BSN Tracker

naproxen

Brand: Aleve, Naprosyn, Anaprox

⚠ BBW Beers Criteria Prototype: ibuprofen
Drug Class: nonsteroidal anti-inflammatory drug (NSAID)
Drug Family: NSAID
Subclass: non-selective COX inhibitor (propionic acid derivative)
Organ Systems: cnsmusculoskeletal

Mechanism of Action

Non-selective COX-1 and COX-2 inhibitor in the propionic acid class with longer duration than ibuprofen due to longer half-life. Maintains anti-inflammatory, analgesic, and antipyretic effects through prostaglandin synthesis inhibition. Among NSAIDs, has the most favorable cardiovascular risk profile.

COX-1COX-2

Indications

  • pain
  • fever
  • dysmenorrhea
  • osteoarthritis
  • rheumatoid arthritis
  • acute gout
  • ankylosing spondylitis

Contraindications

  • active GI bleeding/ulceration
  • severe renal impairment
  • aspirin sensitivity
  • perioperative CABG pain
  • third trimester pregnancy

Adverse Effects

Common

  • GI upset
  • dyspepsia
  • nausea
  • edema

Serious

  • GI bleeding/ulceration
  • AKI
  • cardiovascular events (lower risk than other NSAIDs)
  • hypertension

Pharmacokinetics (ADME)

Absorption well absorbed orally; bioavailability ~95%; food slows absorption minimally
Distribution protein binding >99%; Vd ~0.16 L/kg
Metabolism hepatic CYP1A2 and CYP2C9; inactive metabolites
Excretion renal (95%)
Half-life 12-17 hours (twice daily dosing)
Onset 1 hour
Peak 2-4 hours
Duration 8-12 hours
Protein Binding >99%
Vd 0.16 L/kg

Drug Interactions

Drug / Agent Mechanism Severity
anticoagulants additive bleeding risk major
antihypertensives (ACE inhibitors/ARBs/diuretics) reduce antihypertensive efficacy; AKI risk major
lithium reduce renal lithium clearance major

Nursing Considerations

  1. Longer half-life (12-17 hours) allows twice-daily dosing, improving patient adherence compared to every-4-to-6-hour ibuprofen.
  2. Naproxen has the most favorable cardiovascular risk profile among non-selective NSAIDs; preferred for patients requiring NSAID who have moderate cardiovascular risk.
  3. Same GI and renal precautions as ibuprofen; use lowest effective dose for shortest duration.
  4. OTC naproxen sodium (Aleve 220 mg) and prescription naproxen are different salt forms; 220 mg naproxen sodium = 200 mg naproxen base.

Clinical Pearls

  • Naproxen has a paradoxically favorable cardiovascular profile relative to other NSAIDs, possibly because its COX-1 antiplatelet effect is prolonged due to its long half-life, partially offsetting COX-2-mediated cardiovascular risk.
  • For acute gout, high-dose naproxen (750 mg loading dose, then 250 mg every 8 hours) is equivalent to colchicine and preferred in patients with contraindications to colchicine.

Safety Profile

Pregnancy avoid
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Acute Gout Ankylosing Spondylitis Dysmenorrhea Fever Nonsteroidal Anti-inflammatory Drug (NSAID) Osteoarthritis Pain Rheumatoid Arthritis
← Back to Medications