Naproxen with esomeprazole

How it works

Naproxen non-selectively inhibits cyclo-oxygenase to reduce prostaglandin-mediated inflammation and pain, while esomeprazole irreversibly blocks the gastric proton pump to lower acid secretion and protect the upper gastrointestinal mucosa.

Prescribing in practice

• Although the esomeprazole component reduces upper gastrointestinal risk, it does not abolish the NSAID hazards of serious bleeding, cardiovascular and renal harm, so the lowest effective dose for the shortest time still applies.
• The fixed combination is intended for patients at risk of NSAID-induced ulcers and is not suitable where the individual component doses are inappropriate, including significant renal impairment.
• Be aware of esomeprazole interactions and effects, such as reduced absorption of certain drugs and the small risks linked to long-term acid suppression.

Monitoring

Monitor blood pressure, renal function and for any gastrointestinal symptoms despite the protective component, particularly with prolonged use.

Counselling the patient

• Swallow the combination tablet whole and do not add separate anti-inflammatory painkillers.
• Report black stools, vomiting blood or severe stomach pain straight away.
• Mention this medicine before starting new drugs, as the acid-reducing part can affect their absorption.

Evidence & guidelines

Fixed-dose naproxen with esomeprazole is licensed in the UK for symptomatic arthritis where gastroprotection is needed, reflecting evidence that PPIs reduce NSAID-related ulcer risk.