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 (NSAID)	Noflam® Naxen® Naprosyn® 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 resulting 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.

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 gram daily, 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, the usual dose is 750 mg for the first dose, and then 250 mg every 8 hours until the attack 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.
It is not harmful if you miss your naproxen dose. If you miss a dose, take it when you remember, with or after food. Do not take double the amount of tablets.

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. Discuss with your doctor if taking naproxen is suitable for you.
Non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen 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. Seek medical attention immediately if you experience symptoms such as:
- chest pain
- shortness of breath or trouble breathing
- sudden weakness or numbness in one part or side of the body
- sudden slurred speech.
Some medicines contain NSAIDs, including those used for colds, flu, so always read the labels and avoid taking multiple medicines that contain NSAIDs.

Possible side effects

Like all medicines, naproxen can cause side effects, although not everyone gets them. Often side effects improve as your body adjusts to the new medicine.

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 while taking naproxen. This can increase your risk of side effects.
Taking NSAIDs together with medicines called ACE inhibitors and diuretics (water pills) can be harmful to your kidneys. If you are taking ACE inhibitors 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 diuretics are furosemide, bumetanide, bendroflumethiazide, chlortalidone, indapamide and metolazone.
Read more: The triple whammy SafeRx

Learn more

The following links provide further information about naproxen.

Medsafe Consumer Information Sheets:

Naprosyn SR Modified release tablet

Naxen

Noflam

New Zealand Formulary Patient Information: naproxen

Credits: Sandra Ponen, Pharmacist. Reviewed By: Dr J Bycroft. Health Navigator NZ Last reviewed: 31 Jul 2017 Page last updated: 22 Jul 2018

Information for clinicians

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

Medsafe prescriber updates

NSAIDs and risk of cardiovascular events (September 2013)
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 Risk of Cardiovascular Events

NSAIDs and risk of cardiovascular events (September 2013)

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 Risk of Cardiovascular Events

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

Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors (December 2010)
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: Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors

Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors (December 2010)

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: Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors