What is the recommended dosage of naproxen (Nonsteroidal Anti-Inflammatory Drug) for adults?

Recommended Naproxen Dosage for Adults

The recommended standard dosage of naproxen for adults is 250-500 mg twice daily, with a maximum daily dose of 1000 mg for most conditions. 1

Dosing Guidelines by Condition

Rheumatoid Arthritis, Osteoarthritis, and Ankylosing Spondylitis

• Starting dose: 250 mg, 375 mg, or 500 mg twice daily 1
• Maintenance: Dose may be adjusted based on clinical response
• For limited periods (up to 6 months): May increase to 1500 mg/day when higher anti-inflammatory activity is required 1

Pain Management and Primary Dysmenorrhea

• Starting 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: Total 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

Special Populations

Elderly Patients

• Use the lowest effective dose 1
• Start at lower doses and titrate upward as needed
• No specific dose adjustment required, but caution is advised with high doses 1

Renal Impairment

• Mild impairment: Lower starting dose recommended
• Moderate to severe impairment (CrCl <30 mL/min): Not recommended 1

Hepatic Impairment

• Lower starting dose recommended 2
• Maximum daily dose should not exceed 2g/day in patients with liver dysfunction 2

Administration Guidelines

• Can be taken with food to reduce gastrointestinal side effects
• Morning and evening doses do not need to be equal 1
• Administration more frequently than twice daily generally does not improve response 1

Safety Considerations

Cardiovascular Risk

• All NSAIDs carry cardiovascular risks 2
• Naproxen (RR: 0.92) appears to have a lower cardiovascular risk profile compared to other NSAIDs like diclofenac (RR: 1.63) and ibuprofen (RR: 1.51) 2
• Monitor blood pressure within 1-2 weeks of starting therapy, especially in patients with hypertension 2

Gastrointestinal Risk

• Can cause GI toxicity 3
• Consider gastric protection when used over prolonged periods 3

Drug Interactions

• May reduce effectiveness of antihypertensive medications 2
• Preferred over ibuprofen in patients on aspirin therapy 2

Common Pitfalls to Avoid

1. Exceeding the maximum recommended daily dose
2. Not adjusting dosage in elderly or those with mild renal/hepatic impairment
3. Using in patients with moderate to severe renal impairment
4. Failing to monitor blood pressure after initiating therapy
5. Not providing gastric protection during prolonged use

Remember that naproxen tablets, suspension, delayed-release tablets, and sodium tablets have pharmacokinetic differences that may affect onset of action, despite all circulating as naproxen in plasma 1. Choose the appropriate formulation based on when pain relief is needed.