Is it safe to increase naproxen (nonsteroidal anti-inflammatory drug) from 375mg to 500mg BID (twice a day) for a 29-year-old male patient with normal range of motion (ROM) and capillary refill, 6 days post-wrist injury?

Naproxen Dose Increase for Wrist Injury

Yes, increasing naproxen from 375mg to 500mg BID is safe and appropriate for this 29-year-old male patient with wrist injury, normal ROM, and normal capillary refill. 1

Rationale for Dose Adjustment

Naproxen is an appropriate choice for managing musculoskeletal pain from traumatic injuries. The FDA-approved dosing for naproxen specifically supports this dose increase:

• The recommended dose for pain management is 500mg followed by 500mg every 12 hours 1
• For acute painful conditions, naproxen 500mg BID is within the standard dosing range 1
• The maximum daily dose should not exceed 1000mg for ongoing pain management 1

Benefits of Naproxen for Wrist Injury

Naproxen provides several advantages in this clinical scenario:

• Effective analgesic and anti-inflammatory properties for musculoskeletal injuries 2
• Convenient twice-daily dosing regimen due to its relatively long half-life 3
• Demonstrated efficacy in acute traumatic injury and post-traumatic pain 2

Safety Considerations

The dose increase appears safe for this patient based on several factors:

1. Age and health status: At 29 years old without mentioned comorbidities, the patient is at low risk for NSAID-related adverse events
2. Normal examination findings: Normal ROM and capillary refill suggest adequate healing progression
3. Appropriate timing: 6 days post-injury is within the acute phase where anti-inflammatory therapy is beneficial

Clinical Practice Guidelines Support

Guidelines support the use of NSAIDs like naproxen for acute musculoskeletal injuries:

• NSAIDs are recommended as first-line treatment for inflammatory arthritis with mild pain 4
• For acute musculoskeletal pain, naproxen 500mg BID is specifically mentioned as an appropriate dosage 4
• NSAIDs result in less pain in the short term without significantly increasing adverse events compared to placebo 4

Important Monitoring and Patient Education

While increasing the dose is appropriate, consider these important points:

• Advise the patient to take naproxen with food to minimize GI side effects
• Instruct the patient to use the medication for the shortest duration necessary
• Ensure the patient understands to report any unusual bleeding, stomach pain, or other concerning symptoms
• Consider adding a proton pump inhibitor if treatment extends beyond 1-2 weeks

Alternative Approaches (If Needed)

If the patient experiences inadequate relief with naproxen 500mg BID:

1. Consider adding acetaminophen (up to 3000mg/day) for additional analgesia 4
2. Evaluate for physical therapy if pain persists beyond expected healing time
3. Consider re-imaging if symptoms worsen or fail to improve with appropriate therapy

Remember that "the lowest effective dose for the shortest duration consistent with individual patient treatment goals" should be the guiding principle 1.