What is the appropriate way to write a naproxen prescription, including dosage, administration instructions, quantity, and refill limits?

How to Write a Naproxen Prescription

For prescription naproxen, write for 500 mg twice daily (BID) with food, dispense 60 tablets, with appropriate refills based on duration of therapy, and always include a medication guide per FDA requirements 1, 2.

Standard Prescription Format

Dosing Specifications

• Standard dose: Naproxen 500 mg orally twice daily (BID)
• Alternative doses available: 250 mg three times daily or 375 mg twice daily 1
• Administration: Take with food or milk to minimize GI upset
• Duration: Typically 7-14 days for acute conditions; longer for chronic inflammatory conditions

Quantity and Refills

• Acute pain: Dispense 30-60 tablets (15-30 day supply at 500 mg BID)
• Chronic conditions: Dispense 60-180 tablets with appropriate refills
• FDA requirement: Must include instruction to "Dispense the Medication Guide provided separately to each patient" 2

Sample Prescription

Naproxen 500 mg tablets
Sig: Take 1 tablet by mouth twice daily with food
Disp: 60 tablets
Refills: 0-3 (depending on indication)
Note: Dispense Medication Guide to patient

Critical Safety Considerations Before Prescribing

High-Risk Patients Requiring Gastroprotection

Add a proton pump inhibitor (PPI) or avoid NSAIDs entirely in patients with:

• Age >75 years (1 in 110 annual GI bleeding risk vs. 1 in 2,100 for age <45) 1
• History of NSAID-associated GI bleeding (5% recurrence risk in 6 months even with PPI) 1
• Concurrent anticoagulant use (5-6 times increased bleeding risk) 1
• History of peptic ulcer disease

Cardiovascular Contraindications

Avoid naproxen in:

• Patients with congestive heart failure
• Recent myocardial infarction or elevated cardiovascular risk
• Poorly controlled hypertension (NSAIDs increase BP by mean 5 mmHg) 1

Hepatic and Renal Precautions

• Avoid in cirrhosis due to bleeding and renal complications 1
• Dose reduction not typically required in mild hepatic/renal impairment, but start low and titrate 3

Dosing Alternatives Based on Clinical Context

For Acute Pain (sprains, postoperative, dental)

• 500 mg BID is standard and effective 4, 5, 6
• As-needed (PRN) dosing: 500 mg PRN has similar efficacy to scheduled BID with better safety profile and lower total drug consumption 4
• Median time to rescue medication: 8.9 hours with naproxen vs. 2 hours with placebo 5

For Chronic Inflammatory Conditions

• 500 mg BID or 250 mg TID are equivalent options 1
• Once or twice daily dosing improves compliance due to naproxen's 14-hour half-life 7

Common Pitfalls to Avoid

1. Forgetting the Medication Guide: FDA mandates dispensing the guide with each prescription 2
2. Ignoring age-related risk: GI bleeding risk increases dramatically with age—consider PPI co-prescription for patients >65 1
3. Combining with anticoagulants without gastroprotection: This quintuples bleeding risk 1
4. Prescribing in heart failure patients: NSAIDs worsen fluid retention and cardiovascular outcomes 1
5. Exceeding 2 days/week chronic use: Risk of medication overuse headache and renal complications 8

Cost Considerations

Generic naproxen 500 mg BID costs approximately $18/month, making it one of the most cost-effective NSAIDs available 1. This is substantially cheaper than branded alternatives while maintaining equivalent efficacy.