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

Naproxen Dosage and Administration for Pain Relief

For pain relief, naproxen should be administered at 500 mg twice daily or 250 mg every 6-8 hours, with a maximum initial daily dose of 1250 mg followed by no more than 1000 mg daily for maintenance therapy. 1

Recommended Dosing by Condition

General Pain Management

• Starting dose: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as needed
• Initial maximum daily dose: 1250 mg
• Maintenance maximum daily dose: 1000 mg 1

Specific Conditions

• Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis:

  • 250 mg, 375 mg, or 500 mg twice daily
  • For limited periods (up to 6 months), may increase to 1500 mg/day when higher anti-inflammatory effect is needed 1

• Acute gout:

  • Starting dose: 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
  • Naproxen sodium may be preferred for faster onset of action 1

Formulation Considerations

• Different formulations (tablets, suspension, delayed-release tablets, sodium tablets) have different pharmacokinetics affecting onset of action 1
• Naproxen sodium is recommended when prompt pain relief is desired 1
• Pain relief can begin within 1 hour of administration 1

Dosage Adjustments for Special Populations

Elderly Patients

• Start with lower doses
• Although total plasma concentration remains unchanged, unbound plasma fraction increases in elderly patients 1
• Use lowest effective dose in elderly patients 1

Patients with Renal or Hepatic Impairment

• Lower starting doses recommended for mild impairment 2
• Not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1
• Maximum daily dose should not exceed 2g/day in patients with liver dysfunction 2

Monitoring and Safety Considerations

Cardiovascular Risks

• Monitor blood pressure within 1-2 weeks of starting therapy, especially in hypertensive patients 2
• Naproxen has a lower cardiovascular risk profile compared to other NSAIDs (relative risk of 0.92) 2

Gastrointestinal Risks

• Risk factors for GI toxicity include: age >60 years, history of peptic ulcer disease, significant alcohol use, and high-dose or prolonged NSAID use 3
• Consider gastric protection when used over prolonged periods 2
• Baseline monitoring should include blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood 3
• Repeat monitoring every 3 months to ensure lack of toxicity 3

Important Precautions

• Use the lowest effective dose for the shortest duration possible to minimize risks
• May reduce effectiveness of antihypertensive medications 2
• If two NSAIDs are tried in succession without efficacy, consider alternative approach to analgesia 3
• Dyspepsia and GI discomfort occur in 10-20% of persons taking NSAIDs 3

Comparative Efficacy

• Naproxen sodium 550 mg has been shown to be an effective analgesic for acute postoperative pain with a weighted mean time to remedication of 7.6 hours compared to 2.6 hours for placebo 4
• Clinical trials have confirmed that naproxen's analgesic and anti-inflammatory efficacy is equivalent to many other NSAIDs 5

By following these dosing guidelines and monitoring recommendations, naproxen can provide effective pain relief while minimizing potential adverse effects.