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1 ing); Underlying cardiovascular disease (mayqrisk of MI or stroke); Chronic alco-
hol use/abuse; OB: Avoid using during third trimester; may cause premature closure
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naproxen (na-prox-en) of the ductus arteriosus; Pedi: Children ⬍2 yr (safety not established) ; Geri:qrisk
Aleve, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprosyn, Naprosyn-E, of adverse reactions.
Naprosyn-SR Adverse Reactions/Side Effects
Classification CNS: dizziness, drowsiness, headache. EENT: tinnitus, visual disturbances. Resp:
Therapeutic: nonopioid analgesics, nonsteroidal anti-inflammatory agents, dyspnea. CV: edema, palpitations, tachycardia. GI: DRUG-INDUCED HEPATITIS, GI
antipyretics BLEEDING, constipation, dyspepsia, nausea, anorexia, diarrhea, discomfort, flatu-
Pregnancy Category B (first trimester) lence, vomiting. GU: cystitis, hematuria, renal failure. Derm: photosensitivity,
rashes, sweating, pseudoporphyria (12% incidence in children with juvenile rheu-
matoid arthritis— discontinue therapy if this occurs). Hemat: blood dyscrasias,
Indications
Mild to moderate pain. Dysmenorrhea. Fever. Inflammatory disorders, including: prolonged bleeding time. Misc: allergic reactions including ANAPHYLAXIS and STEV-
ENS-JOHNSON SYNDROME.
Rheumatoid arthritis (adults and children), Osteoarthritis.
Action Interactions
Inhibits prostaglandin synthesis. Therapeutic Effects: Decreased pain. Reduc- Drug-Drug: Concurrent use with aspirinplevels and maypeffectiveness.qrisk
tion of fever. Suppression of inflammation. of bleeding with anticoagulants, thrombolytic agents, eptifibatide, tirofiban,
cefotetan, cefoperazone, valproic acid, corticosteroids, clopidogrel, and ti-
Pharmacokinetics clopidine. Additive adverse GI side effects with aspirin, corticosteroids, alcohol,
Absorption: Completely absorbed from the GI tract. Sodium salt is more rapidly and other NSAIDs. Probenecidqblood levels and mayqtoxicity. Mayqrisk of tox-
absorbed. icity from methotrexate, antineoplastics, or radiation therapy. Mayqserum
Distribution: Crosses the placenta; enters breast milk in low concentrations. levels and risk of toxicity from lithium.qrisk of adverse renal effects with cyclo-
Protein Binding: ⬎99%. sporine, ACE inhibitors, angiotensin II antagonists, or chronic use of aceta-
Metabolism and Excretion: Mostly metabolized by the liver. minophen. Maypresponse to antihypertensives or diuretics. Mayqrisk of hy-
Half-life: Children ⬍8 yr: 8– 17 hr; Children 8– 14 yr: 8– 10 hr; Adults: 10– 20 hr. poglycemia with insulin or oral hypoglycemic agents. Oral potassium
TIME/ACTION PROFILE supplements mayqGI adverse effects.
ROUTE ONSET PEAK DURATION Drug-Natural Products:qanticoagulant effect and bleeding risk with anise, ar-
nica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, Panax
PO (analgesic) 1 hr unknown 8–12 hr
ginseng, licorice, and others.
PO (anti-inflammatory) 14 days 2–4 wk unknown
Route/Dosage
Contraindications/Precautions 275 mg naproxen sodium is equivalent to 250 mg naproxen.
Contraindicated in: Hypersensitivity; Cross-sensitivity may occur with other
NSAIDs, including aspirin; Active GI bleeding; Ulcer disease; Lactation: Passes into Anti-Inflammatory/Analgesic/Antidysmenorrheal
breast milk and should not be used by nursing mothers. PO (Adults): Naproxen— 250– 500 mg twice daily (up to 1.5 g/day). Delayed-re-
Use Cautiously in: Severe cardiovascular, renal, or hepatic disease; History of ul- lease naproxen— 375– 500 mg twice daily. Naproxen sodium— 275– 550 mg
cer disease or any other history of gastrointestinal bleeding (mayqrisk of GI bleed- twice daily (up to 1.65 g/day).
