Naproxen

Sounds like 'nah-PROX-en'

Overview
Clinicians

Easy-to-read medicine information about naproxen – what it is, how to take it safely and possible side effects.

Type of medicine	Also called
Analgesics (pain killer) Anti-inflammatory Non-steroidal anti-inflammatory drug (NSAID)	Noflam® Naprosyn SR®

What is naproxen?

Naproxen is in a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs). It is used to treat different types of pain such as muscle pain, dental pain, migraine and pain from injury or after surgery. Naproxen also helps to ease redness and swelling caused by injury, and acute gout attacks. It blocks the inflammation process in your body and in this way eases swelling and pain. In New Zealand naproxen is available as tablets.

Lower strengths of naproxen tablets (Naprogesic® and Sonaflam®) can be bought over-the-counter from a pharmacy.

Dose

The dose of naproxen will be different for different people. As a guide:

If you are taking naproxen for a long-term condition (such as arthritis), the usual dose is 500 mg to 1 gm per day, taken as either a single dose, or divided into 2 doses during the day.
For short-term conditions (such as muscle/tendon pain or sprains/strains), the usual dose is 250 mg taken 3 or 4 times daily when needed. It is often recommended that a double dose (500 mg) be taken for the first dose.
For gout pain, the usual dose is 750 mg for the first dose, and then 250 mg every 8 hours until the flare has passed.
For period pain, the usual dose is 250 mg three times daily for up to 5 days.

Always take your naproxen exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions.

How to take naproxen

Take naproxen with food or immediately after food, to prevent stomach upset.
Take naproxen with a full glass of water.
Swallow the tablets whole. Do not crush or chew them.
Limit or avoid alcohol while you are taking naproxen. Alcohol can increase the risk of side effects such as stomach upset.
If you forget to take a dose, take it when you next need pain relief and then continue as before. Do not take two doses together to make up for a forgotten dose.

Take care with naproxen

For most people, taking naproxen is safe. However, extra care is needed if you have high blood pressure, high cholesterol, diabetes, stomach ulcers, kidney problems or if you smoke. It can also be harmful if you take it when you are dehydrated or have been sick with nausea or vomiting. Discuss with your doctor if taking naproxen is suitable for you.

NSAIDs (except low-dose aspirin) increase the chance of a heart attack or stroke, which can lead to death. These serious side effects can occur even in the first weeks of using an NSAID and the risk may increase the longer you are taking them. The risk appears greater at higher doses; use the lowest effective amount for the shortest possible time. Some other medicines contain NSAIDs, including those used for colds, flu, so always read the labels and avoid taking multiple medicines that contain NSAIDs.

Precautions – before taking naproxen

Do you have high blood pressure or problems with your heart?
Do you have any problems with the way your kidneys or liver works?
Have you had stomach ulcers?
Do you have inflammatory bowel disease?
Are you pregnant, planning a pregnancy or breastfeeding?
Do you have any breathing problems or asthma?
Have you had an allergic reaction to a medicine, particularly to any other NSAID (such as aspirin, diclofenac and ibuprofen) or a COX-2 such as celecoxib?

If so, it’s important that you tell your doctor before you start taking naproxen. Sometimes a medicine isn’t suitable for a person with certain conditions or taking other medicines, or it can only be used with extra care.

Possible side effects

Side effects	What should I do?
Heartburn Indigestion Stomach discomfort	Take naproxen with food. Talk to your doctor if it is painful.
Serious stomach problems such as really bad stomach pain, blood in the stool or black stools, cough or vomit up blood or dark coloured vomit.	Tell your doctor immediately or ring HealthLine on 0800 611 116
Allergic reaction such as skin rash, itching, swelling of the lips, face, and mouth or difficulty breathing	Tell your doctor immediately or ring HealthLine on 0800 611 116
Chest pain Shortness of breath or trouble breathing Weakness in one part or side of the body Slurred speech	Tell your doctor immediately or ring HealthLine on 0800 611 116

Interactions

Naproxen interacts with some medicines, especially those used for high blood pressure, so check with your doctor or pharmacist before you start taking it.

Do not take other NSAIDs such as diclofenac or ibuprofen or COX-2s such as celecoxib while taking naproxen. This can increase your risk of side effects.

Taking NSAIDs together with medicines called ACE inhibitors or ARBs and diuretics (water pills) can be harmful to your kidneys. This is called the ‘triple whammy’. If you are taking ACE inhibitors or ARBs and diuretics, tell your doctor or pharmacist before starting ibuprofen.

Examples of ACE inhibitors are captopril, cilazapril, enalapril, lisinopril, perindopril, quinapril and trandolapril.
Examples of ARBs are losartan, valsartan and candesartan.
Examples of diuretics are furosemide, bumetanide, bendroflumethiazide, chlortalidone, indapamide and metolazone.

