Naproxen

Naproxen is a non-steroidal anti-inflammatory drug (NSAID) of the propionic acid class, prescribed for the relief of pain, inflammation, and stiffness associated with a broad range of musculoskeletal and inflammatory conditions.

Common indications include rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout, tendinitis, bursitis, dysmenorrhoea, and acute musculoskeletal pain.

Naproxen works by non-selectively inhibiting both cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2) enzymes, thereby reducing the synthesis of prostaglandins.

Prostaglandins are lipid mediators that promote inflammation, pain, and fever.

By lowering prostaglandin levels at the site of tissue injury, naproxen provides effective anti-inflammatory, analgesic, and antipyretic activity.

Naproxen has a relatively long half-life (12 to 17 hours) compared with other NSAIDs such as ibuprofen, allowing for twice-daily dosing and providing sustained symptom relief.

Epidemiological data suggest that naproxen may carry a lower cardiovascular risk than some other NSAIDs, making it a preferred choice for patients who require long-term anti-inflammatory therapy and have cardiovascular risk factors.

Take naproxen with or after food to reduce the risk of gastrointestinal irritation. Swallow the tablets whole with a glass of water.

Take the lowest effective dose for the shortest duration necessary to control symptoms. If prescribed twice daily, space the doses approximately 12 hours apart.

Do not lie down for at least 30 minutes after taking naproxen to reduce the risk of oesophageal irritation.

If your prescriber has also recommended a proton pump inhibitor for gastroprotection, take it as directed.

For musculoskeletal disorders: 500 mg to 1,000 mg daily in one or two divided doses. The maximum daily dose is 1,250 mg on the first day, reducing to 1,000 mg daily thereafter.

For acute gout: 750 mg initially, followed by 250 mg every 8 hours until the attack subsides. For dysmenorrhoea: 500 mg initially, then 250 mg every 6-8 hours as needed.

In elderly patients, the lowest effective dose should be used and renal and gastrointestinal function monitored.

Common (1 in 10 to 1 in 100): dyspepsia, nausea, abdominal pain, constipation, diarrhoea, headache, dizziness, drowsiness, tinnitus, oedema.

Uncommon (1 in 100 to 1 in 1,000): gastric or duodenal ulceration, gastrointestinal bleeding, rash, pruritus, stomatitis, impaired renal function, elevated liver enzymes, visual disturbances.

Rare (1 in 1,000 to 1 in 10,000): aplastic anaemia, agranulocytosis, hepatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, interstitial nephritis, aseptic meningitis, anaphylaxis.

All NSAIDs carry a dose-dependent risk of gastrointestinal complications and cardiovascular thrombotic events.

Naproxen should be used at the lowest effective dose for the shortest possible duration.

It may increase the risk of cardiovascular thrombotic events, particularly at high doses and with prolonged use, although this risk appears lower than with some other NSAIDs.

Gastrointestinal ulceration and bleeding can occur without warning; consider co-prescribing a proton pump inhibitor in patients with risk factors.

Use with caution in patients with asthma, hypertension, heart failure, renal impairment, or hepatic impairment. Avoid use in the third trimester of pregnancy.

Naproxen is contraindicated in patients with active peptic ulceration or gastrointestinal bleeding, a history of gastrointestinal bleeding or perforation related to previous NSAID therapy, severe heart failure, severe hepatic impairment, severe renal impairment (CrCl below 30 ml/min), the third trimester of pregnancy, and hypersensitivity to naproxen or any NSAID (including those who have experienced asthma, urticaria, or rhinitis triggered by aspirin or other NSAIDs).