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 Implementation
● Administration in higher than recommended doses does not provide increased ef-
PO (Children ⬎2 yr): Analgesia: 5– 7 mg/kg/dose q 8– 12 hr. Inflammatory dis- fectiveness but may cause increased side effects. Use lowest effective dose for the PDF Page #2
ease: 10– 15 mg/kg/day divided q 12 hr, maximum: 1000 mg/day. shortest duration possible to minimize cardiac risks.
● Coadministration with opioid analgesics may have additive analgesic effects and
Antigout
may permit lower opioid doses.
PO (Adults): Naproxen— 750 mg naproxen initially, then 250 mg q 8 hr. Na- ● Analgesic is more effective if given before pain becomes severe.
proxen sodium— 825 mg initially, then 275 mg q 8 hr. ● PO: For rapid initial effect, administer 30 min before or 2 hr after meals. May be
OTC Use (naproxen sodium) administered with food, milk, or antacids to decrease GI irritation. Food slows but
does not reduce the extent of absorption. Do not mix suspension with antacid or
PO (Adults): 200 mg q 8– 12 hr or 400 mg followed by 200 mg q 12 hr (not to ex-
other liquid prior to administration. Swallow extended-release, delayed-release,
ceed 600 mg/24 hr).
PO (Geriatric Patients ⬎65 yr): Not to exceed 200 mg q 12 hr. and controlled-release tablets whole; do not break, crush, or chew.
● Dysmenorrhea: Administer as soon as possible after the onset of menses. Pro-
NURSING IMPLICATIONS phylactic treatment has not been shown to be effective.
Assessment
● Patients who have asthma, aspirin-induced allergy, and nasal polyps are Patient/Family Teaching
at increased risk for developing hypersensitivity reactions. Assess for ● Advise patient to take this medication with a full glass of water and to remain in an
rhinitis, asthma, and urticaria. upright position for 15– 30 min after administration.
● Pain: Assess pain (note type, location, and intensity) prior to and 1– 2 hr follow- ● Instruct patient to take medication as directed. Take missed doses as soon as re-
ing administration. membered but not if almost time for the next dose. Do not double doses.
● Arthritis: Assess pain and range of motion prior to and 1– 2 hr following admin- ● May cause drowsiness or dizziness. Advise patient to avoid driving or other activi-
istration. ties requiring alertness until response to the medication is known.
● Fever: Monitor temperature; note signs associated with fever (diaphoresis, tachy- ● Caution patient to avoid the concurrent use of alcohol, aspirin, aceta-
cardia, malaise). minophen, or other OTC medications without consulting health care
● Lab Test Considerations: Evaluate BUN, serum creatinine, CBC, and liver professional. Use of naproxen with 3 or more glasses of alcohol per day
function tests periodically in patients receiving prolonged therapy. may increase risk of GI bleeding.
● Mayqserum potassium, BUN, serum creatinine, alkaline phosphatase, LDH, AST,
● Advise patient to inform health care professional of medication regimen prior to
and ALT tests levels. Maypblood glucose, hemoglobin, and hematocrit concentra-
treatment or surgery.
tions, leukocyte and platelet counts, and CCr.
● Caution patient to wear sunscreen and protective clothing to prevent photosensi-
● Bleeding time may be prolonged up to 4 days following discontinuation of therapy.
● May alter test results for urine 5-HIAA and urine steroid determinations. tivity reactions (especially in children with JRA).
● Instruct patients not to take OTC naproxen preparations for more than 3 days for
Potential Nursing Diagnoses fever and to consult health care professional if symptoms persist or worsen.
Acute pain (Indications) ● Advise patient to consult health care professional if rash, itching, visual distur-
Chronic pain (Indications) bances, tinnitus, weight gain, edema, black stools, persistent headache, or influ-
Impaired physical mobility (Indications) enza-like syndrome (chills, fever, muscle aches, pain) occurs.
䉷 2015 F.A. Davis Company CONTINUED
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naproxen
Evaluation/Desired Outcomes
● Relief of pain.
● Improved joint mobility. Partial arthritic relief is usually seen within 2 wk, but
maximum effectiveness may require 2– 4 wk of continuous therapy. Patients who
do not respond to one NSAID may respond to another.
● Reduction of fever.
Why was this drug prescribed for your patient?
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
