Naproxen

How it works

It non-selectively inhibits cyclo-oxygenase enzymes COX-1 and COX-2, reducing prostaglandin synthesis to produce anti-inflammatory, analgesic and antipyretic effects.

Prescribing in practice

• Use the lowest effective dose for the shortest duration because of dose-related risks of serious gastrointestinal bleeding and ulceration, particularly in older patients and those on anticoagulants, with gastroprotection considered where appropriate.
• It can cause fluid retention, raised blood pressure and renal impairment, so use caution in heart failure, hypertension and chronic kidney disease.
• Avoid in active peptic ulceration and severe heart failure, and use cautiously with other nephrotoxic or anticoagulant drugs.

Monitoring

Monitor blood pressure, renal function and for gastrointestinal symptoms during longer-term use, especially in those with comorbidity.

Counselling the patient

• Take with or after food and report black stools, vomiting blood or severe indigestion.
• Avoid combining with other anti-inflammatory painkillers including over-the-counter ones.
• Stay hydrated and report swelling or reduced urine output.

Evidence & guidelines

Naproxen is a first-line NSAID in UK rheumatology practice and is noted to carry a relatively favourable cardiovascular risk profile among NSAIDs in NICE guidance.