What is the recommended dosage of Naproxen (Nonsteroidal Anti-Inflammatory Drug) for Osteoarthritis (OA)?

From the Guidelines

Naproxen should be considered as an alternative treatment for osteoarthritis (OA) if initial treatments such as paracetamol and ibuprofen fail to relieve symptoms. The dosage of naproxen is not explicitly stated in the provided evidence, however, based on general medical knowledge, the typical recommended dosage is 250-500 mg twice daily, with a maximum daily dose of 1000 mg 1.

Key Considerations

• Start with the lowest effective dose, usually 250 mg twice daily, and increase if needed for pain relief.
• Take naproxen with food to reduce gastrointestinal side effects.
• For elderly patients or those with kidney issues, a lower dose of 250 mg twice daily is advisable.
• The medication should be taken regularly for optimal effect, but used for the shortest duration necessary to control symptoms.

Mechanism of Action and Side Effects

• Naproxen works by inhibiting cyclooxygenase enzymes that produce prostaglandins, which are responsible for inflammation and pain.
• Common side effects include stomach upset, heartburn, and increased risk of cardiovascular events with long-term use.
• Patients with heart disease, high blood pressure, kidney problems, or a history of stomach ulcers should consult their healthcare provider before taking naproxen, as they may need additional monitoring or alternative medications 1.

Treatment Approach

• Initial treatment for painful joints attributed to degenerative arthritis should be paracetamol in doses of up to 4 g daily, followed by ibuprofen if paracetamol fails to relieve symptoms 1.
• Naproxen or other non-steroidal anti-inflammatory drugs may be considered if relief of symptoms is still inadequate 1.

From the FDA Drug Label

The recommended dose is 250 mg, 375 mg, or 500 mg twice daily During long-term administration, the dose of naproxen may be adjusted up or down depending on the clinical response of the patient. A lower daily dose may suffice for long-term administration. The recommended naproxen dosage for OA is 250 mg, 375 mg, or 500 mg twice daily. The dose may be adjusted based on the patient's clinical response. A lower daily dose may be sufficient for long-term administration 2.

From the Research

Naproxen Dosage for OA

• The recommended dosage of naproxen for osteoarthritis (OA) is not explicitly stated in the provided studies, but the efficacy and safety of different dosages are discussed 3, 4, 5.
• A study from 1982 found that 250 mg of naproxen administered twice daily and 500 mg of naproxen administered as a single dose at night had similar efficacy and safety in osteoarthritic patients 4.
• Another study from 2004 compared the analgesic efficacy and safety of nonprescription doses of naproxen sodium (440/660 mg) and ibuprofen (1200 mg) in patients with OA of the knee, and found that both treatments were effective in relieving pain compared to placebo 5.
• The study also found that naproxen sodium (440/660 mg) provided more effective pain relief for most variables compared to placebo, and for night pain compared to ibuprofen 5.

Dosage Comparison

• A review of 28 clinical trials involving ibuprofen for OA found that ibuprofen at a dose of over 1,200 mg daily was superior to placebo, and at doses of 1,200 to 1,800 mg/day was as effective or more effective than 3,200 to 3,600 mg/day of aspirin or 4,500 mg/day of aspirin plus acetaminophen 6.
• However, the optimal dosage of naproxen for OA is not clearly established, and more research is needed to determine the most effective and safe dosage regimen 3, 4, 5.

Treatment Options for OA

• Nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen, are commonly used to treat OA, and have been shown to provide some pain relief and functional improvements 3, 7.
• Other treatment options for OA include weight loss, intra-articular injections, physical therapy, and bracing, which can be used alone or in combination with NSAIDs to manage symptoms and improve function 7.