Naproxen

Naproxen is a non-steroidal anti-inflammatory drug (NSAID) with a long duration of action. Compared with ibuprofen or diclofenac, it only needs to be taken twice a day.

The active ingredient is available in Germany as a generic and under various brand names. Naproxen is used for musculoskeletal pain, rheumatic diseases and menstrual pain.

Because of its long duration of action, naproxen is particularly suitable for patients who need even pain relief throughout the day.

Naproxen inhibits cyclooxygenase (COX-1 and COX-2):

Mechanism of action:

• Blocks prostaglandin synthesis
• Reduces pain, inflammation and fever

Special feature – long half-life:

• Half-life: 12–15 hours (considerably longer than ibuprofen at 2–4 h)
• More even drug levels throughout the day
• Only 2 doses per day needed

Cardiovascular profile: Some NSAIDs, especially at high doses and with long-term treatment, may be associated with a slightly increased risk of heart attack or stroke. For naproxen (1000 mg daily), data point to a possibly lower risk, but some risk cannot be ruled out. In uncontrolled high blood pressure, heart failure, ischemic heart disease, peripheral arterial occlusive disease or cerebrovascular disease, naproxen is only used after careful medical consideration. The same applies before longer-term treatment in patients with risk factors such as high blood pressure, raised blood lipids, diabetes mellitus or smoking.

Naproxen is suitable for:

• Osteoarthritis and rheumatoid arthritis
• Back pain
• Menstrual pain
• Gout attacks
• Tendinitis, bursitis
• Mild to moderately severe pain

Particularly suitable for:

• Patients who prefer taking it 2 times a day

Not suitable:

• In active gastrointestinal ulcers
• In severe heart, liver or kidney failure
• In the last trimester of pregnancy

Tablets:

• 250 mg, 500 mg

Usual dosage:

• 250–500 mg twice daily
• Maximum daily dose: 1250 mg (initial dose), thereafter 1000 mg

For an acute gout attack:

• Initial dose: 750 mg, then 250 mg every 8 hours

Recommendation: The lowest effective dose for as short a time as possible.

How to take:

• Take with sufficient water
• With or after a meal
• Morning and evening, 12 hours apart

Important notes:

• Do not combine with other NSAIDs
• Do not take on an empty stomach
• For long-term use, consider stomach protection with a PPI
• Regular monitoring of kidney function and blood count

Naproxen must not be taken in cases of:

• Hypersensitivity to naproxen or other NSAIDs
• Active stomach or intestinal ulcers
• Severe heart failure
• Severe kidney or liver failure
• The last trimester of pregnancy

Use with caution in:

• Elderly patients (increased risk of GI bleeding)
• Bronchial asthma
• Bleeding tendency
• Use of anticoagulants

Pregnancy: In the 1st and 2nd trimesters, only if strictly indicated. Contraindicated in the 3rd trimester.

Common (1–10%):

• Stomach pain, heartburn, nausea
• Headache, dizziness
• Edema

Uncommon (0.1–1%):

• Stomach ulcers, GI bleeding
• Skin rash
• Elevated liver enzymes

Rare:

• Severe allergic reactions
• Kidney function disorders
• Changes in blood count

Note: The risk of GI bleeding is somewhat higher with naproxen than with ibuprofen. Some risk of heart attack and stroke cannot be ruled out with naproxen either.

Increased risk of bleeding with:

• Anticoagulants
• ASA, other NSAIDs
• SSRI antidepressants
• Corticosteroids

Reduced effect of:

• ACE inhibitors, sartans
• Diuretics

Increased toxicity of:

• Methotrexate
• Lithium