What is the recommended dosage and usage of naproxen sodium (Nonsteroidal Anti-Inflammatory Drug) for pain relief?

Naproxen Sodium Dosing for Pain Relief

For acute pain management, start with naproxen sodium 550 mg initially, followed by 275 mg every 8-12 hours, not exceeding 1250 mg on day one and 1000 mg daily thereafter. 1

Standard Dosing Regimens by Indication

Acute Pain, Primary Dysmenorrhea, Tendonitis, and Bursitis

• Initial dose: 500-550 mg, followed by 250-275 mg every 8-12 hours 1
• Maximum first day: 1250 mg total 1
• Maximum subsequent days: 1000 mg daily 1
• Naproxen sodium is preferred over naproxen base for acute pain due to more rapid absorption and faster onset of pain relief (within 1 hour) 1, 2

Over-the-Counter Dosing

• OTC naproxen sodium (Aleve): 440 mg (two 220 mg tablets) twice daily 3
• Higher OTC doses (440 mg, 550 mg) demonstrate superior efficacy compared to lower doses (220 mg) due to linear pharmacokinetics 4

Chronic Inflammatory Conditions (Rheumatoid Arthritis, Osteoarthritis)

• Standard dose: 250-500 mg twice daily 3, 1
• Maximum routine long-term dose: 1000 mg daily (500 mg twice daily) 3, 5, 1
• For severe cases requiring higher anti-inflammatory activity: may increase to 1500 mg daily for limited periods up to 6 months, though this increases risk 1

Acute Gout

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

Duration and Monitoring

Treatment Duration

• Use the lowest effective dose for the shortest duration necessary 5, 1
• Initial treatment trial: 2-4 weeks at maximum tolerated dose 3
• Reassess response at 2-4 weeks; if insufficient, switch to another NSAID 3
• Consider tapering after 12 weeks of sustained response 3

Monitoring Requirements for Long-Term Use

• Every 3 months: blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood 3
• Discontinue if BUN or creatinine doubles 3
• Discontinue if liver enzymes increase to 3× upper limit of normal 3
• Discontinue immediately if GI bleeding occurs 3, 5

Critical Safety Considerations

Gastrointestinal Risk Management

• GI complications are the most common NSAID adverse effect, occurring in 10-20% of patients 6, 3
• Risk factors include: prior ulcer history (2-4 fold increased risk), advancing age (4% increased risk per year), concurrent aspirin or anticoagulant use (>10-fold increased risk with combination), and corticosteroid use 6
• Consider gastroprotection with proton pump inhibitor or H2 blocker in high-risk patients 3, 5
• Eradicate H. pylori before starting NSAID therapy in patients with ulcer history 6

Cardiovascular Considerations

• Naproxen demonstrates the lowest cardiovascular risk among NSAIDs (hazard ratio 1.29 vs. ibuprofen 1.50, celecoxib 2.57, rofecoxib 2.80, diclofenac 2.40) 5
• Naproxen is the preferred NSAID when NSAID therapy is necessary in patients with cardiovascular disease 5
• Use lowest effective dose for shortest duration to minimize cardiovascular risk 5
• Monitor blood pressure; discontinue if hypertension develops or worsens 3

Critical Drug Interactions to Avoid

• Do not combine with other NSAIDs (including low-dose aspirin at anti-inflammatory doses) - this increases risk >10-fold without additional benefit 6, 5
• Do not use concurrently with methotrexate 5
• NSAIDs significantly increase bleeding risk when combined with anticoagulants 3
• Avoid in patients on concurrent nephrotoxic drugs 3

Renal Precautions

• Not recommended in moderate to severe renal impairment (creatinine clearance <30 mL/min) 1
• Avoid in patients with compromised fluid status 3
• Consider lower starting doses in elderly patients and those with mild renal or hepatic impairment 1

Administration Considerations

• Take with food to minimize GI side effects 6
• Morning and evening doses do not need to be equal 1
• Dosing more frequently than twice daily does not improve response for chronic conditions 1
• Different formulations (tablets, suspension, delayed-release) have pharmacokinetic differences affecting onset of action and are not bioequivalent 1

Common Pitfalls

• Combining multiple NSAIDs increases toxicity without improving efficacy 6, 5
• Failing to screen for H. pylori in patients with ulcer history before initiating therapy 6
• Using higher than necessary doses - pharmacokinetic linearity means efficacy increases proportionally with dose, but so does risk 4
• Neglecting regular monitoring in long-term users 3
• Using in patients with cardiovascular disease without considering naproxen as the preferred agent 5