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Naproxen

Naproxen belongs to the same nonsteroidal anti-inflammatory family as ibuprofen, Voltaren and Celebrex. Naproxen treats pain, counteracts inflammation and reduces fever. Patented in 1967, it is sold both as a prescription and as an over-the-counter drug. Both immediate release and sustained release preparations are available. An enteric coated form dissolves in the small intestine rather than the stomach but is erratically absorbed depending on dietary consumption. Naproxen is available either by itself or together with sodium. Aleve is an example of naproxen alone while Anaprox is naproxen sodium. The addition of sodium allows more rapid absorption: 1-2 hours with naproxen + sodium versus 2-4 hours with naproxen. Common adverse effects include headache, abdominal discomfort, dizziness, lightheadedness and sometimes swelling of the ankles and legs. More important complications include sodium retention, high blood pressure and kidney damage. Of most concern, the FDA mandates a warning on naproxen of potential gastrointestinal complications and thrombotic events such as heart attacks and stroke. Gastrointestinal issues include bleeding, ulceration and perforation that may occur without warning. Those with previous ulcers, intestinal bleeding, the elderly and individuals receiving anticoagulants are at heightened risk. The same occurs among those in poor health. Cigarette smokers and alcohol abusers are also prime targets for complications. Cardiovascular risk from naproxen, although low, remains sufficiently worrisome to lead to the FDA warning. Adverse events may be delayed or occur soon after the start of therapy. Prudent advice cautions use of naproxen at the lowest effective dose for the shortest period of time. Combining naproxen with low dose aspirin or other NSAIDs adds to the likelihood of problems.