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Medical News Today: What to know about naproxen

People usually use the drug naproxen to relieve pain and swelling, but it can also help treat fever.

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). Naproxen is available by prescription, or people can purchase lower-strengths forms over the counter.

In this article, we provide an overview of naproxen, including how it works, its uses, and the potential side effects, warnings, and interactions.

What is naproxen?

Bottle of Aleve which is Naproxen
A person can take naproxen for rheumatoid arthritis, osteoarthritis, and dental pain.

Naproxen is a pain medication that relieves inflammation and joint stiffness. Other NSAIDs in the same medication class include acetylsalicylic acid, diclofenac, ibuprofen, and meloxicam.

Naproxen works by blocking the enzyme that produces prostaglandins. Prostaglandins play an essential role in inflammation. The body produces them at the site of injured tissue, and they cause redness, heat, swelling, and pain.

Naproxen is available as naproxen or naproxen sodium. The major difference between naproxen and naproxen sodium is that naproxen sodium is more rapidly absorbed.

The body reaches peak levels of naproxen in 2–4 hours and naproxen sodium in 1–2 hours, meaning that it absorbs naproxen sodium faster than regular naproxen.

Uses

People use naproxen for the following conditions:

Brand names

In the United States, over-the-counter (OTC) naproxen is called Aleve. Prescription naproxen is known as Naprosyn and Anaprox.

Naproxen is available for purchase in drug stores, or people can choose between brands online.

Ingredients

There are various types and strengths of naproxen. Regular naproxen tablets contain 250 milligrams (mg), 375 mg, or 500 mg of naproxen.

Fast-absorbing naproxen sodium is available in 220 mg OTC capsules and tablets, and 275 mg and 550 mg tablets by prescription. Low-dose naproxen is available in tablet or capsule form.

Children and people who have difficulty swallowing tablets can use naproxen suspension. Naproxen suspension contains 25 mg of the drug per milliliter (ml).

The following table lists the inactive ingredients in regular naproxen, naproxen sodium, and naproxen suspension. People who have allergies or intolerances to any inactive ingredients should avoid using naproxen.

Naproxen Naproxen sodium Naproxen suspension
  • microcrystalline cellulose
  • croscarmellose sodium
  • povidone
  • magnesium stearate
  • iron oxide
  • microcrystalline cellulose
  • croscarmellose sodium
  • povidone
  • magnesium stearate
  • colloidal silicon dioxide
  • talc
  • methylparaben
  • fumaric acid
  • magnesium aluminum silicate
  • sodium chloride
  • sorbitol solution 70%
  • sucrose
  • flavor
  • FD&C Yellow No. 6

Naproxen is also available in enteric-coated tablets. These tablets release naproxen in the intestine rather than in the stomach. This formulation helps prevent gastrointestinal side effects that manufacturers have sometimes associated with naproxen. Similarly to regular naproxen, enteric-coated tablets come in tablets of 250 mg, 375 mg, and 500 mg.

Dosage and forms

naproxen tablets in a container
A person should take naproxen at the lowest effective dose for the shortest duration.

Naproxen is available as tablets, liquid capsules, and in a liquid form.

The dose of naproxen that a person requires depends on why they are using the medication. A general rule is to use the lowest effective dose for the shortest possible duration. This dosing helps prevent side effects from occurring.

Doctors advise people to take naproxen and other NSAIDs with food to prevent gastrointestinal side effects.

Mild to moderate pain

For fever and mild to moderate pain, adults between 12 and 65 years old can take one 220 mg tablet of naproxen every 12 hours. Children under 12 years old should not take naproxen unless their doctor recommends it.

Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis

People can manage the symptoms of osteoarthritis, which is commonly known as arthritis, rheumatoid arthritis, and ankylosing spondylitis with a dose of 220 mg to 550 mg of naproxen every 12 hours. Naproxen does not cure these conditions but offers relief from pain and inflammation.

Acute gout attacks

People with experience acute gout attacks may take 825 mg for one dose, followed by 275 mg every 8 hours.

Juvenile rheumatoid arthritis

Doctors can prescribe naproxen to manage the pain and inflammation caused by juvenile rheumatoid arthritis. People can administer the liquid suspension of naproxen to children 2 years old and older. The recommended dose is 10 mg per kilogram (kg), or mg/kg divided into two doses 12 hours apart.

Headaches

Using naproxen to relieve pain from headaches and migraine headaches is controversial.

People can try taking 550 mg of naproxen sodium every 12 hours and may increase it to 825 mg if needed. The daily dose should not exceed 1,375 mg.

Naproxen sodium is degraded more slowly than regular naproxen and other NSAIDs. This means that naproxen sodium should remain active for longer than other anti-inflammatory drugs.

However, after 2 hours, headache pain relief is lower with naproxen sodium than with other NSAIDs.

Although naproxen can be used to reduce the pain of headaches and migraine headaches, other NSAIDs may provide better relief.

