Naproxen Dosing and Safety Considerations

Standard Dosing and Safety

The American Academy of Family Physicians recommends standard doses of 250 mg, 375 mg, or 500 mg twice daily for chronic inflammatory conditions, such as rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis 1, 2
The American Academy of Family Physicians advises to use with extreme caution in patients with compromised fluid status or taking concomitant nephrotoxic drugs, as naproxen is not recommended in patients with moderate to severe renal impairment (creatinine clearance <30 mL/min) 1, 2

The American Academy of Family Physicians reports that the GI bleeding risk is age-dependent, with a risk of 1 in 2,100 for adults <45 years vs. 1 in 110 for adults >75 years, and recommends considering co-prescribing a proton pump inhibitor (PPI) or H2 blocker for patients at increased risk 1, 2
The American Academy of Family Physicians notes that mean blood pressure increase of 5 mm Hg with NSAID use, and advises to avoid in patients with congestive heart failure and use with caution in patients with hypertension or cardiovascular disease 1, 2

The American Academy of Family Physicians warns that the risk of GI bleeding increases 3-6 fold when combined with anticoagulants, and INR increases up to 15% when used concurrently with anticoagulants 1, 2
The American College of Rheumatology states that no specific NSAID is preferred over another for efficacy—choice should be based on patient history, risk factors, and comorbidities 3
The American Society of Clinical Oncology recommends naproxen 500 mg twice daily starting on day of pegfilgrastim administration and continuing for 5-8 days to effectively reduce incidence, duration, and severity of bone pain associated with CSF therapy in oncology patients 4