From the FDA Drug Label
A lower dose should be considered in patients with renal or hepatic impairment or in elderly patients Patients With Moderate to Severe Renal Impairment Naproxen-containing products are not recommended for use in patients with moderate to severe and severe renal impairment (creatinine clearance < 30 mL/min) The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
The safe dose of short-term naproxen for sacral illiitus pain in an 84-year-old woman with creatinine clearance of 40 mL/min is not explicitly stated in the label. However, considering the patient's renal impairment and elderly status, a lower dose should be considered. The label recommends not exceeding 1000 mg of naproxen per day for pain management, but does not provide a specific dose for this patient population. Given the patient's creatinine clearance is above the threshold of 30 mL/min, where naproxen is not recommended, a dose at the lower end of the recommended range may be considered, such as 250 mg every 6 to 8 hours. However, this should be done with caution and close monitoring due to the potential for adverse effects 1.
From the Research
For an 84-year-old woman with reduced kidney function (creatinine clearance of 40 mL/min) and sacral iliitis pain, the safest short-term dose of naproxen would be 250 mg once or twice daily (not exceeding 500 mg per day) for no more than 3-5 days. This recommendation is based on the need to balance pain management with the risk of adverse effects, particularly given her moderate renal impairment. Naproxen is primarily eliminated through the kidneys, and reduced kidney function increases the risk of drug accumulation and side effects such as gastrointestinal bleeding, worsening kidney function, and fluid retention 2.
Given the potential risks, it is crucial to monitor the patient closely for signs of these adverse effects. The patient should also be advised to stay well-hydrated but avoid excessive fluid intake that could further stress the kidneys. Taking naproxen with food and possibly with a proton pump inhibitor can help mitigate gastrointestinal risks.
Alternative pain management options, such as acetaminophen (up to 3000 mg daily in divided doses), might be safer for longer use in this patient population, considering the comparative efficacy and safety of different analgesics in managing osteoarthritis pain 3, 4. However, the most recent study on postoperative pulmonary complications after total hip or knee arthroplasty suggests that combinations of acetaminophen and NSAIDs may have benefits in terms of reducing opioid consumption and potentially pulmonary complications 5.
Therefore, the decision to use naproxen should be made with caution, considering the patient's individual risk factors and the potential benefits and risks of alternative pain management strategies. The key is to use the lowest effective dose for the shortest duration necessary to manage the patient's pain while minimizing the risk of adverse effects.