What is the recommended dosage of naproxen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) in 24 hours?

Naproxen Maximum Daily Dosage

The maximum daily dose of naproxen should not exceed 1,000 mg per 24 hours for chronic conditions, with an exception allowing up to 1,250 mg on the first day only for acute pain conditions. 1

Standard Dosing Limits

Chronic Inflammatory Conditions

• Maximum: 1,000 mg per 24 hours for ongoing treatment of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis 1
• Standard dosing: 250-500 mg twice daily 1
• For patients tolerating lower doses well, the dose may be increased to 1,500 mg/day for limited periods up to 6 months when higher anti-inflammatory activity is required, though this carries increased risk 1

Acute Pain Conditions

• First day maximum: 1,250 mg 1
• Initial dose: 500 mg, followed by 500 mg every 12 hours or 250 mg every 6-8 hours 1
• Subsequent days maximum: 1,000 mg per 24 hours 1

Acute Gout

• Initial dose: 750 mg, followed by 250 mg every 8 hours until attack subsides 1
• This translates to a maximum of approximately 1,500 mg on day one, then 750 mg daily thereafter 1

Migraine Treatment

• Maximum: 1,500 mg per day 2
• Dosing: 275-550 mg every 2-6 hours 2
• Maximum initial dose: 825 mg 2

Critical Safety Considerations

Avoid exceeding 1,500 mg per day except in highly selected patients under close monitoring, as this significantly increases cardiovascular, gastrointestinal, and renal risks. 1

High-Risk Populations Requiring Dose Reduction

• Elderly patients: Start with lowest effective dose due to increased unbound drug fraction despite unchanged total plasma concentration 1
• Renal impairment (CrCl <30 mL/min): Naproxen is not recommended 1
• Hepatic impairment: Consider lower doses 1

Mandatory Monitoring

• Gastrointestinal protection with proton pump inhibitor or misoprostol is required for patients taking nonselective NSAIDs like naproxen 2
• Routine assessment for gastrointestinal toxicity, renal function, hypertension, and heart failure 2

Common Pitfalls to Avoid

• Do not combine naproxen with other NSAIDs (including COX-2 inhibitors), as this increases adverse effects without additional benefit 2
• Do not use ibuprofen concurrently with aspirin for cardioprophylaxis, as it interferes with aspirin's antiplatelet effect 2
• Avoid chronic use without reassessment - regular evaluation of continued need is essential 3
• Account for "hidden sources" of NSAIDs in combination products when calculating total daily dose 2