ü Naproxen is a Non-Steroidal Anti-inflammatory drug (NSAID) and is available as an OTC analgesic drug.
ü Naproxen is commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions including migraine, osteoarthritis, kidney stones, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, menstrual cramps, tendinitis and bursitis.
ü Concomitant use of Ketorolac and Naproxen is contraindicated due to cumulative risks of inducing serious NSAID-related adverse events (peptic ulcers, gastrointestinal bleeding and/or perforation).
ü Bleeding risk is elevated by the coadministration of Naproxen with drugs such as Warfarin, Heparin, Low Molecular Weight Heparins (LMWHs) (Enoxaparin, Dalteparin, Tinzaparin, etc.), Coumarins and other anticoagulants (Acenocoumarol, Dicumarol, Phenprocoumon, Dabigatran, Anisindione, Phenindione), Direct thrombin inhibitors (Dabigatran, Desirudin, Lepirudin, Bivalirudin, Argatroban), Direct factor Xa inhibitors (Apixaban, Rivaroxaban), Antiplatelets (Clopidogrel, Aspirin, Prasugrel, Ticagrelor, Ticlopidine, Dipyridamole, Abciximab, Eptifibatide, Tirofiban), Danaparoid, Fondaparinux, Selective serotonin reuptake inhibitors (SSRIs) (Escitalopram, Fluvoxamine, Paroxetine, Vortioxetine, Sertraline, Nefazodone, vilazodone), Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) (Venlafaxine, Desvenlafaxine, Duloxetine, Milnacipran, Levomilnacipran, Sibutramine), Cilostazol, Protein C, Pentoxyfilline, Ginkgo, Meadowsweet, Erlotinib and Gossypol.
ü Plasma concentration of Naproxen is reduced by the administration of drugs such as Dabrafenib and Elvitegravir which induce the CYP2C9 mediated Naproxen metabolism.
ü The drugs like Mifepristone and Sulfamethoxazole elevated plasma levels of Naproxen by inhibiting CYP2C9 mediated Naproxen metabolism.
ü Use of Naproxen in patients taking ACE Inhibitors (Captopril, Enalapril, Imidapril, Temocapril, Delapril, Ramipril, Perindopril, Cilazapril), Angiotensin II receptor blockers (ARBs) (Losartan, Valsartan, Telmisartan), Beta adrenergic blockers, Calcium Channel Blockers, Thiazide Diuretics and Loop Diuretics may decrease the antihypertensive effects by decreasing renal prostaglandin production.
ü Naproxen can decrease the renal prostaglandin synthesis and increase the toxicity of Cyclosporine, Tacrolimus and Lithium.
ü The toxicity of Methotrexate, Pralatrexate and Premetrexed may be elevated by the concomitant use of Naproxen, due to decreased clearance.
ü Concomitant use of Naproxen and Fluoroquinolones (Ofloxacin, Levofloxacin, Norfloxacin) may elevate the risk of seizures.
ü Tobacco smoke contains Polycyclic aromatic hydrocarbons (PAHs) which can stimulate CYP1A2-mediated metabolism of Naproxen and reduce its plasma concentration.
ü Due to the risk of earlier closure of ductus arteriosus, Naproxen should be avoided after 30 weeks of gestation in Pregnant women.
ü Patients should thoroughly read the labels of all over-the-counter and prescription medicines.
ü Patients should talk to their doctor or pharmacist before taking any new prescription or over the counter medication.
ü Physicians should be aware of potential drug interactions with OTC medicines when prescribing new medications.
ü Pharmacists can be instrumental in assisting patients with using OTC medications safely and effectively.
ü Pharmacists should warn consumers of the risks of misusing OTC pain relievers.
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