Prescription naproxen is used to relieve pain, tenderness, swelling, and stiffness caused by osteoarthritis (arthritis caused by a breakdown of the lining of the joints), rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), juvenile arthritis (a form of joint disease in children), and ankylosing spondylitis (arthritis that mainly affects the spine).
Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to relieve pain, inflammation, and fever. It is often prescribed for conditions such as arthritis, muscle pain, menstrual cramps, and headaches. Naproxen works by inhibiting the production of prostaglandins, which are chemicals in the body that promote inflammation, pain, and fever.
Prescription naproxen tablets, extended-release tablets, and suspension are also used to relieve shoulder pain caused by bursitis (inflammation of a fluid-filled sac in the shoulder joint), tendinitis (inflammation of the tissue that connects muscle to bone), gouty arthritis (attacks of joint pain caused by a build-up of certain substances in the joints), and pain from other causes, including menstrual pain (pain that happens before or during a menstrual period).
Nonprescription naproxen is used to reduce fever and to relieve mild pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches, and backaches. Naproxen is in a class of medications called NSAIDs. It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.
What is Naproxen Side Effects ?
Naproxen, like other nonsteroidal anti-inflammatory drugs (NSAIDs), can cause a range of side effects. These may vary in severity, and some may require medical attention if they become serious.
Common Side Effects:
- Stomach pain or discomfort
- Heartburn or indigestion
- Nausea or vomiting
- Constipation or diarrhea
- Dizziness or drowsiness
- Headache
Less Common but More Serious Side Effects:
- Gastrointestinal Problems:
- Stomach ulcers or bleeding: Naproxen can irritate the stomach lining, leading to ulcers, bleeding, or perforation.
- Gastritis: Inflammation of the stomach lining.
- Bloody or black stools: Signs of gastrointestinal bleeding.
- Cardiovascular Issues:
- Increased risk of heart attack or stroke: Especially with long-term use or in individuals with pre-existing heart conditions.
- High blood pressure: Naproxen can elevate blood pressure, particularly when used over extended periods.
- Kidney Problems:
- Reduced kidney function: Naproxen may impair the kidneys’ ability to filter blood, leading to fluid retention and swelling.
- Swelling in hands, feet, or ankles (edema).
- Allergic Reactions:
- Hives or rash
- Difficulty breathing
- Swelling of the face, lips, or throat (angioedema)
- Liver Issues:
- Yellowing of the skin or eyes (jaundice) could be a sign of liver damage.
- Unusual fatigue or dark urine.
- Hematologic Issues:
- Anemia: Naproxen may cause a drop in red blood cell count, leading to fatigue, weakness, or pale skin.
- Easy bruising or bleeding: Caused by reduced clotting ability.
Who Should Be Cautious?
- People with pre-existing heart conditions, stomach ulcers, or kidney disease should use naproxen cautiously.
- Those who are pregnant (especially in the third trimester) or breastfeeding should consult a healthcare provider before use.
If you experience any of the serious side effects, seek immediate medical attention. It’s also recommended to take naproxen with food or an antacid to reduce the risk of stomach irritation.
Warnings of Taking Naproxen
When taking naproxen, it is important to be aware of certain warnings and precautions to minimize risks and avoid serious side effects. These warnings are especially important for people with certain pre-existing conditions or those taking naproxen over extended periods.
Key Warnings of Naproxen:
1. Cardiovascular Risk
- Increased risk of heart attack and stroke: Naproxen, like other NSAIDs, can elevate the risk of serious cardiovascular events, such as heart attack or stroke. This risk may be higher in people with pre-existing heart conditions or those taking the medication for extended periods.
- Use in the aftermath of heart surgery: Naproxen should not be used right before or after heart bypass surgery (coronary artery bypass graft or CABG) due to the risk of complications.
2. Gastrointestinal Risk
- Risk of stomach ulcers and bleeding: Long-term use of naproxen can cause serious gastrointestinal issues such as stomach ulcers, bleeding, or perforation (holes in the stomach or intestines). The elderly and people with a history of peptic ulcers or gastrointestinal bleeding are at higher risk.
- Symptoms of GI problems: Watch for signs such as black or bloody stools, vomiting blood, or severe stomach pain, which may indicate gastrointestinal bleeding.
