What is the recommended dose of prescription naproxen (nonsteroidal anti-inflammatory drug)?

Prescription Naproxen Dosing

For prescription naproxen, the recommended dose depends on the indication: 250-500 mg twice daily for chronic inflammatory conditions like rheumatoid arthritis and osteoarthritis, with a maximum of 1500 mg/day for up to 6 months when higher anti-inflammatory activity is needed; 500 mg initially followed by 500 mg every 12 hours or 250 mg every 6-8 hours for acute pain (maximum 1250 mg first day, then 1000 mg/day thereafter); and 750 mg initially followed by 250 mg every 8 hours for acute gout. 1

Chronic Inflammatory Conditions

Rheumatoid Arthritis, Osteoarthritis, and Ankylosing Spondylitis

• Standard dosing: 250 mg, 375 mg, or 500 mg twice daily 1
• The morning and evening doses do not need to be equal, and dosing more frequently than twice daily is unnecessary 1
• Dose adjustment: May be titrated up or down based on clinical response during long-term administration 1
• Higher-dose option: In patients tolerating lower doses well, increase to 1500 mg/day for limited periods up to 6 months when greater anti-inflammatory/analgesic activity is required 1
• When using 1500 mg/day, ensure sufficient clinical benefit to offset potential increased risk 1

Juvenile Arthritis

• Pediatric dosing: Approximately 10 mg/kg/day in 2 divided doses (5 mg/kg twice daily) 1
• Naproxen oral suspension is recommended over tablets for this indication due to dosing precision 1

Acute Pain Conditions

Pain, Primary Dysmenorrhea, Acute Tendonitis and Bursitis

• Initial dose: 500 mg, followed by 500 mg every 12 hours OR 250 mg every 6-8 hours as needed 1
• Maximum first day: 1250 mg total daily dose 1
• Subsequent days: Maximum 1000 mg/day 1
• Naproxen sodium is preferred for acute conditions when rapid onset of pain relief is desired due to faster absorption 1

Acute Gout

• Initial dose: 750 mg followed by 250 mg every 8 hours until the attack subsides 1
• This represents a higher loading dose strategy appropriate for the intense inflammatory nature of acute gout 2

Special Population Considerations

Elderly Patients

• Start low: Use the lowest effective dose in elderly patients 1
• Although total plasma naproxen concentration is unchanged in the elderly, the unbound plasma fraction increases 1
• Dose adjustment may be required when high doses are needed 1

Renal Impairment

• Moderate to severe renal impairment: Naproxen is not recommended when creatinine clearance is <30 mL/min 1
• A lower starting dose should be considered in patients with renal impairment 1

Hepatic Impairment

• Consider a lower starting dose in patients with hepatic impairment 1

Formulation Considerations

• Different formulations (tablets, suspension, delayed-release tablets, naproxen sodium tablets) are not necessarily bioequivalent 1
• This pharmacokinetic difference affects onset of action and should be considered when changing formulations 1
• Onset of pain relief can begin within 1 hour 1

Clinical Context from Guidelines

Migraine Treatment

• Acute migraine: 275-550 mg every 2-6 hours, with maximum initial dose of 825 mg and avoiding more than 1.5 g/day 2

Gout Prophylaxis

• Low-dose prophylaxis: 250 mg twice daily (with proton pump inhibitor where indicated) when initiating urate-lowering therapy 2

Procedural Pain (IUD Placement)

• Premedication: 500-550 mg orally 1-2 hours before procedure, or 2 over-the-counter naproxen sodium tablets (440 mg total) 2
• Post-procedure: 440-550 mg every 12 hours with food for first 24 hours 2

Bone Pain from CSF Therapy

• CSF-related bone pain: 500 mg twice daily starting on day of pegfilgrastim administration, continuing for 5-8 days 2

Important Safety Considerations

• Always take naproxen with food to reduce gastrointestinal adverse effects 2
• Monitor high-risk patients (>60 years, history of peptic ulcer, significant alcohol use) for gastrointestinal complications 3
• Stop naproxen if gastrointestinal bleeding, peptic ulcer develops, or if urea/creatinine doubles 3
• Use caution in patients with cardiovascular disease history 3