Costochondritis and Anterior Chest Wall Pain

400 mg orally three times daily with food

5-10 mg/kg/dose [child max 400 mg]

(Children 20-29 kg (6-9 years): 200 mg 1-3 times a day; maximum daily dose 600 mg. Contraindicated below 20 kg body weight or younger than 6 years.)

Alternatives, both non-selective NSAIDs. Ibuprofen is the cheaper and the more widely stocked.

Ibuprofen 400 mg film-coated tablets (POM) SmPC section 4.2 (eMC product 7020) for the adult dose: "200-400 mg given as a single dose or 3-4 times a day with an interval of 6 hours as required" and, in rheumatic disease, "a maximum of 2400 mg in 3 or 4 divided doses". That label is contraindicated below 20 kg or 6 years and its only mg/kg line is for adolescents 15 to 17 years, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)".

Non-selective NSAID used to control the musculoskeletal inflammatory pain of costochondritis once dangerous cardiac, pulmonary, and vascular causes of chest pain have been excluded.

500 mg initially followed by 250 mg at 6-8 hour intervals up to a maximum daily dose after the first day of 1250 mg

Not recommended under 16 years for this indication - the product label restricts paediatric naproxen to juvenile idiopathic arthritis (10 mg/kg/day in two divided doses, child over 5 years). Use paracetamol or ibuprofen instead.

Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639)

Alternative non-selective NSAID for costochondritis pain, giving longer-acting anti-inflammatory relief once serious cardiac and pulmonary causes of chest pain have been ruled out.

Costochondritis - disease-level clinical article (costochondritis-clinical.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Apply 2-4 g of 1% gel topically to tender costosternal joints three to four times daily and rub gently - Up to 7 days unless recommended by a doctor

Not for children under 14. The 1% gel is licensed for adults and adolescents from 14 years; below that there is not enough data.

Diclofenac topical gel SmPC section 4.2 (eMC)

Topical NSAID gel provides effective localized pain relief for anterior chest wall tenderness with minimal systemic absorption and lower GI adverse risk.

1 g 3 or 4 times daily (max. 4 g daily)

10-15 mg/kg/dose [child max 500 mg]

(Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily).)

MSF Essential Drugs 2024 - paracetamol (oral)

Adjunct analgesic added to an NSAID for extra pain control in costochondritis; works centrally rather than through an anti-inflammatory action and does not replace the NSAID.