Naproxen / Naproxen Sodium

• Type of Drug: Nonsteroidal anti-inflammatory drug (NSAID).
• Prescribed for: Rheumatoid arthritis, juvenile rheumatoid-arthritis (Naproxen only), osteoarthritis, ankylosing spondylitis, mild to moderate pain, tendinitis, bursitis, gout, fever, sunburn treatment, migraine attacks (Naproxen Sodium only), migraine prevention, menstrual pain, menstrual headaches, and premenstrual syndrome (PMS) (Naproxen Sodium only). Naproxen Sodium is available in an over-the-counter (nonprescription) dosage.

Naproxen General Information

Naproxen is one of 16 nonsteroidal anti-inflammatory drugs (NSAIDs), used to relieve pain and inflammation. We do not know exactly how NSAIDs work, but part of their action may be due to an ability to inhibit the body’s production of a hormone called prostaglandin and to inhibit the action of other body chemicals, including cyclo-oxygenase, lipoxygenase, leukotrienes, lysosomal enzymes, and a host of other factors. NSAIDs are generally absorbed into the bloodstream fairly quickly. Pain relief comes within an hour after taking the first dose of Naproxen and lasts for about 7 hours, but its anti-inflammatory effect takes a lot longer (several days to 2 weeks) to become apparent, and may take 1 month to reach its maximum effect. Naproxen is broken down in the liver and eliminated through the kidneys.

Naproxen Cautions and Warnings

People who are allergic to Naproxen (or any other NSAID) and those with a history of asthma attacks brought on by an NSAID, Iodides, or Aspirin should not take Naproxen.

Naproxen can cause gastrointestinal (GI) bleeding, ulcers, and stomach perforation. This can occur at any time, with or without warning, in people who take chronic Naproxen treatment. People with a history of active GI bleeding should be cautious about taking any NSAID. Minor stomach upset, distress, or gas is common during the first few days of treatment with Naproxen. People who develop bleeding or ulcers and continue treatment should be aware of the possibility of developing more serious drug toxicity.

Naproxen can affect platelets and blood clotting at high doses, and should be avoided by people with clotting problems and by those taking Warfarin.

People with heart problems who use Naproxen may experience swelling in their arms, legs, or feet.
Naproxen can cause severe toxic effects to the kidney. Report any unusual side effects to your doctor, who may need to periodically test your kidney function.

Naproxen can make you unusually sensitive to the effects of the sun (photosensitivity).

Naproxen dosage should be reduced in people with severe liver disease.

Possible Side Effects

• Most common: diarrhea, nausea, vomiting, constipation, stomach gas, stomach upset or irritation, and loss of appetite.
• Less common: stomach ulcers, GI bleeding, hepatitis, gallbladder attacks, painful urination, poor kidney function, kidney inflammation, blood and protein in the urine, dizziness, fainting, nervousness, depression, hallucinations, confusion, disorientation, tingling in the hands or feet, light-headedness, itching, increased sweating, dry nose and mouth, heart palpitations, chest pain, difficulty breathing, and muscle cramps.
• Rare: severe allergic reactions, including closing of the throat, fever and chills, changes in liver function, jaundice (yellowing of the skin or eyes), and kidney failure. People who experience such effects must be promptly treated in a hospital emergency room or doctor’s office.

NSAIDs have caused severe skin reactions; if this happens to you, see your doctor immediately.

Drug Interactions

• Naproxen can increase the effects of oral anticoagulant (blood-thinning) drugs such as Warfarin. You may take this combination, but your doctor may have to reduce your anticoagulant dose.
• The combination of Naproxen and a thiazide diuretic affects the amount of diuretic in your blood. Naproxen may reduce the effect of the diuretic.
• Taking Naproxen with Cyclosporine may increase the toxic kidney effects of both drugs. Methotrexate toxicity may be increased in people also taking Naproxen.
• Naproxen may reduce the blood-pressure-lowering effect of beta blockers (except Atenolol) and loop diuretic drugs.
• Naproxen may increase blood levels of Phenytoin, leading to increased Phenytoin side effects. Blood-Lithium levels may be increased in people taking Naproxen.
• Naproxen blood levels may be affected by Cimetidine because of that drug’s effect on the liver.
• Probenecid may interfere with the body’s elimination of Naproxen, increasing the risk of Naproxen toxic reactions.
• Aspirin and other salicylates may decrease the amount of Naproxen in your blood. These medicines should never be taken at the same time.

Food Interactions

Take Naproxen with food or a magnesium/aluminum antacid if it upsets your stomach.

Naproxen Usual Dose

Adult: 250 mg to 375 mg morning and night, to start. Dose may be increased to 1250 mg per day, if needed.

• Mild to moderate pain: 250 to 275 mg every 6 to 8 hours.
• Nonprescription dose: 1 tablet (200 mg) every 8 to 12 hours. Or, 2 tablets to start, then 1 in 12 hours, and then 1 every 8 to 12 hours. Do not take more than 3 tablets a day.

Seniors (age 65 and older):Do not take more than 200 mg every 12 hours.
Child (age 2 and older): 4.5 mg per pound of body weight divided into 2 doses per day.
Take each dose with a full glass of water and don’t lie down for 15 to 30 minutes after you take the medicine.

Overdosage

People have died from NSAID overdoses. The most common signs of overdosage are drowsiness, nausea, vomiting, diarrhea, abdominal pain, rapid breathing, rapid heartbeat, increased sweating, ringing or buzzing in the ears, confusion, disorientation, stupor, and coma.
Take the victim to a hospital emergency room at once. ALWAYS bring the medicine bottle.

Naproxen Special Information

Naproxen can make you drowsy and/or tired: Be careful when driving or operating hazardous equipment. Do not take any nonprescription products with Acetaminophen or Aspirin while taking this drug; also, avoid alcoholic beverages.

Contact your doctor if you develop skin rash or itching, visual disturbances, weight gain, breathing difficulty, fluid retention, hallucinations, black or tarry stools, persistent headache, or any unusual or intolerable side effects.

If you forget to take a dose of Naproxen, take it as soon as you remember. If you take several doses a day and it is within 4 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take Naproxen once a day and it is within 8 hours of your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.

Naproxen Special Populations

Pregnancy/Breast-feeding
NSAIDs may cross into the fetal blood circulation. They have not been found to cause birth defects, but may affect a developing fetal heart during the second half of pregnancy; animal studies indicate a possible effect. Women who are or who might become pregnant should not take Naproxen without their doctors’ approval; pregnant women should be particularly cautious about using this drug during the last 3 months of their pregnancy. When the drug is considered essential by your doctor, its potential benefits must be carefully weighed against its risks.

NSAIDs may pass into breast milk, but have caused no problems among breast-fed infants, except for seizures in a baby whose mother was taking Indomethacin. Other NSAIDs have caused problems in animal studies. There is a possibility that a nursing mother taking Naproxen could affect her baby’s heart or cardiovascular system. If you must take Naproxen, bottle-feed your baby.

Seniors
Older adults may be more susceptible to Naproxen side effects, especially ulcer disease.