Naproxen Dosing in Adults
The recommended dosing regimen for naproxen in adults is 250-500 mg twice daily for most conditions, with a maximum daily dose of 1500 mg for limited periods and 1000 mg for long-term use. 1
Standard Dosing by Condition
Rheumatoid Arthritis, Osteoarthritis, and Ankylosing Spondylitis
- Initial/Standard dose: 250 mg, 375 mg, or 500 mg twice daily 1
- Maximum dose: Up to 1500 mg/day for limited periods (up to 6 months) when higher anti-inflammatory activity is required 1
- Long-term maintenance: Lower doses often suffice; should not exceed 1000 mg/day 1
Acute Pain, Primary Dysmenorrhea, and Acute Tendonitis/Bursitis
- Starting dose: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as required 1
- Initial maximum: First day should not exceed 1250 mg 1
- Subsequent days: Should not exceed 1000 mg daily 1
Acute Gout
Formulation Considerations
- Different formulations (tablets, suspension, delayed-release tablets, sodium tablets) have different pharmacokinetic properties affecting onset of action 1
- Naproxen sodium is recommended when prompt onset of pain relief is desired 1
- Naproxen sodium 550 mg is equivalent to 500 mg of naproxen 2
Special Populations
Elderly Patients
- Lower doses recommended initially 1
- Although total plasma concentration remains unchanged, the unbound plasma fraction increases in elderly patients 1
- Use lowest effective dose and titrate upward as needed 1
Renal Impairment
- Mild impairment: Lower starting dose with upward titration 1
- Moderate to severe impairment: Not recommended (creatinine clearance <30 mL/min) 1
Hepatic Impairment
- Lower starting dose with careful upward titration 1
Administration Timing
- Morning and evening doses do not need to be equal in size 1
- Administration more frequently than twice daily does not generally improve response 1
- Controlled-release formulations (750-1000 mg) can be given once daily with comparable efficacy to twice-daily conventional tablets 3, 4
Efficacy and Safety Profile
- Onset of pain relief can begin within 1 hour 1
- For postoperative pain, naproxen sodium 550 mg provides approximately 7.6 hours of pain relief compared to 2.6 hours with placebo 2
- Naproxen has a well-established safety profile compared to many newer NSAIDs 5
Precautions
- Monitor for gastrointestinal side effects (10-20% experience dyspepsia, abdominal pain) 6
- Risk of GI bleeding increases with age (one-year risk is 1 in 2,100 adults younger than 45 and 1 in 110 adults older than 75) 6
- Consider gastroprotective agents (PPI or H2 blocker) in high-risk patients 6
- Monitor for cardiovascular complications, especially in patients with hypertension or heart failure 6
Naproxen remains an effective analgesic and anti-inflammatory medication with a convenient once or twice daily dosing regimen that provides reliable pain relief across multiple conditions when used at appropriate doses.