Naproxen

Description

Naproxen, marketed under the trademark name Aleve among others, is a nonsteroidal anti-inflammatory drug utilized to treat aches, menstrual cramps, and inflammatory diseases such as rheumatoid arthritis, gout, and fever. It is taken orally. It is known in rapid and delayed-release formulations. 

• ChEMBL Id: 154
• ChemSpider ID: 137720
• Molar mass: 230.26 g/mol
• Pronunciation: /nəˈprɒksən/
• Metabolism: Liver (to 6-desmethylnaproxen)
• Pregnancy category: : AU: C;
• Protein binding: 99%

Safety – Is Aleve safe? When taken as directed by the designation, Aleve is a safe and effective pain reliever. Since its introduction as an over-the-counter development in 1994, Aleve has been used by millions of individuals as a safe and effective pain reliever. Alternative to Naproxen, Acetaminophen/hydrocodone, Diclofenac, Cymbalta, Voltaren, and Duloxetine.

Background

Naproxen is categorized as a nonsteroidal anti-inflammatory drug (NSAID) and was initially approved for prescription use in 1976 and then for over-the-counter (OTC) use in 1994. It can also effectively manage acute aches as well as pain related to rheumatic diseases and has a well-studied adverse effect profile. Given its prevalent tolerability and effectiveness, naproxen could also be regarded as a first-line treatment for a variety of clinical situations requiring analgesia. Naproxen is known in both immediate and delayed-release formulations, in combination with sumatriptan to treat migraines, and in combination with esomeprazole to decrease the risk of developing gastric ulcers.

Associated Conditions

• Acute Gouty Arthritis
• Acute Migraine
• Ankylosing Spondylitis (AS)
• Back pain
• Bursitis
• Extra-Articular Rheumatism
• Fever
• Flu caused by Influenza
• Headache
• Juvenile Idiopathic Arthritis (JIA)
• Menstrual Distress (Dysmenorrhea)
• Migraine
• Muscle Spasms
• Nasal Congestion
• Osteoarthritis (OA)
• Pain related other conditions
• Post Traumatic Pain
• Postoperative pain
• Primary Dysmenorrhoea
• Rheumatoid Arthritis
• Rheumatoid Arthritis, Juvenile
• Seasonal Allergic Rhinitis
• Sinusitis
• Tendinitis
• Toothache
• Articular inflammation

What is naproxen?

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). It performs by diminishing hormones that cause inflammation and pain in the body. Naproxen is utilized to treat pain and inflammation caused by disorders such as arthritis, ankylosing spondylitis, tendinitis, bursitis, gout, and/or menstrual cramps. It can also be utilized to treat acute aches caused by other requirements not recorded in this medication guide. The delayed-release and/or extended-release capsules are slower-working that are used only for chronic conditions such as arthritis or ankylosing spondylitis. These documents will not work fast enough to treat acute pain.

Naproxen is also available in mixture with other medications under the subsequent brand names: Aleve PM, Aleve-D Sinus and Cold, Treximet, and/or Vimovo

Continuing Education Activity

Naproxen is the Food and Drug Administration authorized for amusing acute gout, ankylosing spondylitis, bursitis, and also polyarticular juvenile idiopathic arthritis, and also osteoarthritis, tendonitis, rheumatoid arthritis, ache, and/or primary dysmenorrhea. It is the first-line remedy for acute gouty arthritis, and also osteoarthritis, musculoskeletal ache, inflammation, and/or dysmenorrhea. While naproxen and other Nonsteroidal anti-inflammatory are approved for the of inflammatory arthropathies such as rheumatoid arthritis and ankylosing spondylitis, they do not alter the duration of the disease, nor do they prevent joint and soft tissue destruction that are typical sequelae of these diseases. This activity outlines the indications, mechanism of action, conditions of administration, significant adverse effects, contraindications, monitoring, and toxicity of naproxen, so providers can also direct patient treatment to optimal outcomes when pain relief is needed.

Objectives:

• Describes the mechanisms of action of naproxen.
• Remember the authorized and off-label indications for initiating therapy with naproxen.
• Summarize the adverse event profile of naproxen.
• Examine the significance of enhancing care coordination among the interprofessional team to enhance the delivery of care for patients who can also help from therapy with naproxen.

How to use naproxen oral

If you are taking an over-the-counter product, read all directives on the product container before taking this medicine. If your medic has specified this prescription, read the Medication Guide furnished by your apothecary before you initiate taking naproxen and every time you get a refill. If you have any questions, ask your medic or pharmacist. Take this remedy by maw as directed by your medic, usually 2 or 3 periods a day with a complete glass of water (8 ounces/240 milliliters). Do not lie down for at trimmest 10 minutes after taking this drug. To prevent stomach upset, take this drug with food, milk, or an antacid.

The dosage is based on your medical possibilities and response to treatment. To decrease your chance of stomach bleeding and other side effects, take this medication at the most subordinate effective dose for the shortest possible time. Do not improve your dose or take this drug more often than required by your doctor or the package label. For ongoing disorders such as arthritis, continue taking this drug as per directed by your medic. For straightforward conditions (such as arthritis), it may take up to two weeks of taking this drug regularly until you get the maximum advantage.

