What is the maximum recommended dosage of naproxen (nonsteroidal anti-inflammatory drug) for adults?

Maximum Recommended Dosage of Naproxen for Adults

The maximum recommended daily dosage of naproxen for adults is 1500 mg per day for limited periods of up to 6 months, with a more typical maximum daily dosage of 1000 mg for long-term use. 1

Dosage Guidelines by Formulation

Naproxen (Regular)

• Initial dose: 250-500 mg twice daily
• Maintenance dose: 500-1000 mg daily in divided doses
• Maximum daily dose: 1500 mg for limited periods (up to 6 months)
• Long-term maximum: 1000 mg daily 1

Naproxen Sodium

• Regular pain/inflammation: 275-550 mg every 12 hours
• Initial dose for acute pain: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours
• Maximum initial daily dose: 1250 mg
• Maximum maintenance daily dose: 1000 mg 1

For Specific Conditions

• Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis: 250-500 mg twice daily (up to 1500 mg/day for limited periods) 1
• Acute gout: Initial 750 mg, followed by 250 mg every 8 hours until attack subsides 1
• Acute pain/primary dysmenorrhea: 500 mg initially, then 500 mg every 12 hours or 250 mg every 6-8 hours 1

Important Clinical Considerations

Dosage Adjustments

• Elderly patients: Lower doses recommended due to increased unbound plasma fraction of naproxen 1
• Renal impairment: Not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1
• Hepatic impairment: Lower doses should be considered 1

Pharmacokinetic Considerations

• Naproxen shows dose-proportional pharmacokinetics up to 500 mg
• At doses >500 mg, there is an increase in the unbound fraction of the drug, which may affect clearance 2
• Different formulations (tablets, suspension, delayed-release) are not necessarily bioequivalent and may have different onset of action 1

Adverse Effects and Precautions

• Common adverse effects: Gastrointestinal toxicity, renal toxicity 3
• Risk increases with: Higher doses, longer duration of treatment, and in elderly patients
• Contraindications: Severe renal impairment, pregnancy (especially third trimester), history of NSAID-induced asthma 3

Dosing Strategy

1. Start with the lowest effective dose based on condition severity
2. Adjust dose based on clinical response and tolerability
3. For chronic conditions, consider a variable dosing regimen which may allow for 20-30% lower consumption with similar efficacy 4
4. Monitor for adverse effects, especially with higher doses or prolonged use

For most patients requiring long-term therapy, maintaining the daily dose at or below 1000 mg is recommended to minimize adverse effects while maintaining efficacy. The 1500 mg daily maximum should be reserved for limited periods when higher anti-inflammatory activity is required 1.