Is naproxen (nonsteroidal anti-inflammatory drug) 500mg suitable for a 14-year-old female?

Naproxen 500mg in a 14-Year-Old Female

Naproxen 500mg twice daily can be given to a 14-year-old female, as this age group should be dosed as adults according to FDA labeling and established guidelines.

Age-Appropriate Dosing

• Patients aged 15 years and older are dosed as adults according to the American Thoracic Society/CDC guidelines 1
• The FDA label specifies that children weighing more than 40 kg should be dosed as adults 2
• At 14 years old, most females meet the weight threshold for adult dosing, making 500mg twice daily appropriate 2

Standard Adult Dosing Regimen

• The recommended dose for rheumatoid arthritis, osteoarthritis, and inflammatory conditions is 250mg, 375mg, or 500mg twice daily 2
• For acute pain management, the recommended starting dose is 500mg, followed by 500mg every 12 hours or 250mg every 6-8 hours 2
• The initial total daily dose should not exceed 1250mg, and thereafter should not exceed 1000mg daily for pain management 2

Pediatric Dosing Context (For Younger Children)

• For juvenile arthritis in children under adult weight, the recommended dose is approximately 10mg/kg/day given in 2 divided doses (5mg/kg twice daily) 2
• Naproxen tablets are not well-suited for weight-based pediatric dosing, so oral suspension is recommended for younger children 2
• Pharmacokinetic studies show that 5mg/kg doses in children aged 5-16 years produce plasma levels similar to 500mg doses in adults 2

Safety Monitoring Requirements

• Monitor blood pressure, renal function (BUN, creatinine), liver function tests, CBC, and fecal occult blood every 3 months during long-term use 3
• Discontinue if BUN or creatinine doubles 3
• Discontinue if liver function tests increase to 3× upper limit of normal 3
• Discontinue immediately if gastrointestinal bleeding occurs 3

Critical Precautions

• Use with caution in patients with history of peptic ulcer disease, cardiovascular disease, or concomitant anticoagulant use 1, 3
• Consider gastroprotection with a proton pump inhibitor or H2 blocker in high-risk patients 3
• NSAIDs significantly increase bleeding risk (3-6 fold) when used with anticoagulants 4
• Avoid in patients with compromised fluid status, renal insufficiency, or concurrent nephrotoxic drugs 3
• Use the lowest effective dose for the shortest duration possible 4

Common Pitfalls to Avoid

• Do not combine naproxen with other NSAIDs (including over-the-counter ibuprofen), as this provides no additional benefit but significantly increases adverse effects 4
• Do not exceed 1000mg daily for routine long-term use 3
• Do not use in patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 2
• Specifically ask about over-the-counter NSAID use, as many patients take additional NSAIDs without informing their physician 4