Naproxen

Naproxen

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Questions & Answers

Side Effects & Adverse Reactions

CARDIOVASCULAR EFFECTS

Cardiovascular Thrombotic Events

Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur.

There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. The concurrent use of aspirin and an NSAID does increase the risk of serious GI events (see Gastrointestinal effects - Risk of Ulceration, Bleeding, and Perforation).

Two large, controlled, clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10-14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see CONTRAINDICATIONS).

Hypertension

NSAIDs, including naproxen sodium, can lead to onset of new hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including naproxen sodium, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy.

Congestive Heart Failure and Edema

Fluid retention, edema and peripheral edema have been observed in some patients taking NSAIDs. Naproxen sodium should be used with caution in patients with fluid retention, hypertension, or heart failure. Since each naproxen sodium tablet contains 25 mg or 50 mg of sodium (about 1 mEq per each 250 mg of naproxen), this should be considered in patients whose overall intake of sodium must be severely restricted.

Gastrointestinal Effects- Risk of Ulceration, Bleeding, and Perforation

NSAIDs, including naproxen sodium, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine, which can be fatal.

These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients, who develop a serious upper GI adverse event on NSAID therapy, is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk. The utility of periodic laboratory monitoring has not been demonstrated, nor has it been adequately assessed. Only 1 in 5 patients who develop a serious upper GI adverse event on NSAID therapy is symptomatic.

NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors. Other factors that increase the risk for GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI adverse event is suspected. This should include discontinuation of the NSAID until a serious GI adverse event is ruled out. For high risk patients, alternate therapies that do not involve NSAIDs should be considered.

Renal Effects

Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a nonsteroidal anti-inflammatory drug may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, hypovolemia, heart failure, liver dysfunction, salt depletion, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of nonsteroidal anti-inflammatory drug therapy is usually followed by recovery to the pretreatment state (see WARNINGS, Advanced Renal Disease).

Advanced Renal Disease

No information is available from controlled clinical studies regarding the use of naproxen sodium in patients with advanced renal disease. Therefore, treatment with naproxen sodium is not recommended in these patients with advanced renal disease. If naproxen therapy must be initiated, close monitoring of the patient's renal function is advisable.

Anaphylactoid Reactions

As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to naproxen sodium. Naproxen should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs (see CONTRAINDICATIONS and PRECAUTIONS: Preexisting Asthma). Emergency help should be sought in cases where an anaphylactoid reaction occurs.

Skin Reactions

NSAIDs including naproxen sodium, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity.

Pregnancy

In late pregnancy, as with other NSAIDs, naproxen sodium should be avoided because it may cause premature closure of the ductus arteriosus.

Legal Issues

There is currently no legal information available for this drug.

FDA Safety Alerts

There are currently no FDA safety alerts available for this drug.

Manufacturer Warnings

There is currently no manufacturer warning information available for this drug.

FDA Labeling Changes

There are currently no FDA labeling changes available for this drug.

Uses

Carefully consider the potential benefits and risks of naproxen sodium tablets and other treatment options before deciding to use naproxen sodium tablets. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see WARNINGS).

Naproxen sodium tablets are indicated:
      For the relief of the signs and symptoms of rheumatoid arthritis
      For the relief of the signs and symptoms of osteoarthritis
      For the relief of the signs and symptoms of ankylosing spondylitis 
      For the relief of the signs and symptoms of juvenile arthritis

Naproxen sodium tablets are also indicated:

  • For relief of the signs and symptoms of tendonitis
  • For relief of the signs and symptoms of bursitis
  • For relief of the signs and symptoms of acute gout
  • For the management of pain
  • For the management of primary dysmenorrhea 

History

There is currently no drug history available for this drug.

Other Information

Naproxen sodium is a member of the arylacetic acid group of nonsteroidal anti-inflammatory drugs.

The chemical name for naproxen sodium is (-)-Sodium 6-methoxy-α-methyl-2-naphthaleneacetate. It has the following structural formula:

Structural Formula

Naproxen sodium is a white to creamy, crystalline solid, freely soluble in water at neutral pH.

