What are the recommended doses of ibuprofen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) and naproxen (NSAID) for pain relief?

Ibuprofen and Naproxen Dosing for Pain Relief

For optimal pain relief, ibuprofen 400 mg is recommended as the standard effective dose, while naproxen 220 mg (over-the-counter) or 500 mg (prescription) provides longer-lasting analgesia. 1

Ibuprofen Dosing

Efficacy by Dose

• 200 mg: Smallest clinically useful dose with 4-6 hours duration 2
• 400 mg: Optimal standard dose with approximately 6+ hours duration 1
• 600 mg: No significant additional pain relief compared to 400 mg 1
• 800 mg: No significant additional pain relief compared to 400 mg 1

A randomized controlled trial comparing these three doses (400 mg, 600 mg, and 800 mg) showed no statistically significant difference in pain reduction at 60 minutes between any of the doses 1. This suggests that 400 mg is the most efficient dose, providing maximum analgesic benefit without unnecessary medication.

Clinical Applications

• For mild to moderate pain: 400 mg every 4-6 hours as needed 3
• For dysmenorrhea: 400 mg every 4 hours as needed 3
• Maximum daily dose: 3200 mg 3

Naproxen Dosing

Efficacy by Dose

• 220 mg (over-the-counter): Effective for mild to moderate pain
• 440-500 mg (prescription): More effective for moderate to severe pain 4

Clinical Applications

• For acute pain: 500 mg initially, followed by 250 mg every 6-8 hours 4
• Initial daily dose should not exceed 1250 mg, with subsequent days not exceeding 1000 mg 4
• Longer duration of action (8-12 hours) compared to ibuprofen (6 hours) 4

Comparative Efficacy

• Ibuprofen 400 mg is comparable to naproxen 220 mg for acute pain relief 2
• Naproxen provides longer duration of action than ibuprofen (8-12 hours vs. 6 hours) 4
• Both medications have similar analgesic efficacy when dosed appropriately 5

Safety Considerations

Cardiovascular Risk

• Use the lowest effective dose for the shortest duration possible 4, 3
• Patients with cardiovascular disease are at higher risk of adverse events 5
• NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke 5

Gastrointestinal Risk

• Higher risk in patients over 60 years, history of peptic ulcer disease, or alcohol use 5
• Consider gastroprotective agents in high-risk patients 5

Renal Risk

• Use with caution in patients over 60 years, compromised fluid status, or with concomitant nephrotoxic drugs 5
• Monitor renal function in at-risk patients 5

Algorithm for NSAID Selection

1. For short-term, mild pain relief:

   • Ibuprofen 400 mg every 6 hours (preferred for faster onset)

2. For longer-lasting pain relief:

   • Naproxen 220-500 mg every 8-12 hours (preferred for less frequent dosing)

3. For patients with cardiovascular risk:

   • Use lowest effective dose for shortest duration
   • Consider alternative non-NSAID analgesics if high risk

4. For patients with GI risk:

   • Consider gastroprotective agents
   • Use lowest effective dose

Key Takeaways

• Ibuprofen 400 mg provides optimal pain relief with no additional benefit from higher doses 1
• Naproxen offers longer duration of action, making it suitable for overnight pain control 4
• The choice between ibuprofen and naproxen should be based on desired onset and duration of action rather than efficacy differences
• Always use the lowest effective dose for the shortest duration to minimize adverse effects 4, 3