Learn more

The following links have more information about naproxen.

Naproxen (Māori) New Zealand Formulary Patient Information

Medsafe Consumer Information Sheets:

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 21 Mar 2019

Information for clinicians

This section will be of most interest to clinicians (eg, nurses, doctors, pharmacists and specialists).

Medsafe prescriber updates

NSAIDs and cardiovascular risk (June 2019)
Key messages All non-steroidal anti-inflammatory drugs (NSAIDs) are associated with a small increased risk of serious cardiovascular adverse events. The risk is increased with high doses, increasing duration of use and in patients with other cardiovascular risk factors. The lowest effective NSAID dose should be used for the shortest possible duration. The overall benefit to risk of harm balance of NSAIDs remains positive. Patients requiring long-term NSAID therapy should be regularly reviewed for efficacy, adverse effects and the development of cardiovascular risk factors. Effectiveness of different NSAIDs may vary between individual patients. Read more: NSAIDs and cardiovascular risk

NSAIDs and cardiovascular risk (June 2019)

Key messages

All non-steroidal anti-inflammatory drugs (NSAIDs) are associated with a small increased risk of serious cardiovascular adverse events.
The risk is increased with high doses, increasing duration of use and in patients with other cardiovascular risk factors.
The lowest effective NSAID dose should be used for the shortest possible duration.
The overall benefit to risk of harm balance of NSAIDs remains positive.
Patients requiring long-term NSAID therapy should be regularly reviewed for efficacy, adverse effects and the development of cardiovascular risk factors.
Effectiveness of different NSAIDs may vary between individual patients.
Read more: NSAIDs and cardiovascular risk

NSAIDs and acute kidney injury (June 2013)
Key messages All NSAIDs (including COX-2 inhibitors) have been associated with the development of acute kidney injury. Acute kidney injury is more likely to occur in patients with other risk factors — particularly hypovolaemic states. Other risk factors include: Increasing age (>65 years), chronic hypertension and atherosclerosis. Pre-exisiting renal or glomerular disease. Use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists. Use of the 'triple whammy' (concurrent use of ACE inhibitor or angiotensin-II receptor antagonist plus diuretic plus NSAID). Renal function should be monitored in at risk patients. If acute kidney injury occurs, the NSAID should be stopped. NSAIDs should be avoided in patients who develop or have a history of interstitial nephritis. Read more: NSAIDs and Acute Kidney Injury

NSAIDs and acute kidney injury (June 2013)

Key messages

All NSAIDs (including COX-2 inhibitors) have been associated with the development of acute kidney injury.
Acute kidney injury is more likely to occur in patients with other risk factors — particularly hypovolaemic states. Other risk factors include:

Increasing age (>65 years), chronic hypertension and atherosclerosis.
Pre-exisiting renal or glomerular disease.
Use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor antagonists.
Use of the 'triple whammy' (concurrent use of ACE inhibitor or angiotensin-II receptor antagonist plus diuretic plus NSAID).

Renal function should be monitored in at risk patients.
If acute kidney injury occurs, the NSAID should be stopped.
NSAIDs should be avoided in patients who develop or have a history of interstitial nephritis.
Read more: NSAIDs and Acute Kidney Injury

NSAIDs and Heart Disease (December 2017)
For all patients requiring treatment with either a non-selective NSAID or COX-2 inhibitor, the extent and severity of gastrointestinal events can be reduced by: Using the lowest effective dose for the shortest duration possible. Avoiding the concomitant use of more than one NSAID, or a NSAID with a COX-2 inhibitor. Avoiding the concomitant use of aspirin and/ or an anticoagulant where possible. If such a combination is necessary, a gastro-protective agent such as a proton pump inhibitor should be considered. Informing patients of, and monitoring for, signs and symptoms of gastrointestinal adverse events. Identifying patients with risk factors for serious GI adverse events and considering the use of a gastro-protective agent such as a proton pump inhibitor. Read more: NSAIDs and Heart Disease

NSAIDs and Heart Disease (December 2017)

For all patients requiring treatment with either a non-selective NSAID or COX-2 inhibitor, the extent and severity of gastrointestinal events can be reduced by:

Using the lowest effective dose for the shortest duration possible.
Avoiding the concomitant use of more than one NSAID, or a NSAID with a COX-2 inhibitor.
Avoiding the concomitant use of aspirin and/ or an anticoagulant where possible. If such a combination is necessary, a gastro-protective agent such as a proton pump inhibitor should be considered.
Informing patients of, and monitoring for, signs and symptoms of gastrointestinal adverse events.
Identifying patients with risk factors for serious GI adverse events and considering the use of a gastro-protective agent such as a proton pump inhibitor.
Read more: NSAIDs and Heart Disease