Each film coated tablet, for oral administration, contains 275 mg or 550 mg naproxen sodium, equivalent to 250 mg or 500 mg naproxen with 25 mg (about 1 mEq) or 50 mg (about 2 mEq) of sodium respectively. In addition, each tablet contains the following inactive ingredients: colloidal silicon dioxide, croscarmellose sodium, hydrogenated vegetable oil, lactose monohydrate, magnesium stearate, microcrystalline cellulose, povidone (K-30) and sodium lauryl sulfate.

The film coating contains: hydroxypropyl methylcellulose 2910, methacrylic acid copolymer, povidone (K-30), simethicone emulsion, talc and titanium dioxide.

Naproxen Manufacturers


  • Lake Erie Medical Dba Quality Care Products Llc
    Naproxen (Naproxen Sodium) Tablet, Film Coated [Lake Erie Medical Dba Quality Care Products Llc]
  • Blenheim Pharmacal,inc.
    Naproxen Tablet [Blenheim Pharmacal,inc.]
  • Proficient Rx Lp
    Naproxen Tablet [Proficient Rx Lp]
  • Zee Medical Inc
    Naproxen (Naproxen Sodium) Tablet [Zee Medical Inc]
  • Biomes Pharmaceuticals
    Naproxen (Naproxen) Tablet [Biomes Pharmaceuticals]
  • Cardinal Health
    Naproxen Tablet [Cardinal Health]
  • Blenheim Pharmacal, Inc.
    Naproxen (Naproxen Sodium) Tablet, Film Coated [Blenheim Pharmacal, Inc.]
  • Blenheim Pharmacal, Inc.
    Naproxen Tablet [Blenheim Pharmacal, Inc.]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Avpak
    Naproxen Tablet [Avpak]
  • Cardinal Health
    Naproxen Tablet [Cardinal Health]
  • Chain Drug Consortium
    Naproxen (Naproxen Sodium) Tablet [Chain Drug Consortium]
  • Watson Labs
    Naproxen (Naproxen) Tablet [Watson Labs]
  • Zydus Pharmaceuticals Usa Inc.
    Naproxen (Naproxen) Tablet [Zydus Pharmaceuticals Usa Inc.]
  • Dr. Reddy’s Laboratories Limited
    Naproxen Tablets Tablet [Dr. Reddy’s Laboratories Limited]
  • Blenheim Pharmacal, Inc.
    Naproxen Tablet Naproxen Sodium Tablet [Blenheim Pharmacal, Inc.]
  • Altura Pharmaceuticals, Inc.
    Naproxen Tablet Naproxen Sodium Tablet [Altura Pharmaceuticals, Inc.]
  • State Of Florida Doh Central Pharmacy
    Naproxen Tablet [State Of Florida Doh Central Pharmacy]
  • State Of Florida Doh Central Pharmacy
    Naproxen Tablet [State Of Florida Doh Central Pharmacy]
  • State Of Florida Doh Central Pharmacy
    Naproxen Tablet [State Of Florida Doh Central Pharmacy]
  • Blenheim Pharmacal, Inc.
    Naproxen Tablet [Blenheim Pharmacal, Inc.]
  • Amneal Pharmaceuticals
    Naproxen Tablet [Amneal Pharmaceuticals]
  • Keltman Pharmaceuticals Inc.
    Naproxen Tablet [Keltman Pharmaceuticals Inc.]
  • Rebel Distributors Corp
    Naproxen Tablet, Delayed Release [Rebel Distributors Corp]
  • Glenmark Generics Inc., Usa
    Naproxen Tablet Naproxen Sodium Tablet [Glenmark Generics Inc., Usa]
  • West-ward Pharmaceutical Corp
    Naproxen Tablet [West-ward Pharmaceutical Corp]
  • Lake Erie Medical Dba Quality Care Products Llc
    Naproxen Tablet, Delayed Release [Lake Erie Medical Dba Quality Care Products Llc]
  • Major Pharmaceuticals
    Naproxen Tablet [Major Pharmaceuticals]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Cardinal Health
    Naproxen Tablet [Cardinal Health]
  • Blenheim Pharmacal, Inc.
    Naproxen Tablet [Blenheim Pharmacal, Inc.]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Physicians Total Care, Inc.
    Naproxen Tablet, Delayed Release [Physicians Total Care, Inc.]
  • Preferred Pharmaceuticals, Inc
