2.1 General Dosing Instructions

Carefully consider the potential benefits and risks of NAPRELAN and other treatment options before deciding to use NAPRELAN. Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals [see Warnings and Precautions (5)].

After observing the response to initial therapy with NAPRELAN, the dose and frequency should be adjusted to suit an individual patient’s needs.

2.2 Rheumatoid Arthritis, Osteoarthritis, and Ankylosing Spondylitis

The recommended starting dose of NAPRELAN Tablets in adults is two NAPRELAN 375 mg tablets (750 mg) once daily, one NAPRELAN 750 mg (750 mg) once daily, or two NAPRELAN 500 mg tablets (1,000 mg) once daily. Patients already taking naproxen 250 mg, 375 mg, or 500 mg twice daily (morning and evening) may have their total daily dose replaced with NAPRELAN Tablets as a single daily dose.

During long-term administration, the dose of NAPRELAN Tablets may be adjusted up or down depending on the clinical response of the patient. In patients who tolerate lower doses of NAPRELAN Tablets well, the dose may be increased to two NAPRELAN 750 mg tablets (1,500 mg), or three NAPRELAN 500 mg tablets (1,500 mg) once daily for limited periods when a higher level of anti-inflammatory/analgesic activity is required. When treating patients, especially at the higher dose levels, the physician should observe sufficient increased clinical benefit to offset the potential increased risk [see Clinical Pharmacology (12.3)]. The lowest effective dose should be sought and used in every patient. Symptomatic improvement in arthritis usually begins within one week; however, treatment for two weeks may be required to achieve a therapeutic benefit.

2.3 Management of Pain, Primary Dysmenorrhea, and Acute Tendinitis and Bursitis

The recommended starting dose is two NAPRELAN 500 mg tablets (1,000 mg) once daily. For patients requiring greater analgesic benefit, two NAPRELAN 750 mg tablets (1,500 mg) or three NAPRELAN 500 mg tablets (1,500 mg) may be used for a limited period. Thereafter, the total daily dose should not exceed two NAPRELAN 500 mg tablets (1,000 mg).

2.4 Acute Gout

The recommended dose on the first day is two to three NAPRELAN 500 mg tablets (1,000 to 1,500 mg) once daily, followed by two NAPRELAN 500 mg tablets (1,000 mg) once daily, until the attack has subsided.

2.5 Dosage Adjustments in Patients with Hepatic Impairment

A lower dose should be considered in patients with renal or hepatic impairment or in elderly patients [see Warnings and Precautions (5.3)]. Studies indicate that although total plasma concentration of naproxen is unchanged, the unbound plasma fraction of naproxen is increased in the elderly. Caution is advised when high doses are required and some adjustment of dosage may be required in elderly patients. As with other drugs used in the elderly it is prudent to use the lowest effective dose.