What is the recommended dose of naproxen (nonsteroidal anti-inflammatory drug, NSAID) sodium for a patient?

Recommended Dosage of Naproxen Sodium for Patients

The maximum recommended daily dose of naproxen sodium is 1500 mg per day for limited periods of up to 6 months, with a typical maintenance dose not exceeding 1000 mg per day. 1

Standard Dosing Recommendations

For Regular Naproxen:

• Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis:
  • 250 mg, 375 mg, or 500 mg twice daily 1
  • Maximum daily dose: 1500 mg/day for limited periods (up to 6 months)
  • Typical maintenance dose: 1000 mg/day 1

For Naproxen Sodium:

• Acute pain, primary dysmenorrhea, acute tendonitis/bursitis:

  • Initial dose: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours 1
  • Initial total daily dose should not exceed 1250 mg
  • Maintenance daily dose should not exceed 1000 mg 1

• Acute gout:

  • Starting dose: 750 mg followed by 250 mg every 8 hours until attack subsides 1

• Migraine:

  • 275 to 550 mg every two to six hours
  • Maximum initial dose: 825 mg
  • Maximum daily dose: 1500 mg 2

Dosing Considerations for Special Populations

• Elderly patients: Lower doses are recommended due to increased unbound plasma fraction of naproxen 1
• Renal impairment:
  • Mild impairment: Lower starting dose with careful titration
  • Moderate to severe impairment (CrCl <30 mL/min): Not recommended 1
• Hepatic impairment: Lower starting dose with careful titration 1

Formulation Considerations

Different formulations of naproxen (tablets, suspension, delayed-release tablets, sodium tablets) have pharmacokinetic differences that may affect onset of action, though they all circulate as naproxen in plasma 1. Naproxen sodium is more rapidly absorbed and recommended when prompt pain relief is desired 1.

Safety Considerations

Risk Factors for Adverse Events

• Advancing age (risk increases approximately 4% per year) 2
• History of ulcer complications (2-4 fold increased risk) 2
• Concurrent use of:
  • Low-dose aspirin (>10-fold increased risk) 2
  • Multiple NSAIDs 2
  • Corticosteroids or anticoagulants 2

Common Adverse Effects

• Gastrointestinal symptoms (dizziness, rash, GI upset, constipation) 2
• Cardiovascular risks (especially with long-term use) 2

Clinical Pearl

When treating acute pain, naproxen sodium demonstrates linear pharmacokinetics, meaning plasma levels increase proportionately with dosage 3. Higher doses (440 mg, 550 mg) provide greater efficacy than lower doses (220 mg) while maintaining a similar safety profile 3, 4.

For patients with chronic pain requiring long-term NSAID therapy, consider gastroprotective agents when used over prolonged periods 2, and use the lowest effective dose for the shortest duration possible to minimize cardiovascular and gastrointestinal risks 2.