If you are accepting this pill “as needed” (not on a regular schedule), acknowledge that pain medications work best if they are used as the first signs of pain arise. If you wait until the pain has deteriorated, the medication may not work as well. If your condition stays or gets worse, or if you think you may have a serious medical issue, get a medical contribution right away. If you are using a nonprescription product to treat fever, confer with the doctor right away if the fever degenerates or lasts more than 3 days.

Naproxen is utilized to decrease pain from different types of conditions such as headaches, muscle aches, tendonitis, dental pain, and menstrual cramps. It also diminishes pain, swelling, and joint stiffness induced by arthritis, bursitis, and gout attacks. This drug is understood as a nonsteroidal anti-inflammatory drug (NSAID). It works by intercepting your body’s presentation of certain natural substances that cause inflammation. If you are feasting a chronic illness such as arthritis, ask your doctor about non-drug treatments and/or use other prescriptions to treat your pain. Check the components on the label even if you have used the consequence before. The manufactory may have changed the ingredients. Also, products with equivalent names may include various types of ingredients meant for different purposes. Taking the wrong product could hurt you.

Why is this medication prescribed?

Prescription naproxen is utilized to reduce pain, tenderness, swelling, and stiffness induced by osteoarthritis (arthritis caused by the research of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), juvenile arthritis (a condition of joint disease in kids), and ankylosing spondylitis (arthritis that mainly affects the spine). These medications naproxen tablets, extended-release tablets, and suspension are also employed to subside shoulder aches induced by bursitis (inflammation of a fluid-filled sac in the shoulder joint), tendinitis (inflammation of the tissue that connects muscle to bone), gouty arthritis (episodes of joint pain caused by a build-up of certain substances in the joints), and pain from other causes, including menstrual pain (pain that ensues before or during a menstrual period). The nonprescription of medication is employed to subside fever and to alleviate mild aches from headaches, muscle aches, also arthritis, menstrual periods, the common cold, toothaches, and backaches. Naproxen is in a variety of medications called NSAIDs. It works by stopping the body’s presentation of a substance that causes pain, fever, and inflammation.

What other drugs will affect naproxen?

Request your medication before employing naproxen if you take an antidepressant such as citalopram, escitalopram, also fluoxetine (Prozac), fluvoxamine, and also paroxetine, sertraline (Zoloft), trazodone, and/or vilazodone. Assuming any of these prescriptions with an NSAID may cause you to bruise or bleed easily.

Ask a medic or pharmacist if it is safe for you to use this medicine if you are also employing any of the following drugs:

• cholestyramine;
• cyclosporine;
• digoxin;
• lithium;
• methotrexate;
• pemetrexed;
• phenytoin or similar seizure medications;
• probenecid;
• warfarin (Coumadin, Jantoven) or similar blood thinners;
• a diuretic or “water pill”;
• heart or blood pressure medication; or
• insulin or oral diabetes medicine.

This list is not complete. Other drugs may also interact with naproxen, including medication and over-the-counter medicines, vitamins, and herbal products. Not all conceivable exchanges are listed in this medication guide.

How long does naproxen stay in your system?

• After you take a dose of naproxen, the drug may survive as long as 4 days in your body.
• Relying on the condition you are feasting with naproxen, you may also take a dose every 6 to 12 hours. Or you might also take naproxen up to twice per day. Regardless of how continually you take naproxen, you will likely only take it until your symptoms go away.
• Analyses have established the dosages that assist keep an effective level of the drug in the body for the different conditions naproxen treats. Your medic will recommend the right dosage of naproxen for your condition.
• After you finished taking naproxen, the drug should be fully gone from your body in approximately 4 days.
• If you have questions about how prolonged naproxen survives in your body, ask your doctor and/or pharmacist.
• After bringing your last dose of naproxen it should be out of your design within 93.5 hours. Naproxen has a withdrawal half-life of 12 to 17 hours. This is the route it takes for your body to reduce plasma drug levels by half. It takes roughly 5.5 x elimination half-life for a drug to be eliminated from your method. Thus naproxen will be in your design for approximately 93.5 hours (5.5 x 17 hours).

How should I take naproxen?

• Employ naproxen exactly as required on the label, or as prescribed by your doctor. Do not take this drug in larger quantities or for longer than recommended. Utilize the most inferior dose that is effective in treating your condition. Astound the oral suspension (liquid) well just before you measure a dose. Traditional liquid medicine with the dosing syringe provided, or with a particular dose-measuring spoon and/or prescription cup. If you do not have a dose-measuring gadget, request your pharmacist for one.
• If you change the labels, strengths, or forms of this medicine, your dosage conditions may change. Ask your pharmacist if you have any inquiries about the kind of naproxen you are using.
• If a child is utilizing this medicine, tell your doctor if the child has any weight differences. Doses are based on the weight of children, and any modifications may impact your child’s dose.
• If you use this drug long-term, you may need frequent medical tests.
• This medicine may also cause unusual results with certain medical tests. Tell any physician who regales you that you are using naproxen.
• Supply at room temperature away from moistness, heat, and light. Maintain the bottle tightly completed when not in use. Read all patient attributes, medication guides, and education sheets provided to you. Invite your doctor and/or pharmacist if you have any queries.

