BMA Concise Guide to Medicine & Drugs

Naproxen

Brand names Arthroxen, Naprosyn, Synflex, and others

Used in the following combined preparations Napratec (with misoprostol), Vimovo (with esomeprazole)

QUICK REFERENCE

Drug group Non-steroidal anti-inflammatory drug and drug for gout

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Naproxen, one of the non-steroidal anti-inflammatory drugs (NSAIDs), is used to reduce pain, stiffness, and inflammation.

The drug relieves the symptoms of adult and juvenile rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis, although it does not cure the underlying disease.

Naproxen is also used to treat acute attacks of gout, and may sometimes be prescribed for the relief of migraine and pain following orthopaedic surgery, dental treatment, strains, and sprains. It is also effective for treating painful menstrual cramps.

Gastrointestinal side effects are fairly common, and there is an increased risk of bleeding. Hence, for long-term use, naproxen is often prescribed with a gastro-protective drug.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Every 6–8 hours as required (general pain relief); 1–2 x daily (arthritis); every 6–8 hours (gout). All doses should be taken with food.

Adult dosage range Mild to moderate pain, menstrual cramps 500mg (starting dose), then 250mg every 6–8 hours as required. Arthritis 500–1,000mg daily. Gout 750mg (starting dose), then 250mg every 8 hours until attack has subsided.

Onset of effect Pain relief begins within 1 hour. Full anti-inflammatory effect may take 2 weeks.

Duration of action Up to 12 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 4 hours, take a single dose now and skip the next.

Stopping the drug When taken for short-term pain relief, naproxen can be safely stopped as soon as you no longer need it. If prescribed for long-term treatment, however, you should seek medical advice before stopping the drug.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. But if you notice any unusual symptoms, or if a large overdose has been taken, notify your doctor.

POSSIBLE ADVERSE EFFECTS

Most adverse effects are not serious and may diminish with time. Indigestion or heartburn, nausea, and vomiting are common. More rarely, headache, drowsiness, dizziness, swelling of the legs or feet, or weight gain may occur. Discuss with your doctor if any of these are severe. If you develop a rash or itching, you should stop taking the drug and consult your doctor. If black or bloodstained faeces, wheezing, or breathlessness occur, stop taking the drug and contact your doctor without delay.

INTERACTIONS

General note Naproxen interacts with a wide range of drugs to increase the risk of bleeding and/or peptic ulcers. It may also increase the blood levels of lithium, methotrexate, and digoxin.

Antihypertensive drugs and diuretics The beneficial effects of these drugs may be reduced by naproxen.

Ciclosporin Naproxen increases the risk of kidney impairment with this drug.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have heart problems or high blood pressure.

· You have a bleeding disorder.

· You have had a peptic ulcer, oesophagitis, or acid indigestion.

· You are allergic to aspirin or other NSAIDs.

· You suffer from asthma.

· You are taking other medicines.

Pregnancy The drug may increase the risks of adverse effects on the baby’s heart and may prolong labour if taken in the third trimester. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk, but at normal doses adverse effects on the baby are unlikely. Discuss with your doctor.

Infants and children Prescribed only to treat juvenile arthritis. Reduced dose necessary.

Over 60 Increased likelihood of adverse effects. Reduced dose may therefore be necessary.

Driving and hazardous work Avoid such activities until you have learned how naproxen affects you because the drug may reduce your ability to concentrate.

Alcohol Avoid. Alcohol may increase the risk of stomach irritation with naproxen.

Surgery and general anaesthetics Naproxen may prolong bleeding. Discuss with your doctor or dentist before surgery.

PROLONGED USE

There is an increased risk of bleeding from peptic ulcers and in the bowel with prolonged use of naproxen. There is also a small risk of a heart attack or stroke. To minimize these risks, the lowest effective dose is given for the shortest duration.