The maximum daily dose of over-the-counter naproxen sodium is 660 mg for most adults. That’s three 220 mg tablets in 24 hours, with the first dose being two tablets (440 mg) followed by one tablet (220 mg) every 8 to 12 hours. Prescription doses can go higher, up to 1,500 mg per day for short periods, but only under medical supervision.
OTC vs. Prescription Limits
Over-the-counter naproxen sodium (the kind sold as Aleve) comes in 220 mg tablets. The standard OTC regimen is 440 mg to start, then 220 mg every 8 to 12 hours, not exceeding 660 mg in a day. You should not use OTC naproxen for more than 10 consecutive days for pain or 3 days for fever without talking to a doctor.
Prescription naproxen works differently. Doctors may prescribe 250 mg, 375 mg, or 500 mg tablets of naproxen base (not naproxen sodium), with typical daily doses ranging from 500 mg to 1,000 mg split into two doses. For conditions like rheumatoid arthritis or severe inflammation, the dose can be increased to 1,500 mg per day for limited periods. That upper limit is reserved for people who tolerate lower doses well and need stronger anti-inflammatory effects.
Naproxen Base vs. Naproxen Sodium
This distinction matters when you’re counting milligrams. Naproxen sodium (the OTC form) contains a sodium molecule that makes each tablet slightly heavier than the equivalent naproxen base dose. A 220 mg naproxen sodium tablet delivers about 200 mg of actual naproxen. A 550 mg prescription naproxen sodium tablet equals roughly 500 mg of naproxen base. The pain relief is the same, but the numbers on the label differ, which can cause confusion if you’re switching between formulations.
Why the Dose Lasts So Long
Naproxen stays active in your body much longer than ibuprofen or aspirin. Its half-life ranges from 12 to 17 hours, meaning it takes that long for your body to clear just half of each dose. This is why you only need to take it once or twice a day instead of every four to six hours. It also means that doses stack up if you take them too frequently. Taking more than the recommended amount doesn’t speed up pain relief but does increase the amount of drug circulating in your system for an extended period.
Who Should Take Less
Adults over 65 are more sensitive to naproxen’s effects and more likely to experience stomach or kidney problems at standard doses. Lower doses for shorter durations are the general recommendation for older adults, since higher amounts used regularly may not provide better pain relief and are more likely to cause harm.
You should avoid naproxen entirely or use it only under close medical guidance if you have:
- Kidney disease: Naproxen reduces blood flow to the kidneys, which can worsen existing damage. Severe kidney disease rules it out completely.
- Heart disease or a history of heart attack or stroke: NSAIDs as a class raise cardiovascular risk, particularly with long-term use.
- A history of stomach ulcers or intestinal bleeding: Naproxen irritates the stomach lining and can reopen old ulcers or cause new ones.
- Aspirin-sensitive asthma: Naproxen can trigger serious breathing reactions in people with this condition.
- Pregnancy at 20 weeks or later: Naproxen can cause complications for the baby and should not be taken in the second half of pregnancy unless specifically directed.
Dehydration also changes the equation. If you’re significantly dehydrated or have low blood volume, naproxen’s effects on the kidneys become more dangerous. Rehydrating before taking naproxen is important.
Medications That Change the Risk
Several common medications interact with naproxen in ways that raise the chance of bleeding or organ damage. Blood thinners like warfarin or rivaroxaban combined with naproxen significantly increase internal bleeding risk. SSRI antidepressants (like citalopram) also raise bleeding risk when taken alongside naproxen, because both affect how platelets work. Corticosteroids like prednisolone compound the stomach irritation. Diuretics and blood pressure medications can become less effective, and the combination puts extra strain on the kidneys.
One rule is absolute: do not combine naproxen with ibuprofen or any other NSAID. They work through the same mechanism, so stacking them multiplies side effects without adding meaningful pain relief.
Signs You’ve Taken Too Much
Naproxen overdose symptoms include severe stomach pain, nausea, vomiting, drowsiness, blurred vision, and ringing in the ears. More serious signs include confusion, difficulty breathing, seizures, and loss of consciousness. If you or someone else has taken significantly more than the recommended dose and develops any of these symptoms, call 911 or Poison Control at 1-800-222-1222.
Even without a single large overdose, regularly exceeding the daily limit over days or weeks can quietly damage the stomach lining, raise blood pressure, and stress the kidneys. The risks from naproxen tend to build with dose and duration, so staying at the lowest effective dose for the shortest time that manages your pain is the smartest approach.