Mechanism of Action

Naproxen blocks arachidonate binding to competitively inhibit both cyclooxygenase (COX) isoenzymes, COX-1 and COX-2, resulting in anesthetic and/or anti-inflammatory effects. COX-1 and COX-2 are motivations of arachidonic acid conversion to prostaglandin G (PGG), the foremost step of the synthesis of prostaglandins and thromboxanes involved in rapid physiological reactions. COX-1 is constitutively portrayed in most tissues, while COX-2 is only expressed in the brain, kidney, bones, reproductive organs, and special tumors such as colon and/or prostate cancers. COX-1 is accountable for prostaglandin synthesis in response to provocation by circulating hormones and supporting healthy renal function, gastric mucosal integrity, and/or hemostasis. COX-2 is inducible in multiple cells in response to specific mediators of inflammation (e.g., interleukin-1, tumor necrosis factor, lipopolysaccharide).

The anti-inflammatory mechanism of naproxen is due to reduced prostaglandin synthesis by inhibiting COX-1 and COX-2. The majority of anti-inflammation that Naproxen causes is mostly due to inhibition of the COX-2 isoenzyme; though, it should be noted that COX-1 is also expressed at different inflammatory sites. Additionally, COX-1 is also expressed in the joints of patients with rheumatoid arthritis or osteoarthritis, particularly in the synovial lining. Consequently, although Naproxen targets both COX-1 and COX2, it is scarcely more selective for the former. Besides, naproxen is most effective in the setting of pain receptor sensitivity. It seems prostaglandins, specifically prostaglandins E and F, are accountable for sensitizing these pain receptors; therefore, naproxen has an added, indirect analgesic effect by inhibiting further prostaglandin production. The liver considerably metabolizes naproxen, and nearly 95% of the drug is excreted in the urine. This drug has a half-life of 12 hours to 17 hours. 

Pharmacodynamics

Naproxen is a habitual non-selective NSAID and is useful as an analgesic, anti-inflammatory, and antipyretic. Comparable to other Nonsteroidal anti-inflammatory drugs, the pharmacological activity of naproxen can also be attributed to the inhibition of cyclo-oxygenase, which in turn recedes prostaglandin synthesis in various tissues and fluids comprising the synovial fluid, gastric mucosa, and/or the blood.

Although naproxen is an adequate analgesic, it can have unintended deleterious effects on the patient. For illustration, naproxen can adversely affect blood pressure control. An investigation found that the use of naproxen caused an expansion in blood pressure, although the increase was not as significant as that found with ibuprofen use.

Further, studies have found that the chance of upper gastrointestinal bleeding is on average four-fold higher for someone taking Nonsteroidal anti-inflammatory drugs. Other factors that raise the risk of upper gastrointestinal bleeding include the concurrent usage of corticosteroids or anticoagulants and a history of gastrointestinal ulcers.

Absorption

Naproxen is obtainable as a free acid and sodium salt. At comparable doses, (naproxen 500 mg is equal to naproxen sodium 550 mg) they counter barely in their rates of absorption, but otherwise, they are therapeutically and pharmacologically identical. Naproxen sodium achieves a rise in plasma concentration after 1 hour, while extreme plasma concentration is observed after 2 hours with naproxen (free acid). There are no distinctions between the 2 forms in the post-absorption phase pharmacokinetics. The discrepancy in initial absorption should also be considered when treating acute pain since naproxen sodium might also present a quicker onset of action.

The compromise Cmax for the diverse formulations (immediate release, enteric-coated, controlled out, etc.) of naproxen are equal and range from 94 mcg/mL to 97.4 mcg/mL. In one pharmacokinetic examination, the mean Tmax of naproxen 500 mg (immediate avoidance) given every 12 hours over 5 days was 3 hours, which corresponded to a mean Tmax of 5 hours for Naprelan 1000 mg (controlled escape) given every 24 hours over 5 days. In this equivalent research, the AUC0-24hr was 1446mcgxhr/mL for naproxen drug quick escape and 1448 mcgx hr/mL for the controlled release formulation. A specific investigation approximating the pharmacokinetics of Naprosyn tablets and EC-Naprosyn followed the subsequent values: Tmax and AUC0-12hrs of EC-Naprosyn were 4 hours and 845 mcg hr/mL respectively, and Tmax and AUC0-12hrs importance of Naprosyn was 1.9 hours and 767 mcgxhr/mL respectively.

When dispense in a variety with sumatriptan the Cmax of naproxen drug is approximately 36% more subordinate analogized to naproxen sodium 550 mg tablets, and the median Tmax is 5 hours. Depending on the AUC and Cmax of the naproxen drug, Vimovo (naproxen and/or esomeprazole combination product) and enteric-coated naproxen drug might also be considered bioequivalent. Generally, naproxen is rapidly and thoroughly absorbed when administered orally and rectally. Food may contribute to a pause in the absorption of orally administered naproxen, but will not affect the period of absorption.

The volume of distribution – Naproxen has a volume of distribution of 0.16 L/kg.