    Naproxen Tablet [Preferred Pharmaceuticals, Inc]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen Tablet [Pd-rx Pharmaceuticals, Inc.]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen Tablet, Delayed Release [Pd-rx Pharmaceuticals, Inc.]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen (Naproxen) Tablet [Pd-rx Pharmaceuticals, Inc.]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen (Naproxen) Tablet [Pd-rx Pharmaceuticals, Inc.]
  • Rebel Distributors Corp.
    Naproxen Tablet [Rebel Distributors Corp.]
  • Lake Erie Medical & Surgical Supply Dba Quality Care Products Llc
    Naproxen Tablet [Lake Erie Medical & Surgical Supply Dba Quality Care Products Llc]
  • H.j. Harkins Company, Inc.
    Naproxen Tablet [H.j. Harkins Company, Inc.]
  • H.j. Harkins Company, Inc.
    Naproxen Tablet, Delayed Release [H.j. Harkins Company, Inc.]
  • Lake Erie Medical Dba Quality Care Products Llc
    Naproxen (Naproxen ) Tablet [Lake Erie Medical Dba Quality Care Products Llc]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen Tablet [Pd-rx Pharmaceuticals, Inc.]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen Tablet [Pd-rx Pharmaceuticals, Inc.]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Camber Pharmaceuticals
    Naproxen Tablet [Camber Pharmaceuticals]
  • Preferred Pharmaceuticals, Inc
    Naproxen Tablet [Preferred Pharmaceuticals, Inc]
  • Stat Rx Usa Llc
    Naproxen Tablet Naproxen Sodium Tablet [Stat Rx Usa Llc]
  • Life Line Home Care Services, Inc.
    Naproxen Tablet [Life Line Home Care Services, Inc.]
  • Rebel Distributors Corp
    Naproxen Tablet [Rebel Distributors Corp]
  • Stat Rx Usa Llc
    Naproxen Tablet [Stat Rx Usa Llc]
  • Mckesson Contract Packaging
    Naproxen Tablet [Mckesson Contract Packaging]
  • Unit Dose Services
    Naproxen Tablet [Unit Dose Services]
  • Unit Dose Services
    Naproxen Tablet [Unit Dose Services]
  • Rebel Distributors Corp
    Naproxen Tablet [Rebel Distributors Corp]
  • Lake Erie Medical & Surgical Supply Dba Quality Care Products Llc
    Naproxen Tablet [Lake Erie Medical & Surgical Supply Dba Quality Care Products Llc]
  • Lake Erie Medical & Surgical Supply Dba Quality Care Products Llc
    Naproxen Tablet [Lake Erie Medical & Surgical Supply Dba Quality Care Products Llc]
  • Stat Rx Usa Llc
    Naproxen Tablet [Stat Rx Usa Llc]
  • Stat Rx Usa Llc
    Naproxen Tablet [Stat Rx Usa Llc]
  • Stat Rx Usa Llc
    Naproxen Tablet, Delayed Release [Stat Rx Usa Llc]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen Tablet [Pd-rx Pharmaceuticals, Inc.]
  • Aidarex Pharmaceuticals Llc
    Naproxen Tablet [Aidarex Pharmaceuticals Llc]
  • Bryant Ranch Prepack
    Naproxen Tablet [Bryant Ranch Prepack]
  • Bryant Ranch Prepack
    Naproxen Tablet, Delayed Release [Bryant Ranch Prepack]
  • Liberty Pharmaceuticals, Inc.
    Naproxen Tablet [Liberty Pharmaceuticals, Inc.]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Pd-rx Pharmaceuticals, Inc.
    Naproxen Tablet [Pd-rx Pharmaceuticals, Inc.]
  • West-ward Pharmaceutical Corp
    Naproxen (Naproxen Sodium) Tablet, Film Coated [West-ward Pharmaceutical Corp]
  • Marksans Pharma Limited
    Naproxen Tablet [Marksans Pharma Limited]
  • Teva Pharmaceuticals Usa Inc
    Naproxen Tablet, Delayed Release [Teva Pharmaceuticals Usa Inc]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Blenheim Pharmacal, Inc.
    Naproxen Tablet [Blenheim Pharmacal, Inc.]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Cardinal Health
    Naproxen Tablet [Cardinal Health]
  • Sandoz Inc
