Description

Simple

A painkiller used to treat some types of arthritis, joint inflammation, menstrual pain, and mild to moderate pain.

Clinical

An NSAID used to treat rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, polyarticular juvenile idiopathic arthritis, tendinitis, bursitis, acute gout, primary dysmenorrhea, and mild to moderate pain.

Overview

Naproxen is classified as a nonsteroidal anti-inflammatory dug (NSAID) and was initially approved for prescription use in 1976 and then for over-the-counter (OTC) use in 1994.[3] It can effectively manage acute pain as well as pain related to rheumatic diseases, and has a well studied adverse effect profile.[5] Given it's overall tolerability and effectiveness, naproxen can be considered a first line treatment for a variety of clinical situations requiring analgesia.[5] Naproxen is available in both immediate and delayed release formulations, in combination with sumatriptan to treat migraines, and in combination with esomeprazole to lower the risk of developing gastric ulcers.[12][13][Read more

Pharmacology

Indication

Naproxen is indicated for the management of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, polyarticular juvenile idiopathic arthritis, tendinitis, bursitis, acute gout, primary dysmenorrhea, and for the relief of mild to moderate pain.[ Read more

Pharmacodynamic

Naproxen is an established non-selective NSAID and is useful as an analgesic, anti-inflammatory and antipyretic.[ Read more

Mechanism of action

As with other non-selective NSAIDs, naproxen exerts it's clinical effects by blocking COX-1 and COX-2 enzymes leading to decreased prostaglandin synthesis.[3] Although both enzymes contribute to prost... Read more

Absorption

Naproxen is available as a free acid and sodium salt.[ Read more

Protein binding

Naproxen is highly protein bound with >99% of the drug bound to albumin at therapeutic levels.[12][13]

Volume of distribution

Naproxen has a volume of distribution of 0.16 L/kg.[12][13]

Clearance

Naproxen is cleared at a rate of 0.13 mL/min/kg.[12][13]

Half life

The elimination half-life of naproxen is reported to be 12-17 hours.[3][13]

Route of elimination

After oral administration, about 95% of naproxen and it's metabolites can be recovered in the urine with 66-92% recovered as conjugated metabolite and less than 1% recovered as naproxen or desmethylnaproxen.[ Read more

Toxicity

Although the over-the-counter (OTC) availability of naproxen provides convenience to patients, it also increases the likelihood of overdose.[3] Thankfully, the extent of overdose is typically mild wit... Read more

Adverse Effects

Contraindications

  • Regions: US
  • Patient Conditions:
      • Name: NSAID induced allergic reaction
      • Drugbank Id: DBCOND0121040
  • Regions: US
  • With Therapies:
      • Name: Coronary Artery Bypass Graft Surgery
      • Drugbank Id: DBCOND0032060
  • Regions: US
  • Patient Conditions:
      • Name: Asthma, Aspirin-Induced
      • Drugbank Id: DBCOND0001812
      • Name: Aspirin induced urticaria
      • Drugbank Id: DBCOND0121038
      • Name: Aspirin induced allergic reaction
      • Drugbank Id: DBCOND0121037
  • Regions: US
  • Patient Conditions:
      • Name: NSAID induced urticaria
      • Drugbank Id: DBCOND0121036
  • Regions: US
  • Patient Conditions:
      • Name: NSAID-Induced Asthma
      • Drugbank Id: DBCOND0117585
  • Regions: US
  • Patient Conditions:
      • Name: Hypersensitivity to naproxen
      • Drugbank Id: DBCOND0121035

Food Interactions

  • Take with food. Food reduces GI irritation.