Protein binding – Naproxen is favorably protein affixed with >99% of the drug associated with albumin at restoring levels.

Metabolism

Naproxen is laboriously metabolized in the liver and experiences both Phase I and Phase II metabolism. The first step concerns the demethylation of naproxen via CYP 1A2, 2C8, and 2C9. Both naproxen and desmethyl naproxen move to Phase II metabolism; however, desmethyl naproxen can form both acyl and phenolic glucoronide products, while naproxen only produces acyl glucuronide. The acyl glucuronidation procedure involves UGT 1A1, 1A3, 1A6, 1A7, 1A9, 1A10, and 2B7, while phenolic glucuronidation is catalyzed by UGT 1A1, 1A7,1A9, and 1A10. Desmethylnaproxen also experiences sulphation which is adjudicated by SULT 1A1, 1B1, and 1E1.

Route of elimination

After oral administration, about 95% of naproxen and its metabolites can be recovered in the urine with 66 to 92% recovered as conjugated metabolite and less than 1% recovered as naproxen or desmethyl naproxen. 

Half-life

The elimination half-life of naproxen is reported to be 12 to 17 hours.

Clearance

Naproxen is cleared at a speed of 0.13 mL/min/kg

Toxicity

Although the over-the-counter (OTC) availability of naproxen supplies convenience to patients, it also improves the likelihood of overdose. Thankfully, the period of overdose is commonly mild with adverse effects normally limited to drowsiness, lethargy, epigastric pain, nausea, and vomiting. Although there is no antidote for naproxen overdose, symptoms will generally subside with appropriate supportive care.

this drug is classified as Category B during the foremost 2 trimesters of pregnancy, and Type D during the third trimester. Naproxen is contraindicated in the 3rd trimester since it boosts the chance of premature closure of the fetal ductus arteriosus and should be bypassed in pregnant women starting at 30 weeks gestation.

Naproxen overdose is often due to its over-the-counter availability, but the overdose is usually mild in severity, and serious adverse consequences from overdose are rare. There is no general antidote for naproxen overdose; however, monitoring vital signs and supportive care is suggested. The role of activated charcoal is unconvinced due to time constraints and unclear benefits, and there is no role for hemodialysis due to naproxen’s high degree of protein binding. Nevertheless, ingestion of large amounts of Naproxen can also lead to severe toxicity causing seizures and metabolic acidosis, which can potentially cause renal failure. Thus, although hemodialysis is not generally recommended, it can also correct acid-base disturbances and provide additional support to those with renal impairment in characteristic situations.

Administration of drug

Naproxen can also be administered orally, in both direct and extended-release tablets or suspension states, or topically. Naproxen might also be taken orally with food, milk, antacids (preferably aluminum and/or magnesium hydroxide-containing antacids), proton pump inhibitors (PPI), or misoprostol to decrease the incidence of GI adverse effects. Naproxen sodium is the most readily available structure, and it has revealed a faster absorption compared to naproxen.

As a practice, therapy with naproxen, as well as all NSAIDs, forms with the lowest effective dose for the shortest possible duration. Also, consider starting with a lower dose in geriatric patients due to the likelihood that the patient has comorbidities such as cardiovascular disease, chronic kidney disease, and/or a history of GI ulcer or bleeding that increases the risk of adverse effects from Nonsteroidal anti-inflammatory therapy.

Specific dosing recommendations and treatment durations:

Mild to Moderate Arthritis (osteoarthritis, rheumatoid arthritis, and/or ankylosing spondylitis)

• 220 to 550 mg PO separately 12 hours
• Take with food if GI upset occurs
• Max: 1650 mg every day for up to 6 months

Acute Gouty Arthritis

• 825 mg PO once, observed by 275 mg PO every 8 hours until symptom resolution
• Take with food if GI upset occurs

Acute Severe Headache or Migraine

• Controversial about isolated naproxen sodium use in patients sorrowing from acute migraines.
• Naproxen sodium has a more extended half-life compared to other Nonsteroidal anti-inflammatory options, but headache substitute rates at 2 hours after initial treatment are lower than ibuprofen.
• Naproxen sodium dosing suggestions: 550 mg every 12 hours; can also improve the dosage to 825mg PO if needed; do not exceed the max of 1375 mg daily.

Maximum Recommended Daily Doses for Children

• 12 years and more aging – 20 mg/kg/day by mouth, not to transcend 1000 mg/day by mouth; for non-prescription benefit, 660 mg/day by mouth
• 2 to 12 years – 20 mg/kg/day by mouth, not to transcend 1000 mg/day by mouth. Non-prescription use is not recommended
• More diminutive than 2 years – Safety and efficacy remain not established

Patients with Hepatic Impairment Dosing

• Although specific procedures are not available, caution is advised concerning dosing; utilize the lowest recommended dosing regimen initially.

Patients with Renal Impairment Dosing

• If creatinine clearance (CrCl) is more significant than or equal to 30 mL/minute, no dosage adjustment is needed.
• Naproxen is not advised for patients with creatinine clearance of less than 30 mL/min.

