What is the recommended dose of Non-Steroidal Anti-Inflammatory Drugs (NSIDs) for treating dysmenorrhea?

NSAID Dosage for Dysmenorrhea

For the treatment of dysmenorrhea, ibuprofen should be given in a dose of 400 mg every 4 hours as necessary for the relief of pain. 1

First-Line Treatment Options

NSAIDs are the established initial therapy for dysmenorrhea because they directly address the underlying pathophysiology - the discharge of prostaglandins into uterine tissue 2. The FDA-approved dosage specifically for dysmenorrhea is:

• Ibuprofen: 400 mg every 4 hours as needed for pain relief 1
• Naproxen: 500 mg initially, then 250 mg every 6-8 hours as needed (OTC dose: 200-220 mg) 3

Mechanism and Efficacy

NSAIDs work by inhibiting prostaglandin synthesis, which directly addresses the cause of dysmenorrhea pain. Clinical evidence shows:

• NSAIDs provide effective pain relief within 30 minutes of administration 3
• Naproxen 400 mg provides greater pain relief than acetaminophen and placebo within 30 minutes 3
• Success rates of 67-71% for moderate to good pain relief have been demonstrated with NSAIDs 4

Treatment Algorithm

1. Start with standard NSAID dosing:

   • Ibuprofen 400 mg every 4 hours as needed 1
   • Use the lowest effective dose for the shortest duration consistent with treatment goals 1

2. If inadequate relief:

   • Consider alternative NSAIDs such as naproxen 250 mg 3-4 times daily 4
   • For severe cases, consider combination therapy with acetaminophen 2

3. Administration timing:

   • Begin at earliest onset of menstrual pain 1
   • Some patients benefit from starting treatment 1-2 days before expected menstruation 4

Important Precautions

When prescribing NSAIDs for dysmenorrhea, be aware of these safety considerations:

• Contraindications: Avoid in patients with aspirin/NSAID-induced asthma, history of GI bleeding or ulceration, severe heart failure, and third trimester of pregnancy 5
• Maximum daily dose: Do not exceed 2400 mg total daily dose of ibuprofen 1
• GI protection: If gastrointestinal symptoms develop, consider administering with meals or milk 1
• Cardiovascular risk: Use caution in patients with cardiovascular disease, as NSAIDs may increase risk of adverse cardiovascular events 6

Alternative Approaches

If NSAIDs are contraindicated or ineffective:

• Acetaminophen: Can be used as an alternative, though evidence suggests it's less effective than NSAIDs for dysmenorrhea 3
• Hormonal treatments: Oral contraceptives may be considered for long-term management
• Nutritional supplements: Some evidence supports magnesium and vitamin B1 supplementation, though the evidence is limited 7

Remember that early and adequate dosing of NSAIDs is key to effective management of dysmenorrhea pain, with treatment beginning at the earliest onset of symptoms.