Maximum recommended daily dose

People should only use OTC naproxen for a short-term period of between 3–5 days for pain and no more than 3 days for fever. If they need ongoing treatment, people should consult their doctor first.

For children between 2–12 years old, the maximum daily dose by weight is 20 mg/kg. They should not be taking more than 1,000 mg in 24 hours.

When OTC medications, children 12 years and older should not take more than 660 mg in 24 hours.

Studies have not shown any benefit in using daily doses higher than 1,000 mg, but some sources suggest a maximum of 1,650 mg per day for up to 6 months for arthritis.

Side effects

woman with a headache which is a possible side effect of naproxen
Common side effects of naproxen may include headache and dizziness.

The frequency and severity of side effects that naproxen causes depend on several factors.

Considerations include the dose and duration of treatment, other medical diagnoses a person may have, and individual risk factors.

The following sections discuss the common and serious side effects of naproxen.

Common side effects

The following table from the naproxen monograph lists the most common side effects grouped by body system. The side effects in this table occur in approximately 3 to 9 percent of people.

Body system Side effect
Gastrointestinal tract Heartburn, constipation, abdominal pain, nausea
Central nervous system Headache, dizziness, drowsiness, depression, fatigue
Skin Itchy skin, ecchymoses, skin eruptions
Cardiovascular system Dyspnea, peripheral oedema
Senses Ringing in the ear

Serious side effects

Although people can buy low-dose naproxen without a prescription, it is not safe for everyone.

People with serious heart conditions, such as heart disease, cerebrovascular disease, and congestive heart failure, may experience severe side effects from taking naproxen.

Severe side effects of naproxen include:

People with high blood pressure should only take naproxen cautiously.

Naproxen can cause sodium retention in the kidneys, which can result in increased blood pressure. A person with high blood pressure should consult their doctor before taking naproxen.

Gastrointestinal side effects of taking naproxen can be severe. Bleeding in the stomach, the formation of ulcers, and stomach or intestinal blockages can occur when taking naproxen. Most often, older adults are the most vulnerable age group for gastrointestinal side effects.

People who have a history of ulcers or gastrointestinal bleeding have a 10-fold higher risk for developing a bleed when taking naproxen. For these individuals, even short-term treatment can be risky.

Interactions

Naproxen may interact with several prescription and nonprescription drugs. Drinking alcohol and taking naproxen may increase the risk of gastrointestinal side effects.

Selective serotonin reuptake inhibitors

People taking the antidepressant class of selective serotonin reuptake inhibitors (SSRIs) have an increased risk of gastrointestinal bleeding and ulcers when taking naproxen. SSRIs include:

  • citalopram
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • paroxetine
  • sertraline
  • vortioxetine

Oral steroids

Oral steroids, such as prednisone and antiplatelet drugs, may also increase stomach and intestinal bleeding and ulceration if people combine them with naproxen.

Blood thinners

Naproxen blocks the aggregation of platelets, which is an essential step in blood clotting. Blocking the aggregation of platelets can increase the time it takes for bleeding to stop.

People must talk to a doctor before combining naproxen with blood thinners, such as antiplatelet and anticoagulant medications.

Pregnancy and breastfeeding

Women should avoid taking naproxen in the third trimester of pregnancy.

NSAIDs can prevent the body from producing prostaglandin, which may affect pregnancy. Taking naproxen during the third trimester of pregnancy may cause heart malformations in the fetus.

Also, nursing babies may experience serious side effects if the mother is taking naproxen. Doctors do not recommend naproxen for women who are breastfeeding.

Warnings and what to consider before taking naproxen

If a person has a history of an allergy or intolerance to any NSAID, they should not take naproxen. Cross-allergies and intolerances may occur between NSAIDs.

Aspirin-induced asthma

One type of intolerance to NSAIDs is aspirin-induced asthma. Asthma symptoms and severe allergic reactions may occur when affected individuals take aspirin. These people should avoid naproxen and all other NSAIDs because of the risk of developing severe side effects.

Pregnancy

During the first two trimesters of pregnancy, women should use naproxen cautiously. Once the pregnancy enters the third trimester, they must avoid taking naproxen. Naproxen may be present in breast milk, which can cause serious side effects for an infant.

Drug interactions

People should not combine certain antidepressants, high blood pressure, and blood thinners with naproxen.

Medical conditions

Certain diagnoses may increase the likelihood of experiencing side effects, such as heart disease, ulcers, and kidney disease.

Age

Children under 12 years old should avoid using naproxen unless a doctor prescribes the medication.

Summary

Naproxen is a prescription and nonprescription NSAID. People can use it to relieve pain that inflammation causes.

Naproxen is not safe for everyone. People taking certain medications should use naproxen cautiously to avoid side effects. People with stomach or intestinal diseases, cardiac disease, or kidney disease should discuss the use of NSAIDs with their doctor.

Naproxen can also be dangerous during pregnancy and breastfeeding.

At the appropriate dose, naproxen is a safe and effective pain reliever.