Adverse Effects of drug

Primary adverse effects of naproxen include dyspepsia, nausea, dizziness, elevated liver enzymes, increased blood pressure, diminished renal function, rash, increased bleeding risk, and GI ulcers. Serious but infrequent adverse effects include blood dyscrasias, Stevens-Johnson syndrome, myocardial infarction, stroke, heart failure, and anaphylaxis. The pursuing are several mechanisms for the above adverse effects:

GI Effects: COX-1 and COX-2 inhibition direct to reduced prostaglandin synthesis in the gastric mucosa. The prostaglandins sustain mucosal integrity, therefore declined synthesis induces reduced protection to the tissue. Nevertheless, studies indicate COX-1 has a more significant effect on the integrity of the mucosa; therefore, selective COX-2 inhibitors such as Celecoxib do not have as much of an effect on gastric tissue.

Renal Effects: Prostaglandins assembled by both COX-1 and COX-2 are important regulators of the renal process, hemodynamics, and sodium and water reabsorption in the kidneys. When renal blood flow is dependent upon prostaglandin synthesis, NSAID administration can also significantly reduce renal blood flow, leading to acute kidney injury and renal failure. Also, alterations in sodium and water reabsorption may raise blood pressure, especially in patients with pre-existing hypertension.

Platelet Effects: Platelet proliferation inhibition with naproxen is due to the dose-dependent inhibition of COX-1 in platelets. This action conducts in reduced levels of platelet thromboxane A2 and an enhanced bleeding time. This inhibition is reversible upon desist of naproxen. Despite the learned inhibition of platelet function, investigations examining an improvement in clinical bleeding time have shown varied results.

If your doctor has referred you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many individuals employing this naproxen medication do not have severe side effects. This drug may also rarely cause serious (possibly fatal) liver disease. Get medical assistance right away if you have any symptoms of liver damage, including nausea or vomiting that does not stop, loss of appetite, stomach or abdominal pain, yellowing eyes or skin, or dark urine.

A very serious allergic response to this drug is rare. However, get medical help right away if you detect any symptoms of a serious allergic reaction, including fever, swollen lymph nodes, rash, itching or swelling (especially of the face or tongue, or throat), severe dizziness, and/or trouble breathing.

This is not a whole checklist of possible side effects. If you notice other consequences not listed above, contact your doctor or pharmacist. Get emergency medical assistance if you have signs of a heart attack or stroke: chest aches to spread to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, and/or feeling the difficulty of breath.

Indications of Naproxen

Naproxen was originally approved in 1976 for pharmaceutical usage and stayed a prescription drug until it acquired approval as an over-the-counter (OTC) medication in 1994. It is believed the first-line therapy for acute gouty arthritis, osteoarthritis, musculoskeletal ache, inflammation, and dysmenorrhea. While Naproxen and extra NSAIDs have Food and Drug Administration clearance for the treatment of inflammatory arthropathies, such as rheumatoid arthritis and ankylosing spondylitis, they do not change the course of the condition, nor do they prevent joint and soft tissue destruction that are distinctive sequelae of these diseases. In these cases, disease-modifying anti-rheumatic drugs (DMARDs) have become the first-line therapy for inflammatory arthropathies, and Nonsteroidal anti-inflammatory drugs such as naproxen are utilized as adjunctive therapy.

Off-label benefits of naproxen contain dining acute migraines and migraine prophylaxis, with Naproxen being deemed a first-line abortive remedy for acute migraines. Additionally, it could also be used for chronic migraine prevention, along with other medications such as beta-blockers, anti-depressants, and anticonvulsants.

Contraindications of Naproxen

Absolute

• Reported hypersensitivity to NSAID medications
• ASA or NSAID-induced asthma
• Pregnancy (warning against use in 1st trimester, absolute contraindication at 30 weeks gestation)
• Perioperative usage for coronary artery bypass graft surgery (CABG)

Relative Risk/Caution Against Using

• Recent Myocardial infarction and/or history of heart disease
• Hypertension
• Congestive heart failure
• Fluid retention or oedema
• Dehydration
• History of gastrointestinal adverse events (peptic ulcer disease, GERD)
• Bleeding or coagulopathy conditions
• Hepatic disease
• Renal disease
• Asthma
• Sodium restrictions
• Chronic alcohol use
• Tobacco use
• Elderly or geriatric patients
• Females actively trying to conceive

Monitoring

Patients taking naproxen should obtain monitoring for pain relief, significant transformations in blood pressure, worsening kidney function, and GI symptoms such as gastroesophageal reflux disease (GERD), abdominal pain, or melena. For patients on chronic nonsteroidal anti-inflammatory drug therapy, periodic monitoring with complete blood counts to evaluate for anemia and chemistry panels to consider kidney and liver function merit consideration.

Enhancing Healthcare Team Outcomes

Naproxen is readily obtainable OTC and widely utilized for pain relief for many different types of patients. A few of these patients take medications or have medical comorbidities that place them at a significantly higher chance of serious adverse events. Eventually, they are unaware of the chance and may also think that naproxen’s availability OTC means its use is safe for everyone. It is important for all interprofessional healthcare team associates who work in a primary care setting to routinely ask their patients whether they are taking OTC medications and enlighten them about the potential risks and benefits of NSAIDs, particularly corresponding to their specific medical histories and conditions.

