What is the recommended dose of naproxen (nonsteroidal anti-inflammatory drug, NSAID) for acute gout flare management?

From the Guidelines

For a gout flare, naproxen is typically prescribed at an initial dose of 750 mg, followed by 250 mg every 8 hours until the flare subsides, as recommended by recent guidelines 1. The treatment should begin at the first sign of a gout attack and usually continues for 5-7 days or until symptoms resolve. It's essential to take naproxen with food or milk to reduce stomach irritation. Naproxen works by reducing inflammation and pain by inhibiting prostaglandin synthesis through blocking cyclooxygenase enzymes. Some key points to consider when taking naproxen for gout include:

• Staying well-hydrated while taking naproxen
• Avoiding alcohol, which can worsen gout symptoms
• Potential dose adjustment or avoidance of naproxen if you have kidney disease, heart conditions, or are taking certain medications like blood thinners
• Contacting your healthcare provider if symptoms don't improve within 48 hours or if you experience severe side effects such as black stools, severe stomach pain, or difficulty breathing, as suggested by the American College of Physicians 1. It's also important to note that the choice of drug for acute gout flares should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.

From the FDA Drug Label

The recommended starting dose is 750 mg of naproxen followed by 250 mg every 8 hours until the attack has subsided. The recommended dose of naproxen for acute gout flare is 750 mg initially, followed by 250 mg every 8 hours until the attack has subsided 2.

• The initial dose is 750 mg.
• The maintenance dose is 250 mg every 8 hours.
• The dose should be adjusted based on the patient's response and potential adverse events.

From the Research

Naproxen Dose for Gout Flare

• The recommended dose of naproxen for gout flare is 750 mg immediately, then 250 mg every 8 hours for 7 days 3.
• This dosing regimen was compared to low-dose colchicine in a randomized trial, and no significant difference in pain intensity was found between the two groups 3.
• Naproxen caused fewer side effects compared to colchicine, supporting its use as a first-line treatment for gout flares in primary care 3.
• Other studies suggest that low-dose NSAIDs, such as naproxen 250 mg orally twice a day, can be used for prophylaxis of acute gout flares after initiation of urate-lowering therapy 4.

Comparison with Other Treatments

• Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids are also effective in relieving pain in adults with acute gout episodes 5.
• The choice of treatment may depend on individual patient factors, such as comorbidities and contraindications 6.
• IL-1 inhibitors are a new option for flare refractory to standard therapies, but their use is not yet established as a first-line treatment 6.

Special Considerations

• Patients with chronic kidney disease may require adjusted dosing of naproxen and other gout medications 7.
• There is limited information on the efficacy and safety of gout flare prophylaxis and therapy use in patients with advanced chronic kidney disease 7.