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

Naproxen Dosing for Shoulder Strain

For shoulder strain, use naproxen 500 mg twice daily (every 12 hours) for 2-4 weeks, then reassess response and consider tapering if symptoms have resolved. 1

Standard Dosing Regimen

• Prescription naproxen: 375-500 mg twice daily is the recommended dose range, with 500 mg twice daily being the standard for acute musculoskeletal conditions like shoulder strain 1
• Over-the-counter naproxen sodium (Aleve): 440 mg (two 220 mg tablets) twice daily is the equivalent OTC formulation 1
• Administer doses every 12 hours due to naproxen's relatively long half-life, which allows for convenient twice-daily dosing 2, 3

Treatment Duration and Monitoring

• Initial treatment period: 2-4 weeks at maximum tolerated dose before evaluating response 1
• Reassess at 2-4 weeks: If response is insufficient, consider switching to another NSAID or adding alternative treatments 1
• If adequate response achieved: Continue treatment with consideration for tapering after 12 weeks of sustained symptom control 1
• Do not continue beyond 2-4 weeks without reassessment, as prolonged NSAID use significantly increases gastrointestinal, cardiovascular, and renal complications 4

A direct study of naproxen versus indomethacin in periarthritis of the shoulder (a similar condition) demonstrated that naproxen 250 mg in the morning and 500 mg at night significantly reduced pain over 4 weeks of treatment 5. This supports the twice-daily dosing strategy for shoulder conditions.

Safety Considerations and Monitoring

Gastrointestinal protection:

• Consider adding a proton pump inhibitor or H2 blocker in high-risk patients (history of peptic ulcer, age >60, concurrent anticoagulant use) 1
• Monitor for fecal occult blood with long-term use 1
• Discontinue immediately if GI bleeding occurs 1

Cardiovascular and renal monitoring:

• Use the lowest effective dose for the shortest duration to minimize CV risk 6
• Monitor blood pressure, as NSAIDs can increase BP by approximately 5 mm Hg 4
• Check renal function (BUN, creatinine) if treatment extends beyond 2 weeks, especially in elderly patients 1, 4
• Discontinue if BUN or creatinine doubles 1

Contraindications and cautions:

• Avoid in patients with severe renal impairment (GFR <30 mL/min/1.73 m²) 4
• Use with extreme caution in patients with cardiovascular disease, heart failure, or hypertension 1, 6
• NSAIDs significantly increase bleeding risk when combined with anticoagulants (5-6 fold increase) 1, 4
• Do not combine with other NSAIDs, as this increases risk without additional benefit 6

Common Pitfalls to Avoid

• Do not use indefinitely without reassessment: Continuing NSAID monotherapy beyond 2 months without reevaluation is inappropriate 4
• Do not ignore cardiovascular risk factors: Long-term use increases cardiac ischemic events 4
• Do not fail to provide gastroprotection in high-risk patients: The risk of GI bleeding increases from 1 in 2,100 in adults under 45 to 1 in 110 in adults over 75 4
• In elderly patients: Start with lower doses (consider 250 mg twice daily initially) and titrate upward as tolerated 4, 6

Evidence Quality Note

While the primary dosing recommendations come from high-quality guideline sources 1, it's important to note that no specific NSAID has been shown superior to others for musculoskeletal conditions 7. The choice between naproxen, ibuprofen, or other NSAIDs should be based on patient-specific factors including prior response, comorbidities, and risk factors for adverse effects 7.