It is also crucial for professional healthcare providers to communicate with primary maintenance providers, nurse practitioners, and pharmacists when starting medication or treating a patient for a condition in which NSAID therapy is not recommended or contraindicated. Providers should also apprise their patients about their medical condition and how it affects their capability to take a widely available OTC medication. These interprofessional team workouts will increase therapeutic effectiveness and assist prevent unwanted adverse effects. 

What should I understand about the storage and disposal of this medication?

Maintain this medicine in the container it came in, tightly closed, and out of reach of children. Keep it at room temperature and out from excess heat and moisture (not in the bathroom).

It is predominant to keep all medications out of sight and reach of children as many vessels (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them smoothly. To rescue young children from poisoning, always lock safety caps and immediately place the medication in a safe place – one that is up and away and out of their sight and reach.

Unneeded medicines should be disposed of in special ways to ensure that pets, kids, and other people cannot consume them. Nonetheless, you should not flush this medication down the toilet. Rather, the best way to dispose of your medication is through a medicine take-back program. Converse with your pharmacist or contact your local garbage or recycling department to know about take-back programs in your community. See the Food and Drug Administrations Safe Disposal of Medicines website for more knowledge if you do not have access to a take-back program.

Interactions of drug

Drug interactions might also alter how your prescriptions work or improve your chance of serious side effects. This document does not possess all possible drug interactions. Keep a list of all the products you use (including prescription or nonprescription drugs and herbal products) and share it with your medic and pharmacist. Do not start, stop, or change the dosage of any medications without your medic’s approval.

A few evolutions that might also co-operates with this remedy are aliskiren, Angiotensin-converting enzyme inhibitors (such as captopril, and lisinopril), angiotensin II receptor blockers (such as losartan, and valsartan), cidofovir, corticosteroids (such as prednisone), and lithium, “water pills” (diuretics like furosemide).

This medicine may also improve the chance of bleeding when taken with other drugs that also may cause bleeding. Instances contain anti-platelet drugs such as clopidogrel, and “blood thinners” such as dabigatran, enoxaparin, and warfarin, among others.

Inspect all drug and nonprescription medicine labels carefully since many medications possess pain relievers or fever reducers (aspirin, Nonsteroidal anti-inflammatory drugs such as celecoxib, ibuprofen, or ketorolac). These drugs are equivalent to naproxen and may boost your risk of side effects if taken together. Although, if your doctor has referred you to take low-dose aspirin to control heart attack or stroke (usually 81 to 162 milligrams a day), you should persist in taking the aspirin unless your doctor instructs you otherwise. Everyday usage of naproxen may also decrease aspirin’s ability to prevent heart attack or stroke. Talk with your medic about the risks and benefits. Request about other medications that can be used to treat pain or fever.

This medication may also interfere with certain lab tests, conceivably causing false test results. Assemble sure lab personnel and all your doctors know you use this drug.

Dosage forms and strengths

The table below points to the conditions and strengths known for generic naproxen and naproxen sodium, as well as some of the brand-name versions of the drug.

• All documents listed are taken orally (swallowed). Strengths are given in milligrams (mg).
• naproxen, brand type – Naprosyn, immediate-release tablet, naproxen: 250 mg, 375 mg, 500 mg, Naprosyn: 500 mg
• naproxen, brand type – EC-Naprosyn, delayed-release tablet, 375 mg, 500 mg
• naproxen sodium, brand type – Anaprox DS, immediate-release tablet, naproxen: 220mg, 275 mg, 550 mg, Anaprox DS: 550 mg
• naproxen sodium, brand type- Naprelan, extended-release tablet, 375 mg, 500 mg, 750 mg

Dosage for OA, rheumatoid arthritis, and ankylosing spondylitis

Adult dosage (ages 18 years and older)

Naproxen:

Immediate-release oral tablet

• The expected dosage is 250 mg to 500 mg twice daily.
• The maximum dose is 1,500 mg per day. This should be given for a little time (up to 6 months).

Delayed-release oral tablet

• The typical dosage is 375 mg to 500 mg twice daily.
• The maximum dose is 1,500 mg per day. This should be provided for a limited time (up to 6 months).

Naproxen sodium:

Immediate-release oral tablet

• The expected dosage is 275 mg to 550 mg twice daily.
• The maximum dose is 1,650 mg per day. This should be delivered for a limited time (up to 6 months).

Extended-release oral tablet

• The expected dosage is 750 mg or 1,000 mg once daily.
• The maximum dose is 1,500 mg per day. This should be given for a limited period.

Child dosage (ages 0 to 17 years)

A dosage for individuals younger than 18 years hasn’t been established.

Special dosage considerations

If you are more aged than 65 years, your body may also process this drug more slowly. At the start of therapy, your doctor may prescribe a reduced dose so that too much of this drug does not create up in your body. Too much medicine in your body can also be dangerous.

Dosage for polyarticular juvenile idiopathic arthritis

Child dosage (ages 2 to 17 years)

Youngsters in this age cluster generally obtain the oral suspension form of this drug (a kind of liquid mixture). The dosage will be based on your child’s importance. It should be given double daily in doses that are evenly spaced throughout the day.

