What is the recommended dose and treatment of Naproxen (Naproxen) for acute gout?

From the Guidelines

Naproxen is an effective treatment option for acute gout attacks, typically prescribed at a dose of 500 mg initially, followed by 250 mg every 8 hours until the attack subsides, usually for 5-7 days. For some patients, a higher initial dose of 750 mg followed by 250 mg every 8 hours may be appropriate. Always take naproxen with food to minimize gastrointestinal side effects. During treatment, rest the affected joint, apply ice for 20-30 minutes several times daily, and stay well-hydrated. Naproxen works by reducing inflammation through inhibition of prostaglandin synthesis, directly addressing the painful inflammatory response in gout. However, naproxen should be used cautiously in patients with kidney disease, heart conditions, or a history of gastrointestinal bleeding, as noted in studies such as 1 and 1.

While effective for acute attacks, naproxen does not lower uric acid levels and isn't appropriate for long-term gout management. For recurrent gout, medications like allopurinol or febuxostat may be needed to reduce uric acid levels and prevent future attacks, as discussed in 1 and 1. The American College of Physicians recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks, unless there are specific indications such as recurrent gout or problematic gout, as stated in 1.

Key considerations for naproxen use in gout treatment include:

• Starting dose: 500 mg initially, with options for a higher initial dose of 750 mg for some patients
• Maintenance dose: 250 mg every 8 hours
• Duration: Until the attack subsides, usually 5-7 days
• Precautions: Use with caution in patients with kidney disease, heart conditions, or a history of gastrointestinal bleeding
• Concomitant care: Rest, ice, hydration, and potentially other medications for recurrent gout management.

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 the treatment of acute gout is:

• 750 mg as the initial dose, followed by
• 250 mg every 8 hours until the attack has subsided 2

From the Research

Naproxen Dose for Gout

• The effectiveness of naproxen in the management of acute gouty arthritis was assessed in a study published in 1975 3.
• In this study, patients were treated with either 600 mg naproxen initially, followed by 300 mg every 8 hours for the first 48 hours, or a loading dose of 750 mg naproxen, followed by 250 mg every 8 hours for a duration of 72 hours.
• The response of 15 of the 20 patients was either excellent or good, while the response was fair in three and poor in two.

Treatment of Gout with Naproxen

• Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to relieve pain in adults with acute gout episodes 4.
• According to a review published in 2025, standard pharmacotherapies for gout flares include NSAIDs, such as naproxen, as well as colchicine and oral or intramuscular corticosteroids 5.
• Naproxen was found to be effective in alleviating the inflammation of acute gout in a study published in 1975, with no significant undesirable side effects observed 3.

Comparison with Other Treatments

• Other treatments for gout include urate-lowering therapies, such as allopurinol and febuxostat, which aim to prevent gout flares 5, 4.
• Colchicine and NSAIDs, such as naproxen, can be used to prevent painful flares during early urate-lowering therapy 6, 7.
• The choice of treatment for gout depends on various factors, including the severity of the disease, comorbidities, and patient preference 5.