Naproxen Administration Instructions
Naproxen should be taken at the lowest effective dose for the shortest duration consistent with individual treatment goals, with a standard dosage of 375-500 mg twice daily (every 12 hours) for prescription naproxen. 1, 2
Dosage Guidelines
- For prescription naproxen, the recommended dose is 250 mg, 375 mg, or 500 mg twice daily, depending on the condition being treated 2
- For over-the-counter naproxen sodium (Aleve), the equivalent dosage would be 440 mg (2 tablets of 220 mg) twice daily 1
- Always take naproxen with food to minimize gastrointestinal side effects 3, 2
- For acute pain management, start with 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as required, not exceeding 1250 mg on the first day and 1000 mg daily thereafter 2
- For acute gout, begin with 750 mg followed by 250 mg every 8 hours until the attack subsides 2
Administration Timing
- Morning and evening doses do not need to be equal in size 2
- Taking naproxen more frequently than twice daily generally does not improve response due to its relatively long half-life 2, 4
- For acute pain conditions where rapid onset is desired, naproxen sodium may be preferred over regular naproxen 2, 5
Duration of Treatment
- Initial treatment should be for 2-4 weeks at the maximum tolerated and approved dosage 1
- After 2-4 weeks, evaluate treatment response and consider tapering after 12 weeks of sustained response 1
- Long-term use requires regular monitoring for adverse effects 3
Special Populations
- For elderly patients, consider starting at a lower dose and adjusting based on response, although total plasma concentration remains unchanged 2
- Dosage adjustments are generally not required for mild renal or hepatic impairment, but starting at a lower dose is prudent 2, 6
- Naproxen is not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 2
Monitoring and Precautions
- Monitor for gastrointestinal side effects, which occur in 10-20% of patients 3
- For patients at high risk of GI complications (age >60, history of peptic ulcer disease, concomitant use of anticoagulants or corticosteroids), consider gastroprotection with proton pump inhibitors 3
- Monitor blood pressure, as NSAIDs can worsen hypertension 3
- For long-term use, periodic monitoring of renal function, liver function, and fecal occult blood is recommended 3
- Discontinue naproxen if GI bleeding, significant elevation in liver enzymes, or worsening hypertension develops 3
Drug Interactions
- Use caution when combining with anticoagulants, as this significantly increases bleeding risk 3
- Avoid concurrent use with other NSAIDs or aspirin 3
- Be aware of potential interactions with lithium, methotrexate, and probenecid 7
Common Pitfalls to Avoid
- Exceeding recommended dosages, which increases risk of adverse effects without necessarily improving efficacy 2
- Using in late pregnancy (last 6-8 weeks), which can cause complications including premature closure of the ductus arteriosus 3
- Failing to recognize that dyspeptic symptoms don't always correlate with clinically significant ulcerations 3
- Using in patients with pre-existing renal disease, congestive heart failure, or cirrhosis without careful monitoring 3
By following these guidelines, patients can maximize the benefits of naproxen while minimizing potential risks associated with its use.