Child dosage (ages 0 to 23 months)

The dosage for children more youthful than 2 years has not been established.

Dosage for tendonitis, bursitis, and menstrual pain

Adult dosage (ages 18 years and older)

Naproxen:

Immediate-release oral tablet

• The initial dose is 500 mg, observed by 250 mg every 6 to 8 hours as needed.
• The highest daily dose on day 1 of therapy is 1,250 mg. Added daily doses should not exceed 1,000 mg.

Delayed-release oral tablet

• The initial dose is 1,000 mg once every day.
• The dose may also be temporarily expanded to 1,500 mg once daily if greater pain relief is required.

Naproxen sodium:

Immediate-release oral tablet

• The initial amount is 550 mg, observed by 275 mg every 6 to 8 hours or 550 mg every 12 hours as needed.
• The maximum everyday dose on day 1 of therapy is 1,375 mg. Extra daily doses should not exceed 1,100 mg.

Child dosage (ages 0 to 17 years)

The dosage for individuals younger than 18 years has not been established.

Special dosage considerations

If you are older than 65 years, your body may process this medicine more slowly. At the beginning of the remedy, your medic may also prescribe a smaller dose so that too much of this drug does not build up in your body. Too much medicine in your body can be dangerous.

Dosage for gout pain and inflammation

Adult dosage (ages 18 years and older)

Naproxen:

Immediate-release oral tablet

• The initial dose is 750 mg, observed by 250 mg every 8 hours until the episode subsides.

Delayed-release oral tablet

• The initial dose is 1,000 mg to 1,500 mg once daily observed by 1,000 mg once daily until the attack reduces.

Naproxen sodium:

Immediate-release oral tablet

• The initial dose is 825 mg, obeyed by 275 mg every 8 hours until the attack subsides.

Child dosage (ages 0 to 17 years)

The dosage for individuals younger than 18 years hasn’t been established.

Special dosage considerations

If you are more senior than 65 years, your body may process this drug more slowly. At the start of therapy, your doctor may also prescribe a reduced dose so that too much of this drug does not build up in your body. Too much medicine in your body can be dangerous.

Disclaimer: Our goal is to supply you with the most relevant and current information. Nevertheless, because drugs affect each person differently, we cannot guarantee that this checklist includes all possible dosages. This knowledge is not a substitute for medical advice. Always speak with your physician or pharmacist about dosages that are right for you.

Overdose

If somebody has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, reach a poison control command right away. US residents can also call their regional poison control center at 1-800-222-1222. Canadian citizens can call a provincial poison control command. Symptoms of overdose may include severe stomach pain, extreme drowsiness, and seizures.

Notes

Do not share this medication with others.

Lab and/or medical tests (such as blood pressure, complete blood count, and liver or kidney function) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you have arthritis, lifestyle changes (such as weight loss if needed, and strengthening/conditioning exercises) may help improve your flexibility and joint function. Consult your doctor for specific instructions.

Missed Dose

If you are receiving this medication on a regular schedule (not just “as needed”) and you forgot a dose, take it as soon as you recognize it. If it is roughly the time of the next dose, forget the missed dose. Take your next dose of the drug at the normal duration. Do not wrinkle the dose to catch up.

Storage

Store at room temperature away from sunlight and condensation. Do not keep it in the bathroom. Maintain all medicines away from children and pets.

Do not wash pharmaceuticals down the toilet or pour them into a drain unless instructed to do so. Appropriately discard this development when it is expired or no longer required. Confer your druggist and/or local waste disposal division.

Precautions

• Before taking naproxen, tell your medic and/or pharmacist if you are allergic to it; aspirin, or another Nonsteroidal anti-inflammatory drug (such as ibuprofen, or celecoxib); or if you have any other allergies. This development may also contain stagnant ingredients, which can also cause allergic reactions or other problems. Speak to your pharmacist for more particulars.
• Before utilizing this drug, tell your medic and/or pharmacist your medical history, especially of: asthma, aspirin-sensitive asthma (a history of deteriorating breathing with runny or stuffy nose after taking aspirin or other NSAIDs), blood conditions (such as anemia), bleeding or clotting difficulties, growths in the nose (nasal polyps), heart condition (such as previous heart attack), high blood pressure, liver disorder, stroke, swelling (edema, fluid retention), stomach or intestinal or esophagus issues (such as bleeding, heartburn, ulcers).
• Kidney problems can also sometimes happen with the use of NSAID medications, including naproxen. Difficulties are more probable to occur if you are thirsty, have heart failure or kidney disease, are an older adult, or if you take certain medicines (see also Drug Interactions section). Drink plenty of fluids as required by your doctor to prevent dehydration and tell your medic right away if you have a change in the amount of urine.
• This drug may make you dizzy and/or drowsy. Alcohol or marijuana (cannabis) might also make you more dizzy or drowsy. Do not drive, operate machinery, or do anything that needs attention until you can do it safely. Articulate to your doctor if you are using marijuana (cannabis).
• This medicine may also cause stomach bleeding. Daily use of alcohol and tobacco, particularly when combined with this medicine, may increase your risk of stomach bleeding. Determine alcohol and stop smoking. Request your doctor or pharmacist about how much alcohol you may safely drink.
• This drug might also make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Operate sunscreen and wear defensive clothing when outdoors. Notify your medic right away if you get sunburned and/or have skin blisters or redness.
• Some naproxen products contain salt (sodium). Advise your doctor if you are on a salt-restricted diet. Before having surgery, notify your doctor or dentist about all the products you utilize (including prescription drugs, nonprescription drugs, and herbal products).
• Older grown-ups may be at greater risk for stomach or intestinal bleeding, kidney problems, heart attack, and stroke while employing this drug.
• Before employing this drug, women of childbearing age should talk with their doctor(s) about the benefits and risks. Notify your medic if you are pregnant or if you plan to become pregnant. This medicine may harm an unborn baby and cause issues with normal labor or delivery. It is not recommended for service in pregnancy from 20 weeks until delivery. If your doctor decides that you require to use this medication between 20 and 30 weeks of pregnancy, you should employ the lowest effective dose for the shortest possible time. You should not use this remedy after 30 weeks of pregnancy.

