What is the recommended dosing for naproxen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) in adults?

Naproxen Adult Dosing Recommendations

The recommended adult dosing for naproxen varies by indication, with standard dosing being 250-500 mg twice daily for most conditions, with a maximum daily dose of 1500 mg for limited periods. 1

Standard Dosing by Indication

Rheumatoid Arthritis, Osteoarthritis, and Ankylosing Spondylitis

• Initial dose: 250 mg, 375 mg, or 500 mg twice daily 1
• Long-term maintenance: May adjust dose up or down based on clinical response
• Maximum dose: Up to 1500 mg/day for limited periods (up to 6 months) when higher anti-inflammatory activity is required 1

Acute Pain, Primary Dysmenorrhea, Acute Tendonitis and Bursitis

• Starting dose: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as required 1
• Initial total daily dose should not exceed 1250 mg
• Subsequent 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 and Considerations

Elderly Patients

• Consider lower starting doses in elderly patients 1
• Although total plasma concentration remains unchanged, the unbound plasma fraction increases in the elderly 1
• Use the lowest effective dose as a prudent approach 1

Patients with Renal or Hepatic Impairment

• Consider lower doses in patients with mild renal or hepatic impairment 1
• Not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1

Duration of Therapy and Monitoring

• Limit duration of therapy to the shortest period possible to minimize adverse effects 2
• Monitor blood pressure within 1-2 weeks of starting therapy 2
• For ankylosing spondylitis, on-demand treatment is conditionally recommended over continuous treatment in stable patients 2

Important Clinical Considerations

Gastrointestinal Risk Management

• Risk of GI complications increases with:
  • Age >65 years
  • History of ulcers
  • Concomitant use of anticoagulants (increases risk 5-6 times) 2
• Consider combining with a proton pump inhibitor for patients at high risk of GI complications 2
• Avoid combining with other NSAIDs as this dramatically increases GI complication risk 2

Cardiovascular Considerations

• Naproxen has a more favorable cardiovascular profile compared to other NSAIDs 2
• Preferred for patients taking aspirin as it doesn't interfere with aspirin's cardioprotective effects 2

Formulation Differences

• Different formulations (tablets, suspension, delayed-release tablets, sodium tablets) are not necessarily bioequivalent 1
• Consider these differences when changing formulation as they may affect onset of action 1

Common Pitfalls to Avoid

1. Exceeding recommended maximum daily doses
2. Using prolonged high-dose therapy without appropriate monitoring
3. Failing to adjust dosing in elderly patients or those with mild renal/hepatic impairment
4. Combining with other NSAIDs, which significantly increases adverse effects
5. Not considering proton pump inhibitor co-therapy in high-risk patients
6. Using in patients with moderate to severe renal impairment

Naproxen's efficacy is well-established across various pain and inflammatory conditions, with a well-understood safety profile compared to many newer NSAIDs 3. When properly dosed and monitored, it provides effective pain relief with onset of action beginning within 1 hour 1.