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

aspirin Exempt I I I I

bromfenac sodium Exempt

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

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

diflunisal Exempt C I I I I A I I I 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 NO NO

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

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

indomethacin 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

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

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

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

nabumetone 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

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

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

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

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Ankle and Foot Disorders

Plantar Heel Pain - Plantar Faciitis Tarsal Tunnel SyndromeAchilles Tendinopathy Achilles Tendon Rupture Ankle and Foot Fractures Ankle SprainAnkle Tendinopathy - Tendinopthaty

other than AchillesCharcot Joint Midtarsus Sprain ParonchyiaFoot Neuroma - Morton's Neuroma Foot Ulceration

Forefoot and Midfoot Franctures -

Tarsal, metatarsal, PhalangealHammer Toe

Hindoot Fractures - Calcaneous

Talus

Category

Condition

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

aspirin Exempt A A A A

bromfenac sodium Exempt

celecoxib Exempt I I I I I

choline magnesium trisalicylate Exempt I I I I I

diclofenac

diclofenac potassium Exempt I I I I I

diclofenac sodium Exempt†

diclofenac sodium/misoprostol Exempt A A A A

diflunisal Exempt I I I I I

esomeprazole/naproxen Non-Exempt NO NO NO

etodolac Exempt I I I I I

famotidine/ibuprofen Non-Exempt NO NO NO NO

fenoprofen calcium Exempt I I I I I

flurbiprofen Exempt I I I I I

flurbiprofen sodium Exempt

ibuprofen Exempt I I I I I

indomethacin Exempt I I I I I

ketoprofen Exempt I I I I I

ketorolac tromethamine Exempt† NO NO NO NO NO

meclofenamate sodium Exempt I I I I I

mefenamic acid Exempt I I I I I

meloxicam Exempt I I I I I

nabumetone Exempt I I I I I

naproxen Exempt I* I* I I* I*

naproxen sodium

oxaprozin Exempt I I I I I

piroxicam Non-Exempt NO NO NO NO NO

salsalate Exempt I I I I I

sulindac Exempt I I I I I

tolmetin sodium Exempt I I I I I

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Wiplash-associated injury

Cervical and Thoracic Spine Disorders

Cervicogenic Headache Cervicothoracic Pain Neuropathic Pain Peri-operative management Radicular Pain Syndromes

Chronic Persistent

Pain

Complex Regional

Pain Syndrome

Fibromyalgia -

Tender pointsNeuropathic

Chronic Chronic Chronic Chronic

aspirin Exempt NO NO NO

bromfenac sodium Exempt

celecoxib Exempt I I C I

choline magnesium trisalicylate Exempt I I C I

diclofenac

diclofenac potassium Exempt NR NR NR NR

diclofenac sodium Exempt† NR NR NR NR

diclofenac sodium/misoprostol Exempt NO NO NO NO

diflunisal Exempt I I C I

esomeprazole/naproxen Non-Exempt NO NO NO NO

etodolac Exempt I I C I

famotidine/ibuprofen Non-Exempt NO NO NO NO

fenoprofen calcium Exempt I I C I

flurbiprofen Exempt I I C I

flurbiprofen sodium Exempt

ibuprofen Exempt I I C I

indomethacin Exempt I I C I

ketoprofen Exempt I I C I

ketorolac tromethamine Exempt† NO NO NO NO

meclofenamate sodium Exempt I I C I

mefenamic acid Exempt I I C I

meloxicam Exempt I I C I

nabumetone Exempt I I C I

naproxen Exempt I I C I

naproxen sodium

oxaprozin Exempt I I C I

piroxicam Non-Exempt NO NO NO NO

salsalate Exempt I I C I

sulindac Exempt I I C I

tolmetin sodium Exempt I I C I

Chronic PainCategory

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

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

aspirin Exempt A A I I

bromfenac sodium Exempt

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

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

diclofenac

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

diclofenac sodium Exempt†

diclofenac sodium/misoprostol Exempt I I

diflunisal Exempt I 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

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

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

flurbiprofen sodium Exempt

ibuprofen 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

ketoprofen 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

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

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

nabumetone Exempt 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

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

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

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

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Elbow Disorders

Biceps and Triceps Tendinosis Elbow Contusion Elbow Dislocation Radial Nerve Entrapment Ulnar Neuropathy at the ElbowElbow Fracture Elbow Sprain Lateral Epicondylalgia Medial Epicondylalgia Olecranon Bursitis Pronator Syndrome

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

aspirin Exempt

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

choline magnesium trisalicylate Exempt

diclofenac

diclofenac potassium Exempt

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

diclofenac sodium/misoprostol Exempt

diflunisal Exempt

esomeprazole/naproxen Non-Exempt

etodolac 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

indomethacin Exempt

ketoprofen Exempt

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

meclofenamate sodium Exempt

mefenamic acid Exempt

meloxicam Exempt

nabumetone Exempt

naproxen Exempt

naproxen sodium

oxaprozin Exempt

piroxicam Non-Exempt

salsalate Exempt

sulindac Exempt

tolmetin sodium Exempt

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Allergic Disorders Atopic and Vernal Keratoconjunctivitis Blepharoconjunctivitis Chemical Burns