    Naproxen Tablet, Delayed Release [Sandoz Inc]
  • Polygen Pharmaceuticals Llc
    Naproxen Tablet [Polygen Pharmaceuticals Llc]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Dispensing Solutions, Inc.
    Naproxen Tablet [Dispensing Solutions, Inc.]
  • Dispensing Solutions, Inc.
    Naproxen Tablet [Dispensing Solutions, Inc.]
  • Pharmadel Llc
    Naproxen (Naproxen Sodium) Tablet [Pharmadel Llc]
  • Pharmaceutica North America, Inc.
    Naproxen Tablet [Pharmaceutica North America, Inc.]
  • Clinical Solutions Wholesale
    Naproxen Tablet [Clinical Solutions Wholesale]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Liberty Pharmaceuticals, Inc.
    Naproxen Tablet [Liberty Pharmaceuticals, Inc.]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Avkare, Inc.
    Naproxen Tablet [Avkare, Inc.]
  • American Health Packaging
    Naproxen Tablet [American Health Packaging]
  • Golden State Medical Supply, Inc.
    Naproxen Tablet [Golden State Medical Supply, Inc.]
  • Aurobindo Pharma Limited
    Naproxen Tablet [Aurobindo Pharma Limited]
  • Major Pharmaceuticals
    Naproxen Tablet [Major Pharmaceuticals]
  • Unit Dose Services
    Naproxen Tablet [Unit Dose Services]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Aidarex Pharmaceuticals Llc
    Naproxen Tablet [Aidarex Pharmaceuticals Llc]
  • Aidarex Pharmaceuticals Llc
    Naproxen Tablet, Delayed Release [Aidarex Pharmaceuticals Llc]
  • Teva Pharmaceuticals Usa Inc
    Naproxen Tablet [Teva Pharmaceuticals Usa Inc]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Direct Rx
    Naproxen Tablet [Direct Rx]
  • Blenheim Pharmacal, Inc.
    Naproxen Tablet [Blenheim Pharmacal, Inc.]
  • Kaiser Foundation Hospitals
    Naproxen Tablet [Kaiser Foundation Hospitals]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Remedyrepack Inc.
    Naproxen Tablet [Remedyrepack Inc. ]
  • Aphena Pharma Solutions – Tennessee, Llc
    Naproxen Tablet [Aphena Pharma Solutions – Tennessee, Llc]
  • Proficient Rx Lp
    Naproxen Tablet [Proficient Rx Lp]
  • Aphena Pharma Solutions – Tennessee, Llc
    Naproxen Tablet [Aphena Pharma Solutions – Tennessee, Llc]
  • Ncs Healthcare Of Ky, Inc Dba Vangard Labs
    Naproxen Tablet [Ncs Healthcare Of Ky, Inc Dba Vangard Labs]
  • Bryant Ranch Prepack
    Naproxen Tablet [Bryant Ranch Prepack]
  • Ncs Healthcare Of Ky, Inc Dba Vangard Labs
    Naproxen Tablet [Ncs Healthcare Of Ky, Inc Dba Vangard Labs]
  • Carilion Materials Management
    Naproxen Tablet, Delayed Release [Carilion Materials Management]
  • Carilion Materials Management
    Naproxen Tablet [Carilion Materials Management]
  • Carilion Materials Management
    Naproxen Tablet [Carilion Materials Management]
  • Northwind Pharmaceuticals
    Naproxen Tablet [Northwind Pharmaceuticals]
  • Cardinal Health
    Naproxen Tablet [Cardinal Health]
  • Medline Industries, Inc.
    Naproxen (Naproxen Sodium) Tablet [Medline Industries, Inc.]
  • Preferred Pharmaceuticals Inc.
    Naproxen Tablet [Preferred Pharmaceuticals Inc.]
  • Medsource Pharmaceuticals
    Naproxen Tablet [Medsource Pharmaceuticals]
  • Proficient Rx Lp
    Naproxen Tablet [Proficient Rx Lp]
  • Proficient Rx Lp
    Naproxen Tablet [Proficient Rx Lp]
  • Alivio Medical Products, Llc
    Naproxen Tablet [Alivio Medical Products, Llc]
  • Directrx
    Naproxen Tablet [Directrx]
  • St. Mary’s Medical Park Pharmacy
    Naproxen Tablet [St. Mary’s Medical Park Pharmacy]

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