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Naproxen Sodium

Raj N. Sureja, MD

male holding blue pillsIn two previous articles, Dr. Andrus discussed two over-the-counter analgesics, ibuprofen, and acetaminophen, that are commonly used for the treatment of pain. In this article, I will discuss the third of the trio, Naproxen Sodium, better known by its brand names Naprosyn® or Aleve®, how it was discovered, is manufactured, and how it is used today for relief of acute and chronic pain.

Naproxen Sodium is an oral, non-steroidal anti-inflammatory medication that works as a non-selective COX inhibitor, which blocks prostaglandins that are known to cause inflammation in the body. It was patented in 1967 by the company Sythex and was approved for use in the United States in 1976 as the prescription drug Naprosyn®. In 1994, the FDA approved its use as an over-the-counter drug and generic versions also became available. In 2020, the NIH reports 10 million prescriptions were written for this drug in the United States, not accounting for OTC sales. Other sites show prescriptions for it are declining as OTC use increases. Interestingly, Naproxen is still available only by prescription in much of the world.

Naproxen sodium is fast acting and is typically given in 220 mg tablet or capsule doses. Higher doses of 275 mg and 550 mg may only be obtained by prescription. Those who have problems with swallowing pills may also obtain a liquid form of naproxen sodium from their pharmacy. Naproxen is also available with a stomach-protectant coating for those prone to gastrointestinal issues.

Naproxen Sodium is used to treat mild or moderate discomfort and works especially well on musculoskeletal, menstrual, and dental pain. Because of its anti-inflammatory properties, it is often the “gold-standard” among Orthopaedists and Pain Management physicians when treating patients with arthritis, gout, bursitis, sports injuries, or post-accident pain. It is well-known for relieving swelling, soreness and stiffness in joints and bursa. It also has value as a fever reducer and some studies show it may also have anti-viral properties that make it worthwhile to take when battling influenza.

It is not without side-effects; the most concerning being gastrointestinal issues common with all NSAIDS. Heartburn, indigestion, nausea, vomiting, and stomach pain have all been noted. I always recommend my patients take this drug with food. Other common side effects are confusion, drowsiness, dizziness, and headache. Less common are tinnitus (ringing in the ear), rashes, edema, itchy skin, or fatigue. Rarely seen are stroke, DVTs (blood clots) or heart attack.

Patients who have high blood pressure or known cardiovascular disease should not take naproxen sodium without clearance from their PCP or cardiologist.

Alcohol, steroid use or taking an anti-depressant medication known as an SSRI (serotonin reuptake inhibitor) can cause an interaction with naproxen sodium and increase the risk of gastrointestinal effects.

It is important for you to tell if you taking an anti-depressant or a steroid medication. A history of stomach problems or ulcers puts you at ten times greater risk of developing another ulcer if you take naproxen, than persons who have never had ulcers.

Unlike acetaminophen, naproxen sodium is not commonly mixed with opioid medications to make them more effective. There have been many studies that have been done by researchers to see if pain can be more effectively controlled by doing so; however, the results have been negligible. There do not seem to be adverse effects in doing so, but it has not become the standard of care, like it is for administering acetaminophen with opioids to make both more effective for pain control.

Naproxen sodium should never be taken with another NSAID, such as aspirin or ibuprofen. However, for my patients, it may be used with acetaminophen when more pain control is desired, with my approval and appropriate dosage information.

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