What is the recommended dose of naproxen (nonsteroidal anti-inflammatory drug (NSAID)) for children with juvenile idiopathic arthritis (JIA)?

Naproxen Dosing for Juvenile Idiopathic Arthritis

The recommended dose of naproxen for children with juvenile idiopathic arthritis (JIA) is approximately 10 mg/kg/day given in 2 divided doses (5 mg/kg twice daily). 1

Evidence-Based Dosing Recommendations

• Naproxen is the preferred NSAID for children with JIA due to its established efficacy and safety profile 2
• The FDA-approved dosing for juvenile arthritis is approximately 10 mg/kg/day divided into two doses 1
• Naproxen should be used as adjuvant therapy for pain and inflammation in children with JIA, not as monotherapy 2
• An adequate trial period of at least 8 weeks is recommended for NSAID therapy, given that the time course to response is about 1 month 2

Administration Considerations

• Naproxen oral suspension is better suited for pediatric dosing than tablets, as it allows for more precise weight-based dosing 1
• The morning and evening doses do not need to be equal, and administration more frequently than twice daily does not generally improve response 1
• For optimal pain relief, naproxen should be given consistently, as onset of pain relief can begin within 1 hour 1
• The lowest effective dose should be used for the shortest duration consistent with treatment goals to minimize potential adverse effects 1

Safety Considerations

• Naproxen has demonstrated fewer side effects compared to other NSAIDs in pediatric populations 3
• Common adverse effects (occurring in ≥5% of patients) include upper respiratory tract and gastrointestinal symptoms 4
• Naproxen should be used with caution in patients with renal or hepatic impairment 1
• Naproxen is not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1

Treatment Algorithm

1. Initial therapy: Start naproxen at 10 mg/kg/day divided into two doses (5 mg/kg twice daily) 1, 5
2. Duration: Provide an adequate trial of at least 8 weeks 2
3. Monitoring: Assess clinical response after 4 weeks 3
4. Concurrent therapy: Initiate methotrexate as first-line disease-modifying therapy without delay, as NSAIDs alone are insufficient for disease control 2
5. Long-term management: Adjust naproxen dose based on clinical response, potentially using a lower dose for maintenance therapy 1

Important Clinical Pearls

• While naproxen is effective for symptom management, it should not delay the introduction of disease-modifying antirheumatic drugs (DMARDs) like methotrexate, which is the cornerstone of JIA treatment 2
• Naproxen has shown comparable efficacy to other NSAIDs but with potentially better tolerability in children 3, 5
• Fixed combination products of naproxen with gastroprotective agents (like esomeprazole) may be considered for adolescents at higher risk of gastrointestinal adverse effects 4
• Acetylsalicylic acid (aspirin) is not recommended for children with JIA despite FDA approval due to safety concerns and risk of Reye's syndrome 2