Eye

Foreign 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

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

bromfenac sodium Exempt

celebrex 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

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

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 Exempt†

diclofenac sodium/misoprostol Exempt C 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

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

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

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

flurbiprofen sodium Exempt

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

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

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

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

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

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

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

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

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

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

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

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

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 Hand/Wrist/ Forearm Lacerations Human / Animal Bites Kienbock Disease

Middle and Proximal Phalangeal

and Metacarpal FracturesWrist Sprains

Non-specific Hand/Wrist/ Forearm

PainRadial Nerve Entrapment Scaphoid Fracture

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

aspirin Exempt A A A/B

bromfenac sodium Exempt

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

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*

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 Exempt†

diclofenac sodium/misoprostol Exempt A A

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*

esomeprazole/naproxen Non-Exempt NO NO

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*

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*

flurbiprofen sodium Exempt

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*

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*

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*

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

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*

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*

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*

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*

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

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*

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*

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Osteonecrosis - Avascular NecrosisPeri-Operative Management of the

Hip and Groin

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 Lower Abdominal Strains Meralgia Paresthetica

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

aspirin Exempt C C B/C

bromfenac sodium Exempt

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

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

diclofenac

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

diclofenac sodium Exempt†

diclofenac sodium/misoprostol Exempt I A/C* I

diflunisal 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

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

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

flurbiprofen sodium Exempt

ibuprofen Exempt I I NR NR NO 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

ketoprofen 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

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

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

nabumetone 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

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

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

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

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Meniscal Tears

Knee Disorders

Iliotibial Band Syndrome Knee Bursitis Knee FractureKnee Osteoarthrosis (incl.

Degenerative Joint Disease)Knee Pain Patellar Tendinopathy

Perioperative Management of the

Knee - including Knee Arthropathy

Quadriceps, Gastrocnemius, and

Soleus Strains

Sprains and Tears of the Collateral

Ligaments

Sprains and Tears of the Cruciate

Ligament

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

aspirin Exempt A A

bromfenac sodium Exempt

celecoxib Exempt A/I A/I B A A

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

diclofenac

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

diclofenac sodium Exempt†

diclofenac sodium/misoprostol Exempt A A B A A

diflunisal Exempt A/I A/I B A A

esomeprazole/naproxen Non-Exempt NO NO NO NO

etodolac Exempt A/I A/I B A A

famotidine/ibuprofen 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

flurbiprofen sodium Exempt

ibuprofen Exempt A/I A/I B A A

indomethacin Exempt A/I A/I B A A

ketoprofen Exempt A/I A/I B A A

ketorolac tromethamine Exempt† NO NO NO NO NO

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

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

meloxicam Exempt A/I A/I B A A

nabumetone 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

piroxicam Non-Exempt NO NO NO NO NO

salsalate Exempt A/I A/I B A A

sulindac Exempt A/I A/I B A A

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

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Low Back Disorders

Spinal Fractures Spinal Stenosis SpondylolisthesisFacet Degenerative Joint Disease Low Back Peri-operative Management of Low

Back Pain

Radicular Pain Syndromes -

Including SciaticaSacroiliitis

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

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

bromfenac sodium Exempt

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

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

diclofenac

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

diclofenac sodium Exempt†

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

diflunisal 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

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

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

flurbiprofen sodium Exempt

ibuprofen 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

ketoprofen 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

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

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

nabumetone 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

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

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

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

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Peri-operative Management of the

Shoulder

Shoulder

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

Anterior PosteriorOsteonecrosis Rotator Cuff Tendinopathies

Shoulder Dislocation and Instability -

Glenohumeral Dislocation

Shoulder Osteoarthosis - Glenohumeral

and Acromioclavicular JointShoulder Pain Trigger Points and Myofascial Pain

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

aspirin Exempt

bromfenac sodium Exempt

celcoxib Exempt NR NR

choline magnesium trisalicylate Exempt NR NR

diclofenac

diclofenac potassium Exempt NR NR

diclofenac sodium Exempt† I/NR* NR

diclofenac sodium/misoprostol Exempt NO NO

diflunisal Exempt

esomeprazole/naproxen Non-Exempt NO NO

etodolac Exempt NR NR

famotidine/ibuprofen Non-Exempt NO NO

fenoprofen calcium Exempt NR NR

flurbiprofen Exempt NR NR

flurbiprofen sodium Exempt

ibuprofen Exempt NR NR

indomethacin Exempt NR NR

ketoprofen Exempt NR NR

ketorolac tromethamine Exempt† NO NO

meclofenamate sodium Exempt NR NR

mefenamic acid Exempt NR NR

meloxicam Exempt NR NR

nabumetone Exempt NR NR

naproxen Exempt NR NR

naproxen sodium

oxaprozin Exempt NR NR

piroxicam Non-Exempt NO NO

salsalate Exempt NR NR

sulindac Exempt NR NR

tolmetin sodium Exempt NR NR

Category

Condition

Phase

† = Ophthalmic form Exempt; Oral form Non-Exempt

Needle Stick Postexposure Prophylaxis

PEP for

Hepatitis BPEP for HIV

Opioid Traumatic Brain Injury Work Related Asthma

AsthmaTraumatic Brain InjuryOpioid D/C & Tapering Opioid Overdose