naproxen

naproxen

(na prox' en)

naproxen

Apo-Naproxen (CAN), Apo-Naproxen SR (CAN), EC-Naprosyn, Naprelan, Naprosyn, Naxen (CAN), Novo-Naprox (CAN)

naproxen sodium

Aleve, Anaprox, Anaprox DS, Apo-Napro-Na (CAN)

Pregnancy Category B (first and second trimesters)

Pregnancy Category D (third trimester)

Drug classes

NSAID

Analgesic (nonopioid)

Therapeutic actions

Analgesic, anti-inflammatory, and antipyretic activities largely related to inhibition of prostaglandin synthesis; exact mechanisms of action are not known.

Indications

·        Mild to moderate pain

·        Treatment of primary dysmenorrhea, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendinitis, bursitis, acute gout

·        OTC use: Temporary relief of minor aches and pains associated with the common cold, headache, toothache, muscular aches, backache, minor pain of arthritis, pain of menstrual cramps, reduction of fever

·        Treatment of juvenile arthritis (Naproxen)

Contraindications and cautions

·        Contraindicated with allergy to naproxen, salicylates, other NSAIDs; pregnancy; lactation.

·        Use cautiously with asthma, chronic urticaria, CV dysfunction; hypertension; GI bleeding; peptic ulcer; impaired hepatic or renal function.

Available forms

Tablets—250, 375, 500 mg; 220, 275, 500 mg (as naproxen sodium); DR tablets—375, 500 mg; CR tablets—375, 500 mg; suspension—125 mg/5 mL

Dosages

Do not exceed 1,250 mg/day (1,375 mg/day naproxen sodium).

ADULTS

·        Rheumatoid arthritis or osteoarthritis, ankylosing spondylitis:

Delayed-release (EC-Naprosyn)

375–500 mg PO bid.

Controlled-release (Naprelan)

750–1,000 mg PO daily as a single dose.

Naproxen sodium

275–550 mg bid PO. May increase to 1.65 g/day for a limited period.

Naproxen tablets

250–500 mg PO bid.

Naproxen suspension

250 mg (10 mL), 375 mg (15 mL), 500 mg (20 mL) PO bid.

·        Acute gout:

Controlled-release (Naprelan)

1,000–1,500 mg PO daily as a single dose.

Naproxen sodium

825 mg PO followed by 275 mg q 8 hr until the attack subsides.

·        Acute gout:

Naproxen

750 mg, followed by 250 mg q 8 hr until attack subsides.

·        Mild to moderate pain:

Controlled-release (Naprelan)

1,000 mg PO daily as a single dose.

Naproxen sodium

550 mg PO followed by 275 mg q 6–8 hr.

·        Mild to moderate pain:
500 mg followed by 500 mg q 12 hr or 250 mg q 6–8 hr.

OTC

200 mg PO q 8–12 hr with a full glass of liquid while symptoms persist. Do not exceed 600 mg in 24 hr.

PEDIATRIC PATIENTS

·        Juvenile arthritis:

Naproxen

10 mg/kg/day given in two divided doses.

Naproxen sodium

Safety and efficacy not established.

OTC

Do not give to children < 12 yr unless under advice of physician.

GERIATRIC PATIENTS

Do not take > 200 mg q 12 hr PO.

Pharmacokinetics

Drug	Onset	Peak	Duration
Naproxen	1 hr	2–4 hr	< 7 hr
Naproxen sodium	1 hr	1–2 hr	< 7 hr

Metabolism: Hepatic; T_1/2: 12–15 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Urine

Adverse effects

·        CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthalmic effects

·        Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis

·        GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence

·        GU: Dysuria, renal impairment, including renal failure, interstitial nephritis, hematuria

·        Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis,granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression, menorrhagia

·        Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis

·        Other: Peripheral edema, anaphylactoid reactions to anaphylactic shock

Interactions

Drug-drug

·        Increased serum lithium levels and risk of toxicity with naproxen

Drug-lab test

·        Falsely increased values for urinary 17-ketogenic steroids; discontinue naproxen therapy for 72 hr before adrenal function tests

·        Inaccurate measurement of urinary 5-hydroxyindoleacetic acid

Nursing considerations

Assessment

·        History: Allergy to naproxen, salicylates, other NSAIDs; asthma, chronic urticaria, CV dysfunction; hypertension; GI bleeding; peptic ulcer; impaired hepatic or renal function; pregnancy; lactation

·        Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric evaluation, peripheral sensation; P, BP, edema; R, adventitious sounds; liver evaluation; CBC, clotting times, LFTs, renal function tests; serum electrolytes; stool guaiac

Interventions

·        Give with food or after meals if GI upset occurs.

·        Arrange for periodic ophthalmologic examination during long-term therapy.

·        WARNING: If overdose occurs, institute emergency procedures—gastric lavage, induction of emesis, supportive therapy.

Teaching points

·        Take drug with food or meals if GI upset occurs; take only the prescribed dosage.

·        Dizziness, drowsiness can occur (avoid driving or the use of dangerous machinery).

·        Report sore throat; fever; rash; itching; weight gain; swelling in ankles or fingers; changes in vision; black, tarry stools.

Adverse effects in Italic are most common; those in Bold are life-threatening.