3. Kidney Damage
- Risk of kidney problems: Naproxen can impair kidney function, especially in people with pre-existing kidney conditions or those who are dehydrated. Long-term use increases the likelihood of damage, which can result in swelling (fluid retention), weight gain, or decreased urine output.
4. Liver Damage
- Liver toxicity: Naproxen has been associated with rare cases of liver injury. Symptoms include yellowing of the skin or eyes (jaundice), dark urine, and extreme fatigue. If these symptoms occur, stop the medication and seek medical help.
5. Allergic Reactions
- Severe allergic reactions: Although rare, some individuals may experience serious allergic reactions, including hives, facial swelling, difficulty breathing, or anaphylaxis. If any of these symptoms occur, discontinue use immediately and seek emergency medical help.
6. Hypertension (High Blood Pressure)
- Blood pressure elevation: Naproxen may increase blood pressure, especially in people with pre-existing hypertension. Regular monitoring is recommended, and individuals with uncontrolled blood pressure should use naproxen cautiously.
7. Fluid Retention and Edema
- Swelling and fluid retention: Naproxen can cause fluid retention, leading to swelling in the hands, feet, or ankles. This is especially concerning for people with heart failure or kidney problems.
8. Pregnancy and Breastfeeding
- Avoid during late pregnancy: Naproxen should not be used in the third trimester of pregnancy, as it can cause complications such as premature closure of the ductus arteriosus, a vital fetal blood vessel.
- Breastfeeding: Naproxen can pass into breast milk, so nursing mothers should consult a doctor before taking it.
9. Asthma and Respiratory Problems
- Worsening of asthma symptoms: Naproxen can sometimes trigger asthma symptoms or exacerbate breathing problems in individuals with asthma, especially those who have aspirin-sensitive asthma.
General Precautions:
- Drug interactions: Naproxen can interact with other medications, such as blood thinners (e.g., warfarin), other NSAIDs, corticosteroids, and certain blood pressure medications (e.g., ACE inhibitors, diuretics). Consult with a doctor or pharmacist to avoid harmful interactions.
- Alcohol consumption: Drinking alcohol while taking naproxen can increase the risk of stomach ulcers and gastrointestinal bleeding.
- Long-term use: Prolonged use of naproxen should be avoided unless directed by a healthcare provider. Long-term use increases the risk of many serious side effects, including cardiovascular, gastrointestinal, and kidney issues.
How Should I Take Naproxen?
When taking naproxen, it’s important to follow the instructions given by your healthcare provider or the product label to ensure safe and effective use. Here’s a guide on how to take naproxen properly:
1. Follow the Prescribed Dosage
- Dosage: Naproxen is usually available in doses of 250 mg, 375 mg, and 500 mg. The dosage depends on the condition being treated. Always take the amount prescribed by your doctor, or as directed on the packaging for over-the-counter (OTC) versions like Aleve.
- Adults: The usual recommended dose for pain relief is 250–500 mg twice a day.
- OTC Naproxen (Aleve): Take 220 mg every 8-12 hours, and do not exceed 660 mg in a 24-hour period without medical advice.
- Do not exceed the recommended dose: Taking more than directed can increase the risk of serious side effects.
2. Take Naproxen with Food or Milk
- To prevent stomach upset: Take naproxen with a meal, snack, or a full glass of water or milk. This helps reduce the risk of gastrointestinal side effects such as indigestion, stomach pain, or ulcers.
- Do not lie down immediately after taking it: Stay upright for 10-15 minutes after taking naproxen to avoid irritation of the esophagus.
3. Swallow Tablets Whole
- Do not crush, chew, or break the tablet: Swallow the tablet whole with water. Breaking or crushing the tablet can interfere with its timed-release mechanism and increase the risk of side effects.
4. Stay Hydrated
- Drink plenty of fluids: Naproxen can affect kidney function, especially when the body is dehydrated. Drinking sufficient water helps maintain kidney health during treatment.
5. Use Naproxen Only for Short-Term Relief
- Limit use for temporary pain relief: For OTC naproxen (Aleve), avoid using it for longer than 10 days unless advised by your doctor. For chronic conditions like arthritis, your doctor may recommend long-term use but will likely monitor you for side effects.
