Naproxen

Naproxen

Naproxen side effects: Brand names include Naprosyn, Aleve, Anaprox, Naprelan and Midol extended release among others. Naproxen is available in 250, 375, and 500 mg capsules/tablets and as a 125 mg/ 5 ml liquid preparation. Note that naproxen is also sold as naproxen sodium and that 250 mg naproxen = 275 mg naproxen sodium. Naproxen sodium is sold over the counter in the US as Aleve and other generic brands in 220 mg doses. Naproxen is a non-steroidal anti-inflammatory medication in a class often referred to as NSAID medications or as NSAIDS. These medications are generally used to treat inflammatory conditions like arthritis (including specifically osteoarthritis, rheumatoid arthritis, Ankylosing spondylitis, acute gouty arthritis} tendinitis, bursitis, and other inflammatory conditions. Naproxen is also used as a pain medication. It is also used specifically to treat dysmenorrhea. Naproxen has antipyretic properties and can be used to lower fever also.

Black Box Warnings: These fall into two categories. Cardiovascular Risks may include increased risk of myocardial infarction, stroke and other thromboembolic events which may increase with longer duration of use. Naproxen is contraindicated in post coronary bypass pain control. Gastrointestinal Risks are more common and also serious and include peptic ulcers and serious or fatal gastrointestinal bleeding or perforation. These GI side effects are more common with prolonged use and use in the elderly but can occur at any time and in patients of any age with no warning or early symptoms.

Common Naproxen Side Effects: The most common side effects of naproxen are shared with most of the NSAID class of medications and are acid dyspepsia, gastritis and peptic ulcer disease along with other GI symptoms like nausea, constipation, abdominal pain and asymptomatic elevation of liver transaminase levels. Allergic reactions including a rash and photosensitivity are fairly common. Ringing in the ears called tinnitus is common. Bruising is sometimes seen, and headache, dizziness and drowsiness are fairly common.

Serious Naproxen Side Effects: Although naproxen is available over the counter without a prescription the list of serious naproxen side effects is impressive, and it is a medication that deserves respect and use with caution. Serious naproxen side effects that are not rare include the whole spectrum of acid dyspeptic disease, them more serious being gastric and duodenal ulcers with bleeding or perforation. Additionally long term naproxen side effects can be serious renal toxicity that can lead to renal failure and the need for dialysis or kidney transplant. Naproxen may be more prone than some of the other NSAID medications to cause sodium retention and exacerbations of congestive heart failure and edema. Serious cardiovascular naproxen side effects can also include serious thromboembolic events like acute myocardial infarction (heart attack), stroke and other blood clots. Serious allergic skin reactions like Steven’s Johnson Syndrome and toxic epidermal necrolysis can occur. Various serious blood dyscrasias and serious allergic reactions can be naproxen side effects.

Drug Interactions: Naproxen should be avoided with other NSAID medications and the COX2 inhibitors like Celebrex as well as with aspirin. Naproxen can interfere with the efficacy of the ACE inhibitors, the ARB medications, and many blood pressure medications. See the manufacturer’s prescribing guidelines for complete lists of these type of drug interactions and others.  For specific drug to drug interaction concerns consult your pharmacist or physician. Bleeding from warfarin use can be much more severe in cases of gastrointestinal bleeding complications of naproxen use, and concurrent use is usually avoided. The list of potential drug interactions is extensive.  Especially significant is the reduction in efficacy of the angiotensin converting enzyme inhibitors and the angiotensin receptor blocker groups of antihypertensive medications at blood pressure reduction when naproxen is uses for patients on these drugs.

Unusual Naproxen Side Effects: The sodium retention naproxen side effect is common to most of the NSAID class of medications, but seems to be more dramatic with naproxen than most of the others in the class.

Naproxen use in Pregnancy and Lactation: Pregnancy category C, considered possibly unsafe in lactation.

Monitoring: Your health care provider may want to monitor your blood count or kidney function for longer term use, especially if you are over age 65.

Special considerations: Avoid excessive alcohol while taking naproxen as alcohol can increase the chances of gastrointestinal bleeding from naproxen, and if you have an allergy to aspirin or other NSAIDs you should not take naproxen because the allergy is often associated with naproxen allergy.  Naproxen side effects in general are similar to ibuprofen side effects.

Naproxen has recently been combined with Nexium as Vimovo.  This combination is specifically designed to avoid the gastrointestinal side effects of naproxen, while only using one pill.  The biggest issue with Vimovo is cost.  Duexis is the latest of this type of combination pill, combining famotitine and ibuprofen.  Some patients use either a PPI or a medication like famotidine or ranitidine with their NSAID to prevent ulcers or acid dyspeptic symptoms.

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