shoulder Brachial Plexus InjuriesLabral Tears - incl Superior Labral

Anterior PosteriorOsteonecrosis

Peri-operative Management of the

ShoulderRotator Cuff Tendinopathies

Shoulder Dislocation and Instability -

Glenohumeral Dislocation

Shoulder Osteoarthosis - Glenohumeral

and Acromioclavicular Joint

Category

Condition

Phase


Shoulder Pain

Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic Acute Chronic


diclofenac

diclofenac potassium Exempt NR NR

diclofenac sodium Exempt† I/NR* NR

diclofenac sodium/misoprostol Exempt NO NO

etodolac Exempt NR NR

indomethacin Exempt NR NR

ketorolac tromethamine Exempt† NO NO

sulindac Exempt NR NR

tolmetin sodium Exempt NR NR


meclofenamate sodium Exempt NR NR

mefenamic acid Exempt NR NR


diflunisal Exempt

salsalate Exempt NR NR

COX-2 INHIBITORS

celecoxib Exempt NR NR


meloxicam Exempt NR NR

piroxicam Non-Exempt NO NO


nabumetone Exempt NR NR


esomeprazole/naproxen Non-Exempt NO NO

famotidine/ibuprofen Non-Exempt NO NO

fenoprofen calcium Exempt NR NR

flurbiprofen Exempt NR NR


ibuprofen Exempt NR NR

ketoprofen Exempt NR NR

naproxen Exempt NR NR

naproxen sodium

oxaprozin Exempt NR NR

SALICYLATES

aspirin Exempt

choline magnesium trisalicylate Exempt NR NR

MISCELLANEOUS


Opioid Traumatic Brain Injury Work Related Asthma

PEP for

Hepatitis BPEP for HIV Opioid D/C & Tapering Opioid Overdose Traumatic Brain Injury Asthma

Category

Condition

Phase


Needle Stick Postexposure Prophylaxis

yes, strong evidence, a level evidence a · 2019-04-11 · mefenamic acid exempt i i c i carboxylic...

Documents