Naproxen

How it works

It inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis and thereby decreasing pain and inflammation.

Prescribing in practice

• In older patients the gastrointestinal bleeding, renal and cardiovascular risks are increased, so use the lowest effective dose for the shortest time and consider gastroprotection, particularly with other risk factors.
• Avoid or use caution with anticoagulants, antiplatelets, ACE inhibitors/ARBs and diuretics, and in heart failure, peptic ulcer disease or significant renal impairment.
• Among non-selective NSAIDs naproxen carries comparatively lower cardiovascular thrombotic risk, which may favour it when an NSAID is needed in a patient with cardiovascular concerns.

Monitoring

Monitor renal function and blood pressure, and remain alert for gastrointestinal symptoms, especially in dehydrated or polypharmacy patients.

Counselling the patient

• Take with or after food and report black stools, vomiting blood or persistent indigestion.
• Avoid combining with other anti-inflammatory painkillers, including over-the-counter products.
• Report ankle swelling, breathlessness or reduced urine output.

Evidence & guidelines

Cardiovascular safety meta-analyses indicate naproxen has a lower thrombotic risk than several other NSAIDs, while MHRA guidance reinforces gastrointestinal and renal caution in older adults.