What is the recommended dose of naproxen (nonsteroidal anti-inflammatory drug (NSAID)) for adults?

Naproxen Dosing for Adults

The recommended dose of naproxen for adults is 500 mg twice daily (every 12 hours) for chronic conditions like arthritis, or 500 mg initially followed by 250-500 mg every 8-12 hours for acute pain, 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)

• Start with 250-500 mg twice daily 2, 1
• The maximum daily dose is 1000 mg (2 × 500 mg) for routine long-term use 2
• 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 1
• Morning and evening doses do not need to be equal, and dosing more than twice daily provides no additional benefit 1

Acute Pain Management (Including Primary Dysmenorrhea, Tendonitis, Bursitis)

• Initial dose: 500 mg, followed by 500 mg every 12 hours OR 250 mg every 6-8 hours 1
• Maximum first day: 1250 mg total 1
• Maximum subsequent days: 1000 mg total 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

Acute Gout

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

Over-the-Counter vs Prescription Formulations

Prescription Naproxen

• Available as 250 mg, 375 mg, and 500 mg tablets 1
• Standard dosing: 500 mg twice daily 2, 3

Over-the-Counter Naproxen Sodium (Aleve)

• 440 mg (2 × 220 mg tablets) twice daily is equivalent to prescription naproxen 500 mg twice daily 3
• The sodium salt formulation provides faster absorption and more rapid pain relief 1

Special Populations

Elderly Patients

• Start with the lowest effective dose and titrate upward as needed 1
• Although total plasma naproxen concentration is unchanged in elderly patients, the unbound (active) fraction increases, requiring dose adjustment 1
• Use caution with high doses in this population 1

Renal Impairment

• Naproxen is not recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1
• Consider lower doses in patients with mild renal impairment 1

Hepatic Impairment

• Consider lower starting doses in patients with hepatic dysfunction 1

Duration and Monitoring

Initial Treatment Period

• Treat for 2-4 weeks at maximum tolerated dose before assessing response 3
• If insufficient response after 2-4 weeks, switch to another NSAID or add second-line treatments 3

Long-Term Use

• After 12 weeks of sustained response, consider tapering 3
• Monitor every 3 months: blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood 2

Important Safety Considerations

Gastrointestinal Risks

• Discontinue if BUN or creatinine doubles 2
• Discontinue if liver function tests increase to 3× upper limit of normal 2
• Consider gastroprotection with proton pump inhibitor or H2 blocker in high-risk patients (age >60, history of peptic ulcer disease, significant alcohol use) 2, 3
• Discontinue immediately if GI bleeding occurs 3

Cardiovascular and Renal Risks

• Discontinue if hypertension develops or worsens 2
• Use with extreme caution in patients with cardiovascular disease 2
• Avoid in patients with compromised fluid status or concurrent nephrotoxic drugs 2

Drug Interactions

• NSAIDs with anticoagulants (warfarin, heparin) significantly increase bleeding risk 2
• Avoid combination or monitor closely if unavoidable 2

Managing NSAID-Related Bone Pain (When Used with CSFs)

• If naproxen is being used to prevent bone pain from colony-stimulating factors (CSFs) in cancer patients, administer 500 mg twice daily starting on the day of CSF administration and continuing for 5-8 days 2

Key Clinical Pearls

• Naproxen has a longer half-life than ibuprofen, allowing twice-daily dosing versus three-times-daily for ibuprofen 3
• Different formulations (tablets, suspension, delayed-release, naproxen sodium) are not bioequivalent and have different onset times—consider this when switching formulations 1
• If two different NSAIDs fail sequentially, switch to an alternative analgesic approach (such as opioids) rather than trying additional NSAIDs 2
• The time to onset of pain relief is approximately 30 minutes, with peak effect at 1 hour 2, 1