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NSAID Pregnancy: C (first/second trimester) — D (third trimester)

Naproxen

Brand names: Naprosyn, Naprogesic

Adult dose

Dose: 250–500mg twice daily
Route: Oral
Frequency: Twice daily with food
Acute gout: 750mg initially, then 250–500mg every 8h. Max 1.25g on day 1, then 1g/day. OA/RA: 250–500mg BD.

Clinical pearls

  • Favourable cardiovascular profile compared to diclofenac and COX-2 inhibitors
  • Longer-acting than ibuprofen — twice daily dosing improves adherence
  • PPI gastroprotection required in high-risk patients
  • First-line NSAID for gout in hospital setting alongside colchicine or steroids

Contraindications

  • Active PUD
  • Severe renal or hepatic impairment
  • NSAID/aspirin hypersensitivity
  • Third trimester pregnancy
  • Heart failure (NYHA III–IV)

Side effects

  • GI bleeding/ulceration
  • AKI
  • Hypertension
  • Fluid retention
  • Bronchospasm

Interactions

  • SSRIs — increased GI bleed risk
  • ACE inhibitors — AKI risk
  • Lithium — increased levels
  • Warfarin — increased INR

Monitoring

  • Renal function (prolonged use)
  • Blood pressure
  • GI symptoms

Reference: ACR Gout Guidelines 2020; BSR Gout Guidelines 2017. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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