What is the recommended dosage and usage of Naproxen (Nonsteroidal Anti-Inflammatory Drug) for pain relief?

Recommended Dosage and Usage of Naproxen for Pain Relief

For pain relief, naproxen is recommended at 500 mg twice daily for prescription strength, or 220 mg (naproxen sodium) twice daily for over-the-counter formulations. 1, 2

Dosage Guidelines by Pain Type

General Pain Relief

• Prescription naproxen: 500 mg twice daily (maximum 1000 mg/day) 1
• OTC naproxen sodium (Aleve): 220 mg twice daily 2
• Onset of action: Pain relief can begin within 1 hour 1

Acute Pain Conditions

• Initial dose: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as required 1
• Maximum initial daily dose: 1250 mg on first day 1
• Maximum subsequent daily dose: 1000 mg 1

Specific Pain Conditions

• Acute gout: Starting dose of 750 mg followed by 250 mg every 8 hours until attack subsides 1
• Primary dysmenorrhea: 500 mg initially, then 250 mg every 6-8 hours 1
• Acute tendonitis/bursitis: Same as general acute pain management 1

Administration Considerations

Timing

• Morning and evening doses do not need to be equal in size 1
• Taking medication more frequently than twice daily does not generally improve response 1
• For acute pain, taking naproxen early when pain is mild provides better relief than waiting until pain is moderate or severe 3

Formulation Differences

• Different formulations (tablets, suspension, delayed-release tablets, sodium tablets) have pharmacokinetic differences that may affect onset of action 1
• All circulate in plasma as naproxen but may have different absorption rates 1

Special Populations

Elderly Patients

• Consider lower starting doses in elderly patients 1
• Total plasma concentration remains unchanged, but unbound plasma fraction increases in elderly 1
• Use lowest effective dose in elderly patients 1

Renal/Hepatic Impairment

• Lower doses should be considered 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

Efficacy and Clinical Outcomes

• Naproxen is effective for various pain conditions including rheumatic diseases, acute traumatic injury, postoperative pain, and dysmenorrhea 4
• For postoperative pain, about half of patients experience clinically useful pain relief with 500 mg naproxen compared to 15% with placebo 5
• Median time to rescue medication is 8.9 hours with naproxen 500 mg versus 2.0 hours with placebo 5

Safety and Monitoring

Common Adverse Effects

• Gastrointestinal effects (dyspepsia, abdominal pain)
• Renal effects
• Cardiovascular effects

High-Risk Patients

• GI risk factors: Age >60 years, history of peptic ulcer disease, alcohol use (≥2 drinks/day), high-dose or prolonged NSAID use 2
• Renal risk factors: Age >60 years, compromised fluid status, concomitant nephrotoxic drugs 2
• Cardiac risk factors: History of cardiovascular disease, use with anticoagulants 2

Monitoring Recommendations

• Baseline: Blood pressure, BUN, creatinine, liver function tests, CBC, fecal occult blood 2
• Follow-up: Repeat tests every 3 months during long-term use 2

Risk Mitigation

• Consider gastroprotection (PPI or H2 blocker) for patients at risk of GI complications 2
• Discontinue if BUN or creatinine doubles, if hypertension develops or worsens, or if liver function tests increase significantly 2

Important Considerations

• If two NSAIDs tried in succession without efficacy, use another approach to analgesia 2
• For bone pain related to cancer treatment, naproxen (500 mg twice daily) may help reduce pain 2
• Naproxen may be used to reduce bone pain associated with growth factor administration 2

Remember that naproxen, like all NSAIDs, carries risks of GI, renal, and cardiovascular adverse effects, particularly with long-term use. Always use the lowest effective dose for the shortest duration necessary to control symptoms.