What is the recommended duration of naproxen (nonsteroidal anti-inflammatory drug (NSAID)) therapy?

Duration of Naproxen Therapy

Naproxen should be used at the lowest effective dose and for the shortest duration possible to minimize risks of adverse effects. 1, 2

General Recommendations for Duration

• Naproxen should be prescribed at the lowest effective dose for the shortest duration consistent with individual patient treatment goals 2
• For most conditions, oral NSAIDs should be used at the lowest effective dose and for the shortest duration in patients who respond inadequately to paracetamol (acetaminophen) 1
• The patient's requirements and response to treatment should be re-evaluated periodically to determine if continued therapy is necessary 1

Condition-Specific Duration Guidelines

Acute Pain Conditions

• For acute pain management (including primary dysmenorrhea and acute tendonitis/bursitis): Initial total daily dose should not exceed 1250 mg, thereafter not exceeding 1000 mg daily until pain subsides 2
• For acute gout: Start with 750 mg followed by 250 mg every 8 hours until the attack has subsided 2

Chronic Inflammatory Conditions

• For rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis: The standard regimen is 250-500 mg twice daily 2
• For long-term administration, the dose may be adjusted based on clinical response, with a lower daily dose often sufficient for maintenance therapy 2
• In patients who require higher anti-inflammatory/analgesic activity, doses up to 1500 mg/day may be used, but only for limited periods of up to 6 months 2

Risk Considerations Affecting Duration

• Gastrointestinal (GI) risks increase with longer use and higher dosages 1
• In patients with increased GI risk, non-selective NSAIDs should be used with a gastroprotective agent 1
• Cardiovascular risks may be a class-related side effect of NSAIDs, necessitating caution with prolonged use 1
• In elderly patients, those with renal or hepatic impairment, or those with cardiovascular comorbidities, shorter durations are advisable 2, 3

Special Populations

• For elderly patients: Lower doses should be considered, though total plasma concentration remains unchanged, the unbound plasma fraction increases 2
• For patients with moderate to severe renal impairment: Naproxen is not recommended 2
• For juvenile arthritis: The recommended total daily dose is approximately 10 mg/kg given in 2 divided doses 2

Important Considerations

• The risk of serious GI toxicity is dose-dependent and increases with age, limiting long-term use in osteoarthritis, which is age-associated 1
• For osteoarthritis management, when systemic NSAIDs are needed, they should be used at the lowest effective dosage and shortest duration 1
• When treating patients with naproxen 1500 mg/day, physicians should observe sufficient increased clinical benefits to offset potential increased risk 2

Common Pitfalls to Avoid

• Continuing NSAID therapy without periodic reassessment of need and effectiveness 1
• Using higher doses than necessary for prolonged periods, which increases risk of adverse effects 2, 3
• Failing to consider gastroprotective strategies for patients on longer-term therapy 1
• Not recognizing that both GI and cardiovascular risks increase with duration of therapy 3

Remember that the balance between efficacy and safety should guide naproxen use, with treatment duration limited to the minimum necessary to achieve symptom control.