6. Do Not Mix with Other NSAIDs
- Avoid combining naproxen with other NSAIDs: Do not take naproxen alongside other nonsteroidal anti-inflammatory drugs like ibuprofen, aspirin, or diclofenac unless advised by a healthcare provider. This increases the risk of stomach ulcers, bleeding, and kidney problems.
7. Monitor for Side Effects
- Be aware of potential side effects like stomach pain, nausea, dizziness, unusual bleeding or bruising, or allergic reactions (such as hives or difficulty breathing). Seek medical attention if any serious side effects occur.
8. Be Consistent with Timing
- If prescribed for chronic conditions (e.g., arthritis), take naproxen at the same time(s) each day to maintain a steady level of the drug in your body. If you miss a dose, take it as soon as you remember, unless it’s close to your next scheduled dose.
9. Limit Alcohol Consumption
- Avoid drinking alcohol: Alcohol can increase the risk of stomach bleeding or ulcers when combined with naproxen. Limit alcohol intake while taking this medication.
10. Discuss Drug Interactions with Your Doctor
- Talk to your healthcare provider if you are taking other medications, especially:
- Blood thinners (warfarin, aspirin)
- Blood pressure medications
- Corticosteroids (e.g., prednisone)
- Other NSAIDs or aspirin
What Happens if I Overdose Naproxen ?
Overdosing on naproxen can lead to serious health consequences, requiring immediate medical attention. The effects can range from mild to life-threatening, depending on the amount taken, the duration of the overdose, and individual health factors.
Symptoms of Naproxen Overdose:
- Gastrointestinal Symptoms:
- Severe stomach pain or cramping
- Nausea and vomiting (possibly with blood)
- Indigestion or heartburn
- Diarrhea
- Gastrointestinal bleeding: Signs include black, tarry stools or vomiting blood (may resemble coffee grounds).
- Kidney Damage:
- Decreased or no urine output
- Swelling in hands, feet, or ankles (fluid retention)
- Fatigue and confusion due to impaired kidney function.
- Cardiovascular Issues:
- Chest pain
- Shortness of breath
- Rapid or irregular heart rate
- High blood pressure
- Heart attack or stroke (in severe cases, especially with large overdoses).
- Central Nervous System Effects:
- Drowsiness or extreme fatigue
- Dizziness or lightheadedness
- Headache
- Confusion or disorientation
- Seizures (in severe cases)
- Loss of consciousness or coma (in extreme overdose cases).
- Liver Damage:
- Yellowing of the skin or eyes (jaundice)
- Dark urine and pale stools
- Severe tiredness or weakness
- Respiratory Problems:
- Difficulty breathing or wheezing
- Shallow or slowed breathing
What to Do in Case of Naproxen Overdose:
- Seek Immediate Medical Attention:
- Call emergency services or go to the nearest emergency room right away if an overdose is suspected. Early intervention can reduce the risk of severe complications.
- Do Not Induce Vomiting unless instructed by medical personnel.
- Activated Charcoal: In a hospital setting, doctors may administer activated charcoal to absorb the drug if the overdose was recent.
- Stomach Pumping (Gastric Lavage): In cases of large overdoses, doctors may perform gastric lavage to empty the stomach of the drug.
- Supportive Care:
- IV fluids to prevent dehydration and maintain blood pressure.
- Medications to treat symptoms such as seizures, blood pressure irregularities, or kidney failure.
- Monitoring of vital signs, kidney function, and heart activity.
Long-Term Effects of Overdose:
Even if treated, a naproxen overdose can result in long-term damage, especially to the kidneys, liver, or gastrointestinal system. Kidney damage, in particular, may lead to chronic kidney disease (CKD) or require dialysis in severe cases.
Prevention:
- Always follow prescribed dosages and avoid taking more than the recommended amount.
- Keep track of the timing and dose if taking naproxen regularly, especially in chronic conditions like arthritis.
- Store naproxen out of reach of children to prevent accidental ingestion.
If you suspect an overdose or are experiencing symptoms after taking more than the recommended dose of naproxen, it’s crucial to act quickly to prevent life-threatening complications.
What Other Drugs Will Affect Naproxen?
