1. Introduction
Naproxen is a non-steroidal anti-inflammatory drug (NSAID) used to manage pain, inflammation, and fever. It is commonly prescribed for conditions such as arthritis, menstrual pain, musculoskeletal disorders, and gout. Naproxen works by inhibiting cyclooxygenase (COX) enzymes, reducing the production of prostaglandins responsible for inflammation and pain.
2. Indications
- Osteoarthritis
- Rheumatoid arthritis
- Ankylosing spondylitis
- Gout (acute flare)
- Dysmenorrhoea (menstrual pain)
- Musculoskeletal pain (e.g., back pain, sprains, strains)
- Post-operative pain and inflammation
3. Dosage
Adults:
- Osteoarthritis/Rheumatoid arthritis/Ankylosing spondylitis:
- 250–500 mg twice daily (maximum: 1,500 mg/day for short-term use).
- Acute pain (e.g., dysmenorrhoea, musculoskeletal pain):
- 500 mg initially, followed by 250 mg every 6–8 hours as needed (maximum: 1,250 mg/day).
- Acute gout:
- 750 mg initially, then 250 mg every 8 hours until symptoms resolve.
Children (≥2 years):
- Juvenile arthritis:
- 10 mg/kg/day in two divided doses (maximum: 1,000 mg/day).
Elderly:
- Use the lowest effective dose for the shortest duration due to increased risk of gastrointestinal and cardiovascular side effects.
4. Administration
- Take with food, milk, or an antacid to reduce gastrointestinal discomfort.
- Swallow tablets whole with water.
- Maintain adequate hydration to reduce the risk of kidney side effects.
5. Forms Available
- Immediate-release tablets: 250 mg, 500 mg
- Enteric-coated tablets: 375 mg, 500 mg
- Extended-release tablets: 750 mg
- Oral suspension: 125 mg/5 mL
6. Side Effects
6.1 Common Side Effects:
- Nausea
- Heartburn
- Abdominal pain
- Headache
6.2 Less Common Side Effects:
- Dizziness
- Constipation
- Skin rash
6.3 Rare but Serious Side Effects:
- Gastrointestinal bleeding or ulcers
- Cardiovascular events (e.g., myocardial infarction, stroke)
- Kidney damage (e.g., acute kidney injury)
- Severe allergic reactions (e.g., anaphylaxis, angioedema)
7. Warnings
- Cardiovascular Risk: Prolonged use may increase the risk of heart attack or stroke, particularly at high doses.
- Gastrointestinal Risk: May cause serious gastrointestinal adverse events, such as bleeding, ulceration, or perforation.
- Renal Impairment: Use cautiously in patients with impaired kidney function, as NSAIDs may worsen renal injury.
8. Precautions
- Use cautiously in patients with a history of peptic ulcers, bleeding disorders, or cardiovascular disease.
- Avoid prolonged use in elderly patients due to increased risk of side effects.
- Discontinue if serious skin reactions or hypersensitivity occur.
9. Interactions
- Anticoagulants (e.g., warfarin): Increased risk of bleeding.
- Antihypertensives (e.g., ACE inhibitors, ARBs): Reduced efficacy of blood pressure control.
- Diuretics: Increased risk of kidney damage.
- Methotrexate: Increased toxicity due to reduced clearance.
- Lithium: Increased lithium levels and toxicity.
10. Monitoring Parameters
- Monitor for signs of gastrointestinal bleeding (e.g., black stools, abdominal pain).
- Assess kidney function (creatinine, BUN) in patients on long-term therapy.
- Monitor blood pressure regularly in patients with cardiovascular risks.
11. Use in Children
- Approved for use in children aged ≥2 years for juvenile arthritis. Dose should be carefully calculated based on weight.
12. Use in Pregnancy
- First and second trimesters: Use only if clearly needed.
- Third trimester: Contraindicated due to the risk of premature closure of the ductus arteriosus and other foetal complications.
13. Use in Elderly
- Use the lowest effective dose for the shortest duration due to an increased risk of gastrointestinal, renal, and cardiovascular adverse effects.
14. Use in Kidney Disease
- Use with caution in patients with mild to moderate renal impairment.
- Avoid in patients with severe renal dysfunction or those at risk of acute kidney injury.
15. Use in Liver Disease
- Use with caution in patients with severe hepatic impairment. Dose adjustment may be required.
16. Patient Counselling Points
- Take Naproxen with food or milk to minimise stomach upset.
- Do not exceed the prescribed dose, as higher doses increase the risk of side effects.
- Avoid alcohol, as it may increase the risk of gastrointestinal bleeding.
- Inform your doctor immediately if you experience severe abdominal pain, black stools, or chest pain.
- Stay hydrated to reduce the risk of kidney-related side effects.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Aleve | Bayer | 220 mg Tablet | $15 (100 tablets) |
Naprosyn | Roche | 500 mg Tablet | $25 (30 tablets) |
Anaprox DS | Roche | 550 mg Tablet | $30 (30 tablets) |
Generic Naproxen | Various | 500 mg Tablet | $10 (30 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Naproxen used for?
Naproxen is used to manage pain, inflammation, and fever in conditions like arthritis, gout, and menstrual pain.
2. How does Naproxen work?
It inhibits COX enzymes, reducing prostaglandin production and alleviating inflammation and pain.
3. What is the usual dose of Naproxen?
For most conditions, the dose ranges from 250–500 mg twice daily, depending on the severity.
4. Can Naproxen be taken during pregnancy?
It is not recommended during the third trimester due to the risk of foetal complications.
5. Can Naproxen be taken with other painkillers?
Avoid combining Naproxen with other NSAIDs (e.g., ibuprofen) to reduce the risk of side effects.
6. Can Naproxen cause stomach problems?
Yes, it may cause gastritis, ulcers, or gastrointestinal bleeding, especially with prolonged use.
7. How long does it take for Naproxen to work?
It typically starts working within 30 minutes to 1 hour after oral administration.
8. Is Naproxen safe for children?
Yes, it is approved for children ≥2 years for conditions like juvenile arthritis.
9. Can Naproxen cause high blood pressure?
Prolonged use may reduce the effectiveness of antihypertensives and potentially increase blood pressure.
10. How should Naproxen be stored?
Store at room temperature, away from moisture and heat.
11. Can Naproxen be taken on an empty stomach?
It is best taken with food or milk to reduce gastrointestinal irritation.
12. What should I do if I miss a dose?
Take it as soon as you remember, but skip it if it is close to your next scheduled dose. Do not double the dose.
13. Can Naproxen cause kidney problems?
Yes, prolonged or high-dose use may lead to kidney damage. Stay hydrated to reduce this risk.
14. Can Naproxen be used for headaches?
Yes, it is effective for mild to moderate headaches, including tension headaches and migraines.
15. Do I need a prescription for Naproxen?
Lower doses (e.g., 220 mg) are available over the counter, but higher doses require a prescription.