Naproxen

Naproxen is a non-steroidal anti-inflammatory drug (nsaid) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

Naproxen is used for pain and inflammation in conditions such as:

• Osteoarthritis, rheumatoid arthritis and ankylosing spondylitis
• Acute gout attacks
• Back pain, neck pain and muscle strain
• Period (menstrual) pain — one of the most effective options
• Headache and migraine attacks
• Dental pain and pain after minor procedures
• Tendonitis, bursitis and sports injuries

It relieves symptoms; the underlying disease still needs diagnosis and treatment by a doctor, especially if pain keeps returning.

The usual adult dose of Naproxen is 250–500 mg twice daily (morning and evening), taken with or immediately after food and a full glass of water. For period pain or acute pain, doctors often advise 500 mg first, then 250 mg every 6–8 hours as needed. The usual maximum is 1000 mg per day (short-term up to 1250 mg only on medical advice).

• Use the lowest effective dose for the shortest time
• Elderly patients and those with kidney problems need lower doses
• Not for children unless a doctor specifically prescribes it

Your doctor decides the exact dose and duration for your condition.

Common side effects of Naproxen include:

• Heartburn, stomach pain, nausea, constipation or diarrhoea
• Headache, dizziness or drowsiness
• Ringing in the ears (tinnitus) at higher doses
• Fluid retention and mild rise in blood pressure

Serious but less common effects: stomach ulcers and gastrointestinal bleeding (black stools, vomiting blood), kidney impairment, severe allergic reactions and skin rashes, and a small increase in heart attack and stroke risk with prolonged high-dose use. Stop the drug and seek urgent care if black stools, chest pain or severe abdominal pain occur.

Precautions to follow with Naproxen:

• Always take it with food; long courses may need a gastric-protective medicine (PPI) alongside
• Avoid in dengue fever or suspected dengue — bleeding risk; use paracetamol for fever instead
• Be careful if you are elderly or have ulcer history, kidney disease, heart disease, hypertension, liver disease or asthma
• Avoid when dehydrated from vomiting or diarrhoea
• Do not combine with other NSAIDs or aspirin painkillers
• Long-term users should have periodic blood pressure, kidney and haemoglobin checks
• It may slightly delay blood clotting — mention it before any surgery or dental procedure

Important interactions of Naproxen:

• Other NSAIDs and aspirin — multiply ulcer and bleeding risk; naproxen can also blunt low-dose aspirin's heart protection if taken at the wrong time
• Anticoagulants and antiplatelets (warfarin, clopidogrel) — increased bleeding
• Corticosteroids and SSRIs — added GI bleeding risk
• ACE inhibitors, ARBs and diuretics — risk of kidney injury and weaker blood-pressure control
• Lithium and methotrexate — levels and toxicity rise
• Antacids and cholestyramine — may slow naproxen absorption

Tell your doctor about every medicine, including over-the-counter painkillers, before starting.

Do not take Naproxen if you have:

• Active peptic ulcer or gastrointestinal bleeding, or repeated past episodes
• History of asthma, hives or allergic reaction caused by aspirin or another NSAID
• Severe kidney, liver or heart failure
• Dengue fever or suspected dengue
• The last trimester of pregnancy
• Allergy to naproxen or any ingredient of the product

Use only with specialist advice in established heart disease, uncontrolled hypertension or bleeding disorders.

Pregnancy: Avoid Naproxen in pregnancy unless a doctor decides it is essential, and never use it in the last three months — it can prematurely close a vessel in the baby's heart, affect the baby's kidneys and delay labour. Paracetamol is the preferred painkiller in pregnancy.

Breastfeeding: Naproxen passes into breast milk in small amounts and stays in the body longer than other NSAIDs, so shorter-acting alternatives (such as ibuprofen) are usually preferred. Use during breastfeeding only on your doctor's advice.

Store Naproxen below 30°C in a cool, dry place away from direct sunlight and moisture. Keep tablets in the original blister pack until use, and keep suspension bottles tightly closed. Keep all medicines out of the reach and sight of children. Do not use after the expiry date printed on the pack.