What is the appropriate dosage and usage of naproxen (Non-Steroidal Anti-Inflammatory Drug) for an adult patient with a toothache and no history of gastrointestinal issues, bleeding disorders, or allergy to NSAIDs?

Naproxen for Toothache: Dosing and Usage

For an adult with toothache and no contraindications, start with naproxen 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as needed, not exceeding 1250 mg on the first day and 1000 mg daily thereafter. 1

Recommended Dosing Strategy

The FDA-approved dosing for acute pain management is naproxen 500 mg initially, then 500 mg every 12 hours or 250 mg every 6-8 hours. 1 This regimen is specifically indicated for management of acute painful conditions when prompt onset of pain relief is desired 1.

Key Dosing Parameters:

• Initial dose: 500 mg naproxen 1
• Maintenance: 500 mg every 12 hours OR 250 mg every 6-8 hours 1
• Maximum first day: 1250 mg 1
• Maximum subsequent days: 1000 mg daily 1
• Onset of action: Pain relief begins within 1 hour 1

Alternative Formulation Considerations

Naproxen sodium is preferred over naproxen base for acute pain because it is more rapidly absorbed. 1 The sodium salt formulation provides faster onset of analgesia, which is particularly beneficial for acute toothache 1. Available over-the-counter strengths include naproxen sodium 220 mg, 440 mg, and 550 mg, all of which demonstrate linear pharmacokinetics and dose-proportional efficacy 2.

Duration of Treatment

For temporary painful conditions like toothache, limit NSAID use to the shortest duration necessary. 3 The expense and potential risks of prolonged NSAID therapy are unlikely to be justified for self-limited conditions 3. Treatment should typically not exceed 5-10 days for acute dental pain 3.

Safety Monitoring and Precautions

Gastrointestinal Risk Assessment:

Even in patients without GI history, be aware that:

• Dyspepsia occurs in 10-20% of NSAID users 3
• Age-related bleeding risk: 1 in 2,100 for adults <45 years; 1 in 110 for adults >75 years 3
• Consider adding a proton pump inhibitor if treatment extends beyond a few days 3

Cardiovascular Considerations:

• Naproxen and ibuprofen are the preferred NSAIDs for patients with any cardiovascular risk 3
• NSAIDs can increase blood pressure by an average of 5 mm Hg 3
• Avoid in patients with congestive heart failure 3

Renal Function Precautions:

• Avoid naproxen if creatinine clearance <30 mL/min 1
• Use caution in elderly patients, those with dehydration, or concurrent use of ACE inhibitors 3, 4
• Monitor renal function if treatment extends beyond short-term use 3

Drug Interactions to Avoid

Critical interactions requiring avoidance:

• Lithium: NSAIDs significantly reduce lithium clearance and increase toxicity risk; acetaminophen is the preferred alternative 4
• Anticoagulants (warfarin, heparin): Risk of GI bleeding increases 3-6 fold 3
• Other nephrotoxic medications: Increased risk of acute renal failure 3

Alternative Analgesic Options

If naproxen is contraindicated or not tolerated:

• Acetaminophen 650-1000 mg every 6 hours (maximum 4000 mg/day) is effective for dental pain without NSAID-related risks 3, 4
• Ibuprofen 400 mg every 6-8 hours provides comparable analgesia with potentially lower GI toxicity at standard doses 3

Common Pitfalls to Avoid

• Do not combine naproxen with other NSAIDs (including aspirin or ibuprofen), as this increases toxicity without improving efficacy 3
• Do not exceed maximum daily doses: doing so increases adverse effects without proportional analgesic benefit 1
• Do not use in late pregnancy (last 6-8 weeks before term) due to potential fetal effects and prolonged labor 3
• Avoid alcohol consumption (≥2 drinks/day increases GI bleeding risk significantly) 3