What is the recommended dose of naproxen (Nonsteroidal Anti-Inflammatory Drug) for adults?

Naproxen Dosing for Adults

For adults, naproxen is typically dosed at 250-500 mg twice daily for chronic inflammatory conditions, with a maximum daily dose of 1000-1250 mg depending on the indication. 1

Standard Dosing by Indication

Chronic Inflammatory Conditions (Rheumatoid Arthritis, Osteoarthritis, Ankylosing Spondylitis)

• Standard dose: 250 mg, 375 mg, or 500 mg twice daily 2, 1
• The morning and evening doses do not need to be equal in size 1
• For patients requiring higher anti-inflammatory activity, doses may be increased to 1500 mg/day for limited periods up to 6 months, though this carries increased risk and requires close monitoring 1
• Long-term maintenance may allow for lower daily doses once therapeutic response is achieved 1

Acute Pain Conditions (Pain, Dysmenorrhea, Tendonitis, Bursitis)

• Initial dose: 500 mg, followed by 500 mg every 12 hours OR 250 mg every 6-8 hours 1
• Maximum initial daily dose: 1250 mg 1
• Maximum subsequent daily dose: 1000 mg 1
• For acute pain, naproxen sodium is preferred over naproxen base due to more rapid absorption and faster onset of pain relief (within 1 hour) 1, 3

Acute Gout

• Initial dose: 750 mg, followed by 250 mg every 8 hours until attack subsides 1

Important Dosing Considerations

Formulation Differences

• Naproxen sodium and naproxen base are not bioequivalent and have different pharmacokinetic profiles affecting onset of action 1
• When switching formulations, account for these differences in absorption rates 1
• Sustained-release formulations can be given once daily (1000 mg) with equivalent efficacy to twice-daily conventional dosing but with lower gastrointestinal side effects 4

Special Populations

Elderly Patients:

• Use the lowest effective dose, as unbound plasma fraction increases with age despite unchanged total plasma concentration 1
• Dose adjustment may be required when high doses are necessary 1

Renal Impairment:

• Naproxen is NOT recommended in patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1
• Use with extreme caution in patients with compromised fluid status or taking concomitant nephrotoxic drugs 2

Hepatic Impairment:

• Consider lower doses in patients with hepatic dysfunction 1

Critical Safety Warnings

Gastrointestinal Risk

• GI bleeding risk is age-dependent: 1 in 2,100 for adults <45 years vs. 1 in 110 for adults >75 years 2
• Consider co-prescribing a proton pump inhibitor (PPI) or H2 blocker for patients at increased risk 2
• Avoid in patients with active peptic ulcer disease; use with extreme caution in those with history of peptic ulcer disease 2

Cardiovascular Risk

• Mean blood pressure increase of 5 mm Hg with NSAID use 2
• Avoid in patients with congestive heart failure 2
• Use with caution in patients with hypertension or cardiovascular disease 2

Drug Interactions

• Risk of GI bleeding increases 3-6 fold when combined with anticoagulants 2
• INR increases up to 15% when used concurrently with anticoagulants 2
• Use caution when combining with ACE inhibitors or beta blockers due to potential renal complications 2

Clinical Pearls

• No specific NSAID is preferred over another for efficacy—choice should be based on patient history, risk factors, and comorbidities 2
• For bone pain associated with CSF therapy in oncology patients, naproxen 500 mg twice daily starting on day of pegfilgrastim administration and continuing for 5-8 days effectively reduces incidence, duration, and severity 2
• Approximately 50% of patients achieve clinically useful pain relief with naproxen 500 mg for acute postoperative pain, compared to 15% with placebo 3
• Median time to rescue medication is 8.9 hours with naproxen 500/550 mg versus 2 hours with placebo 3