What is the maximum recommended daily dosage of naproxen (nonsteroidal anti-inflammatory drug)?

Maximum Recommended Daily Dosage of Naproxen

The maximum recommended daily dosage of naproxen is 1500 mg per day for limited periods of up to 6 months, with a more typical maximum daily dose of 1000 mg for long-term use. 1

Standard Dosing Guidelines

Naproxen dosing varies based on formulation, indication, and patient factors:

• Prescription naproxen (Naprosyn):

  • Standard dosing: 250-500 mg twice daily 2, 1
  • Maximum daily dose for long-term use: 1000 mg 1
  • For short periods requiring higher anti-inflammatory effect: Up to 1500 mg/day for limited periods up to 6 months 1

• Over-the-counter naproxen sodium (Aleve):

  • Typical dosing: 220 mg twice daily 2

Dosing by Indication

• Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis:

  • Standard dose: 250 mg, 375 mg, or 500 mg twice daily 1
  • Higher dose when needed: Up to 1500 mg/day for limited periods (≤6 months) 1

• Acute pain, primary dysmenorrhea, acute tendonitis/bursitis:

  • Initial dose: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours
  • First day maximum: 1250 mg
  • Subsequent days maximum: 1000 mg 1

• Acute gout:

  • Starting dose: 750 mg, followed by 250 mg every 8 hours until attack subsides 1

Special Population Considerations

Dose Adjustments Required:

• Elderly patients:

  • Lower doses recommended due to increased unbound plasma fraction of naproxen 1
  • Use lowest effective dose 1

• Renal impairment:

  • Moderate to severe renal impairment (creatinine clearance <30 mL/min): Not recommended 1
  • Mild renal impairment: Lower doses advised 1

• Hepatic impairment:

  • Lower doses recommended 1

Safety Considerations

Gastrointestinal Risk:

The risk of NSAID-related GI complications increases with:

• Higher doses
• Age (particularly >65 years)
• Comorbidities
• Concomitant anticoagulant use (5-6× increased risk) 2

Cardiovascular Risk:

All NSAIDs may increase cardiovascular risk, particularly at higher doses and with prolonged use.

Clinical Pearls

• Naproxen plasma concentrations show a less than proportional increase with increasing dose due to saturation of binding sites on plasma albumin 3
• Some patients may achieve adequate symptom control with a variable dosing regimen that allows for 20-30% lower overall consumption compared to fixed dosing 4
• Morning and evening doses do not need to be equal, and administration more frequently than twice daily generally does not improve response 1

Common Pitfalls to Avoid

1. Exceeding recommended maximum doses: Never exceed 1500 mg/day even for short periods, and generally limit to 1000 mg/day for maintenance therapy 1

2. Prolonged use of maximum doses: The 1500 mg/day dose should only be used for limited periods up to 6 months 1

3. Failure to adjust dosing in high-risk populations: Always consider dose reductions in elderly patients and those with mild renal or hepatic impairment 1

4. Overlooking formulation differences: Different formulations (tablets, suspension, delayed-release, sodium salt) have different pharmacokinetic properties that may affect onset of action 1