Interactions

Type in a drug name to check for interaction with Naproxen
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  • Paracetamol(acetaminophen)
  • Paxil(paroxetine)
  • Pamelor(nortriptyline)
  • Panadol(acetaminophen)
  • Patanol(olopatadine ophthalmic)
  • Pataday(olopatadine ophthalmic)
  • Parnate(tranylcypromine)
  • Pazeo(olopatadine ophthalmic)
(R)-warfarin
The risk or severity of bleeding and hemorrhage can be increased when Naproxen is combined with (R)-warfarin.
(S)-Warfarin
The risk or severity of bleeding and hemorrhage can be increased when Naproxen is combined with (S)-Warfarin.
1-benzylimidazole
The risk or severity of hypertension can be increased when Naproxen is combined with 1-benzylimidazole.
2,5-Dimethoxy-4-ethylamphetamine
The risk or severity of hypertension can be increased when Naproxen is combined with 2,5-Dimethoxy-4-ethylamphetamine.
2,5-Dimethoxy-4-ethylthioamphetamine
The risk or severity of hypertension can be increased when Naproxen is combined with 2,5-Dimethoxy-4-ethylthioamphetamine.
4-Bromo-2,5-dimethoxyamphetamine
The risk or severity of hypertension can be increased when Naproxen is combined with 4-Bromo-2,5-dimethoxyamphetamine.
4-hydroxycoumarin
The risk or severity of bleeding and hemorrhage can be increased when Naproxen is combined with 4-hydroxycoumarin.
4-Methoxyamphetamine
The risk or severity of hypertension can be increased when Naproxen is combined with 4-Methoxyamphetamine.
5-methoxy-N,N-dimethyltryptamine
The risk or severity of hypertension can be increased when Naproxen is combined with 5-methoxy-N,N-dimethyltryptamine.
6-O-benzylguanine
The metabolism of 6-O-benzylguanine can be decreased when combined with Naproxen.
8-azaguanine
The metabolism of 8-azaguanine can be decreased when combined with Naproxen.
8-chlorotheophylline
The metabolism of 8-chlorotheophylline can be decreased when combined with Naproxen.
9-Deazaguanine
The metabolism of 9-Deazaguanine can be decreased when combined with Naproxen.
9-Methylguanine
The metabolism of 9-Methylguanine can be decreased when combined with Naproxen.
Abacavir
Naproxen may decrease the excretion rate of Abacavir which could result in a higher serum level.
Abatacept
The metabolism of Naproxen can be increased when combined with Abatacept.
Abciximab
The risk or severity of bleeding and hemorrhage can be increased when Naproxen is combined with Abciximab.
Abediterol
The risk or severity of hypertension can be increased when Naproxen is combined with Abediterol.
Abiraterone
The serum concentration of Naproxen can be increased when it is combined with Abiraterone.
Acarbose
Naproxen may decrease the excretion rate of Acarbose which could result in a higher serum level.
16 References
  1. 1 . Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C: Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006 Jun 3;332(7553):1302-8.PubMed: 16740558
  2. 2 . Zhang J, Ding EL, Song Y: Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events: meta-analysis of randomized trials. JAMA. 2006 Oct 4;296(13):1619-32. Epub 2006 Sep 12.PubMed: 16968832
  3. 3 . Brutzkus JC, Varacallo M: Naproxen .PubMed: 30247840
  4. 4 . Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J: A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018 Feb 1;9(1):143-150. doi: 10.14336/AD.2017.0306. eCollection 2018 Feb.PubMed: 29392089
  5. 5 . Todd PA, Clissold SP: Naproxen. A reappraisal of its pharmacology, and therapeutic use in rheumatic diseases and pain states. Drugs. 1990 Jul;40(1):91-137. doi: 10.2165/00003495-199040010-00006.PubMed: 2202585
  6. 6 . Davies NM, Anderson KE: Clinical pharmacokinetics of naproxen. Clin Pharmacokinet. 1997 Apr;32(4):268-93. doi: 10.2165/00003088-199732040-00002.PubMed: 9113437
  7. 7 . Falany CN, Strom P, Swedmark S: Sulphation of o-desmethylnaproxen and related compounds by human cytosolic sulfotransferases. Br J Clin Pharmacol. 2005 Dec;60(6):632-40. doi: 10.1111/j.1365-2125.2005.02506.x.PubMed: 16305588
  8. 8 . Bowalgaha K, Elliot DJ, Mackenzie PI, Knights KM, Swedmark S, Miners JO: S-Naproxen and desmethylnaproxen glucuronidation by human liver microsomes and recombinant human UDP-glucuronosyltransferases (UGT): role of UGT2B7 in the elimination of naproxen. Br J Clin Pharmacol. 2005 Oct;60(4):423-33. doi: 10.1111/j.1365-2125.2005.02446.x.PubMed: 16187975
  9. 9 . Tracy TS, Marra C, Wrighton SA, Gonzalez FJ, Korzekwa KR: Involvement of multiple cytochrome P450 isoforms in naproxen O-demethylation. Eur J Clin Pharmacol. 1997;52(4):293-8.PubMed: 9248768
  10. 10 . Ruschitzka F, Borer JS, Krum H, Flammer AJ, Yeomans ND, Libby P, Luscher TF, Solomon DH, Husni ME, Graham DY, Davey DA, Wisniewski LM, Menon V, Fayyad R, Beckerman B, Iorga D, Lincoff AM, Nissen SE: Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial. Eur Heart J. 2017 Nov 21;38(44):3282-3292. doi: 10.1093/eurheartj/ehx508.PubMed: 29020251
  11. 11 . Mellemkjaer L, Blot WJ, Sorensen HT, Thomassen L, McLaughlin JK, Nielsen GL, Olsen JH: Upper gastrointestinal bleeding among users of NSAIDs: a population-based cohort study in Denmark. Br J Clin Pharmacol. 2002 Feb;53(2):173-81. doi: 10.1046/j.0306-5251.2001.01220.x.PubMed: 11851641
  12. 12 . Naprelan FDA Label Link
  13. 13 . Naprosyn FDA Label Link
  14. 14 . Over-the-counter Medications in Pregnancy Link
  15. 15 . Treximet FDA Label Link
  16. 16 . Vimovo FDA Label Link