Naproxen

Indications
 Oral
Rheumatic disorders
Adult: 0.5-1 g as a single dose or in 2 divided doses, up to 1.5 g daily for patients who can tolerate lower doses, for up to 6 mth, if required.
Elderly: Consider dose reductions; use lowest possible effective dose.
Oral
Juvenile idiopathic arthritis
Child: ≥2 yr: 5-7.5 mg/kg bid. Max: 1 g/day.
Oral
Dysmenorrhoea
Adult: Initially, 500 mg followed by 250 mg every 6-8 hr. Max: 1.25 g on the 1st day and 1 g thereafter.
Elderly: Consider dose reductions; use lowest possible effective dose.
Oral
Acute musculoskeletal disorders
Adult: Initially, 500 mg followed by 250 mg every 6-8 hr. Max: 1.25 g on the 1st day and 1 g thereafter.
Elderly: Consider dose reductions; use lowest possible effective dose.
Oral
Acute gout
Adult: Initially, 750 mg followed by 250 mg every 8 hr.
Elderly: Consider dose reductions; use lowest possible effective dose.
Oral
Acute migraine attacks
Adult: 750 mg at the onset of attack, followed after at least ½ an hr by further doses of 250-500 mg daily. Max: 1250 mg daily.
Elderly: Consider dose reductions; use lowest possible effective dose.
Contraindications
 Hypersensitivity. Aspirin or NSAID allergy. Perioperative pain in the setting of CABG surgery. Pregnancy (3rd trimester).
Warnings / Precautions
 Pre-existing CV risk factors or disease e.g. fluid retention, CHF, hypertension. History of GI disease (bleeding or ulcers). Other forms of asthma. Hepatic impairment; closely monitor patients with any abnormal LFT. Renal impairment. Elderly. Lactation.
Adverse Reactions
 Oedema, palpitation, dizziness, drowsiness, headache, light headedness, vertigo, pruritus, skin eruption, ecchymosis, purpura, rash, fluid retention, abdominal pain, constipation, nausea, heartburn, diarrhoea, dyspepsia, stomatitis, flatulence, gross bleeding/perforation, indigestion, ulcers, vomiting, abnormal renal function, haemolysis, anaemia, increased bleeding time, elevated LFTs, visual disturbances, tinnitus, hearing disturbances, dyspnoea, diaphoresis, thirst.
Potentially Fatal: Anaphylactic/anaphylactoid reactions. Exfoliative dermatitis, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN).
Overdose Reactions
 Symptoms: Drowsiness, heartburn, vomiting, CNS depression, leukocytosis, renal failure. Management: Supportive and symptomatic.
Drug Interactions
 Antihypertensive effects of hypotensive agents may be reduced. May increase ciclosporin levels. Increased risk of seizures with fluoroquinolones. May reduce efficacy of diuretics. May diminish the cardioprotective effect of acetylated salicylates. Alcohol may enhance gastric mucosal irritation. Increased serum levels with probenecid.
Potentially Fatal: Increased risk of GI ulceration with corticosteroids. May increase lithium levels/toxicity. Severe bone marrow suppression, aplastic anaemia and GI toxicity may occur with methotrexate. Increased risk of bleeding with anticoagulants (e.g. warfarin, heparin, LMWHs) and antiplatelet agents (e.g. ticlopidine, clopidogrel, aspirin, abciximab, dipyridamole, eptifibatide, tirofiban). Absorption may be reduced with colestyramine (and other bile acid sequestrants).
See Below for More naproxen Drug Interactions
Lab Interactions
 May interfere with 5-hydroxyindole acetic acid (5-HIAA) urinary assays. Discontinue 72 hr before adrenal function testing if the Porter-Silber test is used.
Food Interactions
 Rate of absorption may be reduced with food. Avoid herbs/food with antiplatelet activity e.g. alfalfa, anise, bilberry, grapeseed, green tea, bladderwrack, turmeric, bromelain, cat's claw, celery, ginkgo biloba, coleus, cordyceps, dong quai, evening primrose, feverfew, fenugreek, garlic, ginger, red clover, horse chestnut, ginseng, guggul, horse chestnut seed, horseradish, licorice, prickly ash, reishi, sweet clover, white willow.
Mechanism of Actions
 Naproxen has anti-inflammatory, analgesic, antipyretic actions. It reduces prostaglandin synthesis by inhibiting the enzyme cyclooxygenase. It also inhibits platelet aggregation.
Onset: Analgesic: 1 hr; anti-inflammatory: Approx 2 wk.
Duration: Analgesic: ≤7 hr; anti-inflammatory: ≤12 hr.
Absorption: Readily absorbed from the GI tract (oral); peak plasma concentrations after 2-4 hr. Well absorbed rectally.
Distribution: Diffuses into synovial fluid; crosses the placenta; enters breast milk. Protein-binding: 99%.
Excretion: Via urine (as unchanged drug and metabolites), faeces; 13 hr (elimination half-life).
Administration
 Should be taken with food.
Storage Conditions
 Oral: Store at 15-30°C (59-86°F).
ATC Classification
 G02CC02 - naproxen ; Belongs to the class of antiinflammatory products for vaginal administration used in the treatment and prevention of inflammation.
M01AE02 - naproxen ; Belongs to the class of propionic acid derivatives of non-steroidal antiinflammatory and antirheumatic products.
M02AA12 - naproxen ; Belongs to the class of non-steroidal antiinflammatory preparations for topical use. Used in the treatment of joint and muscular pains.
Storage
 Oral: Store at 15-30°C (59-86°F).
Available As
  • Naproxen 10% w/w
  • Naproxen 125 mg
  • Naproxen 250 mg
  • Naproxen 275 mg
  • Naproxen 300 mg
  • Naproxen 500 mg
  • Naproxen 550 mg
  • Naproxen 750 mg

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