Naproxen can interact with a variety of other drugs, which may increase the risk of side effects or reduce the effectiveness of either naproxen or the other medications. It’s important to inform your healthcare provider about all the medications, supplements, and over-the-counter products you are taking to avoid harmful interactions.
Common Drug Interactions with Naproxen:
1. Other Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- Ibuprofen, aspirin, diclofenac, and celecoxib: Taking naproxen alongside other NSAIDs increases the risk of gastrointestinal bleeding, ulcers, and kidney problems.
- Aspirin for Heart Protection: If you are taking low-dose aspirin for heart protection, consult your doctor, as naproxen can reduce aspirin’s effectiveness while increasing the risk of side effects.
2. Anticoagulants (Blood Thinners)
- Warfarin (Coumadin): Naproxen can increase the risk of bleeding when taken with blood thinners like warfarin. This combination should be closely monitored by a healthcare provider.
- Heparin, dabigatran (Pradaxa), rivaroxaban (Xarelto), and other blood thinners: The risk of serious bleeding is heightened when combined with naproxen.
3. Corticosteroids
- Prednisone, methylprednisolone, and other corticosteroids: These drugs also increase the risk of gastrointestinal bleeding or ulcers when used with naproxen.
4. Blood Pressure Medications
- ACE Inhibitors (e.g., lisinopril, enalapril), ARBs (e.g., losartan, valsartan), and beta-blockers (e.g., metoprolol, propranolol):
- NSAIDs like naproxen may reduce the effectiveness of these blood pressure medications and increase the risk of kidney damage, particularly in people with existing kidney problems.
- Diuretics (Water Pills): Naproxen can reduce the efficacy of diuretics like furosemide (Lasix) and hydrochlorothiazide, and increase the risk of kidney issues.
5. Antidepressants
- Selective Serotonin Reuptake Inhibitors (SSRIs): Medications like sertraline (Zoloft), fluoxetine (Prozac), and citalopram (Celexa) may increase the risk of gastrointestinal bleeding when taken with naproxen.
- SNRIs (e.g., venlafaxine, duloxetine) may also increase the risk of bleeding.
6. Lithium
- Naproxen can increase lithium levels, leading to potential lithium toxicity, as NSAIDs decrease the kidneys’ ability to eliminate lithium from the body. Symptoms of lithium toxicity include tremors, confusion, and kidney issues.
7. Methotrexate
- Methotrexate (used to treat cancer or autoimmune diseases): Naproxen may reduce the body’s ability to clear methotrexate, leading to increased risk of methotrexate toxicity, which can cause bone marrow suppression and kidney damage.
8. Digoxin
- Digoxin (used for heart conditions): Naproxen can increase the concentration of digoxin in the blood, increasing the risk of digoxin toxicity. Symptoms include nausea, vomiting, and heart rhythm problems.
9. Antacids
- Antacids containing magnesium or aluminum: These can reduce the absorption of naproxen, making it less effective. If you take antacids, space them out from naproxen by at least a couple of hours.
10. Cyclosporine
- Cyclosporine (used in organ transplants or autoimmune diseases): Combining cyclosporine with naproxen increases the risk of kidney damage due to the compounded effect on the kidneys.
11. Probenecid
- Probenecid (used to treat gout): This drug may increase the levels of naproxen in your bloodstream, which could heighten the risk of naproxen’s side effects.
12. Alcohol
- Alcohol consumption: Drinking alcohol while taking naproxen increases the risk of stomach ulcers, gastrointestinal bleeding, and liver damage.
Other Medications to Consider:
- Bisphosphonates (e.g., alendronate for osteoporosis): Increased risk of gastrointestinal irritation.
- Phenytoin: Naproxen can increase phenytoin levels, potentially causing toxicity.
- Sulfonylureas (e.g., glipizide or glyburide for diabetes): NSAIDs may increase the effects of sulfonylureas, leading to a risk of low blood sugar (hypoglycemia).
General Recommendations:
- Always inform your healthcare provider about all medications and supplements you’re taking, including over-the-counter products and herbal remedies.
- Monitor for symptoms of drug interactions, such as unusual bleeding, stomach pain, or changes in urine output, and report these to your doctor.
- Do not start or stop any medications without consulting a healthcare provider.
By being aware of potential drug interactions, you can avoid serious complications while using naproxen.