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Naproxen: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on July 26, 2021.

1. How it works

  • Naproxen may be used to treat various pain or inflammatory conditions.
  • Naproxen helps relieve pain and inflammation and works by blocking the effects of cyclooxygenase (COX) enzymes. This prevents prostaglandin synthesis (prostaglandins elevate body temperature and make nerve endings more sensitive to pain transmission).
  • Naproxen belongs to a group of medicines known as NSAIDs (nonsteroidal anti-inflammatory drugs).

2. Upsides

  • Effective for the relief of pain and inflammation associated with arthritis, gout, menstruation, and tendonitis.
  • NSAIDs (including naproxen) are considered first-line options for mild-to-moderate acute pain because at correct dosages they are effective, do not cause dependence, and are readily available at a low cost.
  • Generic naproxen is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Stomach-related side effects including indigestion, heartburn, and bleeding. People of older age, taking other medicines that affect the stomach, or who drink more than 3 glasses of alcohol per day may be more at risk. Naproxen is considered to have an intermediate potential for stomach-related side effects compared with other NSAIDs.
  • Most NSAIDs have been associated with an increased risk of stroke or heart attack. The risk may be higher in patients with preexisting cardiovascular conditions and with higher dosages.
  • May not be suitable for some people including those with kidney disease, a history of stomach ulcers or other gastrointestinal disorders, with pre-existing cardiovascular disease, or following coronary artery bypass graft surgery.
  • May interact with some other medicines such as warfarin, SSRIs, ACE inhibitors, and diuretics.
  • NSAIDs, such as naproxen, should not be used during the last three months of pregnancy because they can cause premature closure of the fetal ductus arteriosus. In addition, the use of NSAIDs at around 20 weeks gestation or later in pregnancy may cause fetal kidney problems leading to oligohydramnios (low amniotic fluid volume) and in some cases kidney impairment. If NSAID treatment is deemed necessary between 20 and 30 weeks of pregnancy, use the lowest effective dose for the shortest possible time. Avoid NSAIDs after 30 weeks gestation.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Naproxen is effective for the short-term relief of pain and inflammation associated with arthritis, gout, menstruation, and tendonitis; however, like other NSAIDs, it has the potential to adversely affect the stomach or heart and increase bleeding tendency. It should not be used from week 20 of pregnancy.

5. Tips

  • Take with food to reduce stomach-related adverse effects.
  • Slow-release, extended-release, or enteric-coated tablets should be swallowed whole, not crushed or chewed.
  • Use the lowest effective dose for the shortest duration of time.
  • The recommended dosage of naproxen may vary depending on the brand being taken. Do not assume that one brand has the same dose as another. Always check the dosage instructions on the label. Also, some brands may take slightly longer to start working than others.
  • Twice daily dosing is recommended; more frequent dosing does not necessarily improve the response to naproxen.
  • Morning and evening dosages do not have to be equal in size.
  • If you are taking naproxen and find it is not working very well for you, you may like to try a different NSAID.
  • NSAIDs should not be used in the last 3 months of pregnancy; always ask your doctor before using any medication during pregnancy.
  • Avoid naproxen if you have a history of asthma or hives after taking aspirin or any other NSAIDs, like ibuprofen.
  • Do not use this medicine in the setting of heart bypass surgery (coronary artery bypass graft, or CABG).
  • See a doctor immediately if you experience any difficulty with breathing, unexplained sickness or fatigue, loss of appetite, vision changes, fluid retention, or abnormal bleeding.
  • NSAIDs, such as naproxen, should not be used in the last 3 months of pregnancy; always ask your doctor before using any medication during pregnancy. Do not use NSAIDs such as naproxen between 20 and 30 weeks gestation without your doctor's advice because this may cause kidney problems and low amniotic fluid volumes in the newborn. Acetaminophen may be considered to treat pain and inflammation during pregnancy.

6. Response and effectiveness

  • Time to peak concentrations varies with different formulations but ranges from 1-4 hours. Pain-relieving effects last for approximately 12 hours.

7. Interactions

Medicines that interact with naproxen may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with naproxen. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with naproxen include:

  • ACE inhibitors or ARBs, such as captopril, enalapril, or losartan
  • antibiotics, such as ciprofloxacin or vancomycin
  • anticoagulants (blood thinners) such as apixaban, dabigatran, fondaparinux, heparin, or warfarin
  • antidepressants, such as citalopram, escitalopram, fluoxetine, or paroxetine
  • antifungals, such as voriconazole
  • antiplatelets, such as clopidogrel or ticagrelor
  • beta-blockers, such as acebutolol, atenolol, bisoprolol, or carvedilol
  • bisphosphonates, such as alendronate
  • corticosteroids, such as dexamethasone or prednisone
  • digoxin
  • diuretics (water pills), such as chlorthalidone, chlorothiazide, hydrochlorothiazide (HCTZ), or furosemide
  • glucagon
  • haloperidol
  • HIV medications (eg, Stribild, tenofovir)
  • metformin
  • other nonsteroidal anti-inflammatories (NSAIDs), such as celecoxib, diclofenac, etodolac, ibuprofen, ketorolac, meloxicam, or nabumetone
  • sulfonylureas (a type of diabetes medication), such as glimepiride, glyburide, or glipizide
  • supplements, such as glucosamine, omega-3 fatty acids, vitamin E
  • others, such as cyclosporine, lithium, methotrexate, pemetrexed, pirfenidone, or tacrolimus.

Drinking alcohol while taking naproxen may increase the risk of gastrointestinal-related side effects or kidney damage.

Note that this list is not all-inclusive and includes only common medications that may interact with naproxen. You should refer to the prescribing information for naproxen for a complete list of interactions.

References

Naproxen. Revised 04/2021. Canton Laboratories. https://www.drugs.com/pro/naprosyn.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use naproxen only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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