Naproxen: Comprehensive NHS-Aligned Information

Naproxen is a non-steroidal anti-inflammatory drug (NSAID) that has been in clinical use since 1976.

It works by blocking the cyclooxygenase enzymes COX-1 and COX-2, which are responsible for producing prostaglandins.

Prostaglandins play a central role in generating pain, inflammation and fever, so by reducing their production, naproxen provides effective relief across a wide range of conditions.

The NHS lists the following as common indications for naproxen:

• Rheumatoid arthritis and osteoarthritis: naproxen reduces joint pain, swelling and morning stiffness
• Ankylosing spondylitis: it helps manage the inflammatory back pain characteristic of this condition
• Acute gout: naproxen is one of the first-line treatments recommended by NICE for acute gout attacks
• Period pain (dysmenorrhoea): it is particularly effective because prostaglandins drive uterine cramping
• Musculoskeletal injuries: sprains, strains and soft-tissue injuries respond well to short courses
• Post-surgical and dental pain: commonly used as part of a multimodal analgesia plan
• Migraine: naproxen 500 mg is an option for acute migraine treatment, sometimes combined with a triptan

Naproxen is available as standard tablets (250 mg and 500 mg), gastro-resistant tablets and a liquid suspension.

Most formulations are prescription-only in the UK, although naproxen 250 mg is available over the counter for period pain under the brand name Feminax Ultra.

It is one of the most commonly prescribed NSAIDs in the NHS, with over 12 million prescriptions dispensed annually in England.

In the UK, naproxen 500 mg tablets are a prescription-only medicine (POM).

This means you need a prescription from a qualified prescriber, which includes GPs, nurse prescribers and pharmacist independent prescribers.

GP appointment

The most common route is through your general practitioner. During the consultation, your doctor will assess your symptoms, check for contraindications and decide whether naproxen is appropriate.

If prescribed, it will appear on your NHS prescription and can be dispensed at any community pharmacy.

NHS prescription charges

In England, the current prescription charge is a flat rate per item regardless of the quantity. In Scotland, Wales and Northern Ireland, prescriptions are free of charge.

If you need naproxen regularly, a prepayment certificate may save you money.

Pharmacy consultation

For period pain, naproxen 250 mg is available without prescription. A pharmacist can sell it after a brief consultation to check suitability.

This is limited to women aged 15 to 50 for the treatment of primary dysmenorrhoea.

Online prescribing services

NHS-linked and private online consultation services can issue naproxen prescriptions after a medical questionnaire and prescriber review.

These services are regulated by the Care Quality Commission (CQC) and must follow the same prescribing standards as face-to-face consultations.

Emergency supply

If you have been prescribed naproxen before and run out, a pharmacist may provide an emergency supply of up to 30 days under specific legal provisions.

This is at the pharmacist's professional discretion and is not available for controlled drugs.

Naproxen is not suitable for everyone. The BNF lists several absolute contraindications and important cautions that your prescriber will check before issuing a prescription.

Absolute contraindications

• Active peptic ulcer or gastrointestinal bleeding
• History of two or more episodes of peptic ulceration or GI haemorrhage
• Severe heart failure (NYHA class III-IV)
• Severe hepatic impairment
• Severe renal impairment (eGFR below 15 mL/min)
• Third trimester of pregnancy (from 30 weeks)
• Known hypersensitivity to naproxen or any other NSAID, including aspirin-sensitive asthma

Use with caution

• Patients over 65: higher GI and cardiovascular risk; use lowest dose with gastroprotection
• History of a single GI bleed or ulcer: co-prescribe a PPI and monitor closely
• Cardiovascular disease: while naproxen has the best CV profile among NSAIDs, caution is still required
• Mild to moderate kidney impairment: monitor eGFR and avoid dehydration
• Asthma: NSAIDs can trigger bronchospasm in susceptible individuals (approximately 10 to 20% of asthma patients)
• Inflammatory bowel disease: NSAIDs may exacerbate Crohn's disease or ulcerative colitis
• Concurrent anticoagulant or antiplatelet therapy: increased bleeding risk

Always provide a complete medication history and list of medical conditions when consulting your prescriber. This ensures naproxen is safe for you or that an appropriate alternative is chosen.

The safety of naproxen during pregnancy depends on the gestational stage, and the drug requires careful consideration during breastfeeding.

First trimester (weeks 1 to 12)

NSAIDs should be avoided unless the benefits clearly outweigh the risks.

Some observational studies have suggested a small increase in the risk of miscarriage and congenital malformations with NSAID use in early pregnancy, although the absolute risk remains low.

Second trimester (weeks 13 to 29)

Naproxen may be used for the shortest duration and at the lowest dose if alternative analgesics (primarily paracetamol) are ineffective.

Your obstetrician or midwife should be involved in the decision.

Third trimester (from week 30)

Naproxen is contraindicated. All NSAIDs at this stage can cause premature closure of the ductus arteriosus in the foetus, reduced amniotic fluid volume (oligohydramnios) and delayed onset of labour.

These effects can have serious consequences for the baby.

Breastfeeding

Naproxen is excreted in breast milk in small amounts. The BNF advises that it can be used with caution during breastfeeding, but at the lowest dose and for the shortest time.

Ibuprofen is generally preferred for breastfeeding mothers because its shorter half-life leads to lower infant exposure.

If you need anti-inflammatory pain relief while nursing, discuss the options with your doctor or health visitor.

Paracetamol remains the safest analgesic choice throughout pregnancy and breastfeeding at standard doses.

Proper storage helps maintain the effectiveness of naproxen, and safe disposal protects both people and the environment.

Storage

Keep naproxen tablets in their original blister packaging or container. Store them at room temperature, away from direct heat, sunlight and moisture.

The bathroom cabinet is often unsuitable because of humidity. A bedroom drawer or kitchen cupboard (away from the cooker) is a better choice.

Do not use naproxen after the expiry date printed on the packaging. Expired NSAIDs may lose potency and, in rare cases, degraded formulations can cause unexpected side effects.

Keep all medicines out of the sight and reach of children. If your household includes young children, consider using a locked medicine cabinet.

Disposal

Do not flush unused naproxen down the toilet or throw it in household rubbish. NSAIDs can contaminate water supplies and harm aquatic organisms.

Return unused or expired naproxen to any community pharmacy. Pharmacies in the UK accept medicines for safe disposal free of charge as part of their NHS contract.

Simply hand the packets over at the counter.

If you are unsure whether your naproxen is still in date or has been stored correctly, your pharmacist can advise whether it is safe to use or whether it should be replaced.

This is a quick, no-appointment check that takes only a few minutes.