This medicine passes into breast milk and may also have undesirable effects on a nursing infant. Confer your medic before breastfeeding.

Important Warning

Individuals who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as naproxen may have a more increased risk of having a heart attack or a stroke than individuals who do not take these medications. These circumstances may also occur without warning and may cause death. These topics may also develop at any time during therapy, but the risk may be higher for someone who takes Nonsteroidal anti-inflammatory drugs for a long time or at higher doses. Do not take a Nonsteroidal anti-inflammatory drug such as naproxen if you have newly had a heart episode unless directed to do so by your doctor. Inform your physician if you or anyone in your family has or has ever had a heart condition, a heart attack, or a stroke if you smoke and if you have or have ever developed cholesterol, high blood pressure, or diabetes. Get emergency medical assistance right away if you encounter any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech.

If you will be participating in a coronary artery bypass graft (CABG; a style of heart surgery), you should not take naproxen respectable before and/or straight after the surgery.

Nonsteroidal anti-inflammatory drugs such as naproxen might also cause ulcers, bleeding, or holes in the esophagus (the pipe between the mouth and stomach), stomach, or intestine. These issues might also develop at any time during therapy, may also happen without noticeable symptoms, and may cause death. The risk may be higher for individuals who take NSAIDs for a long time or at higher doses, are older, have poor health, smoke, or drink large quantities of alcohol while taking naproxen.

Inform your doctor if you take any of the subsequent medications: anticoagulants (”blood thinners”) such as warfarin (Coumadin, Jantoven); aspirin; additional Nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin) and ketoprofen; oral steroids such as dexamethasone, methylprednisolone (Medrol), and/or prednisone (Rayos); salicylate ache relievers such as diflunisal, magnesium salicylate (Doan’s, others), and salsalate; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, in Symbyax), and also fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin-norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). Also notify your physician if you have or have ever had ulcers, exuding in your stomach and/or intestines, other bleeding disorders, or liver disorder. If you encounter any of the subsequent symptoms, quit taking naproxen and contact your doctor: stomach ache, heartburn, vomit that is bloody or glimpses like coffee grounds, blood in the stool, or black and tarry stools.

Maintain all assignments with your medic and the laboratory. Your medic will keep your symptoms and will probably order certain tests to correspond to your body’s reaction to naproxen. Be sure to inform your physician how you are feeling so that your doctor can prescribe the right amount of medicine to treat your circumstances with the lowest risk of serious side effects.

Your physician or druggist will give you the manufacturer’s patient information sheet (Medication Guide) when you begin the restorative with prescription naproxen each time you refill your medication. Read the details carefully and ask your medic or pharmacist if you have any inquiries. You could also see the Food and Drug Administration (FDA) or the manufacturer’s website to receive the Medication Guide.

What to avoid

• Evade drinking alcohol. It may also increase your chance of stomach bleeding.
• Detour taking aspirin or other Nonsteroidal anti-inflammatory drugs unless your medic tells you to.
• Request your medicine before taking any other medicine for pain, arthritis, fever, or swelling. Many drugs available over the counter contain aspirin, salicylates, or other prescriptions similar to naproxen (such as ibuprofen or ketoprofen). Accepting certain developments together can cause you to get too much of this type of medication.
• Request your doctor before utilizing an antacid, and use only the type your doctor advises. A few antacids could also make it harder for your body to engross naproxen.

Key facts

• Take the naproxen medication with or just take it after a meal and/or snack.
• Take the most nether dose of naproxen for the quickest time to supervise your symptoms.
• The most often side effects of naproxen are confusion, headache, ringing in the ears, differences in vision, tiredness, drowsiness, dizziness, and rashes.
• For strains and sprains, some medics suggest waiting 48 hours before taking naproxen because it may also slow down healing. If you are doubtful, articulate to a medic.
• If you are taking naproxen for a lengthy time or are at risk of getting a stomach ulcer, your medic may also prescribe a medicine, such as omeprazole or lansoprazole, to protect your stomach.

FAQ

Author: Dr. Prachi Patel