naproxen Nursing Considerations & Management

Drug Name

Generic Name : naproxen , naproxen sodium

Brand Name: Apo-Naproxen (CAN), Apo-Naproxen EC (CAN), Apo-Naproxen SR (CAN), EC-Naprosyn, Gen-Naproxen EC (CAN), Naprelan, Naprosyn, Novo-Naprox (CAN), Novo-Naprox-EC (CAN) ,Aleve, Anaprox, Anaprox DS, Apo-Napro-Na (CAN), Apo-Napro-NA DS (CAN), Midol Extended Relief, Novo Naprox Sodium (CAN), Novo Naprox Sodium DS (CAN), Novo Naprox Sodium SR (CAN)

Classification: NSAID, Analgesic (nonopioid)

Pregnancy Category B (first and second trimesters)
Pregnancy Category D (third trimester) 

Dosage & Route

Available forms : Tablets—250, 375, 500 mg; 220, 275, 500 mg (as naproxen sodium); DR tablets—375, 500 mg; CR tablets—375, 500 mg; suspension—125 mg/5 mL

Dosages : Do not exceed 1,250 mg/day (1,375 mg/day naproxen sodium).

ADULTS

Rheumatoid arthritis or osteoarthritis, ankylosing spondylitis:

Delayed-release (EC-Naprosyn)

• 375–500 mg PO bid.

Controlled-release (Naprelan)

• 750–1,000 mg PO daily as a single dose.

Naproxen sodium

• 275–550 mg bid PO. May increase to 1.65 g/day for a limited period.

Naproxen tablets

• 250–500 mg PO bid.

Naproxen suspension

• 250 mg (10 mL), 375 mg (15 mL), 500 mg (20 mL) PO bid.

• 1,000–1,500 mg PO daily as a single dose.

• 825 mg PO followed by 275 mg q 8 hr until the attack subsides.

• 750 mg, followed by 250 mg q 8 hr until attack subsides.

• Controlled-release (Naprelan)
• 1,000 mg PO daily as a single dose.

• 550 mg PO followed by 275 mg q 6–8 hr.

• 500 mg followed by 500 mg q 12 hr or 250 mg q 6–8 hr.

OTC

• 200 mg PO q 8–12 hr with a full glass of liquid while symptoms persist. Do not exceed 600 mg in 24 hr.

PEDIATRIC PATIENTS

Juvenile arthritis:

Naproxen

• 10 mg/kg/day given in two divided doses.

Naproxen sodium

• Safety and efficacy not established.

OTC

• Do not give to children < 12 yr unless under advice of physician.

GERIATRIC PATIENTS

• Do not take > 200 mg q 12 hr PO.

Therapeutic actions

• Naproxen has anti-inflammatory, analgesic, antipyretic actions. It reduces prostaglandin synthesis by inhibiting the enzyme cyclooxygenase. It also inhibits platelet aggregation.

Indications

• Mild to moderate pain
• Treatment of primary dysmenorrhea, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendinitis, bursitis, acute gout
• OTC use: Temporary relief of minor aches and pains associated with the common cold, headache, toothache, muscular aches, backache, minor pain of arthritis, pain of menstrual cramps, reduction of fever
• Treatment of juvenile arthritis (Naproxen)

Adverse effects

• Edema, palpitation, dizziness, drowsiness, headache, light headedness, vertigo, pruritus, skin eruption, ecchymosis, purpura, rash, fluid retention, abdominal pain, constipation, nausea, heartburn, diarrhea, dyspepsia, stomatitis, flatulence, gross bleeding/perforation, indigestion, ulcers, vomiting, abnormal renal function, hemolysis, ecchymosis, anemia, increased bleeding time, elevated LFTs, visual disturbances, tinnitus, hearing disturbances, dyspnoea, diaphoresis, thirst.
• Potentially Fatal: Anaphylactic/anaphylactoid reactions. Exfoliative dermatitis, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN).

Contraindications

• Hypersensitivity. Aspirin or NSAID allergy. Perioperative pain in the setting of CABG surgery. Pregnancy (3rd trimester).

Nursing considerations

Assessment

• History: Allergy to naproxen, salicylates, other NSAIDs; asthma, chronic urticaria, CV dysfunction; hypertension; GI bleeding; peptic ulcer; impaired hepatic or renal function; pregnancy; lactation
• Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric evaluation, peripheral sensation; P, BP, edema; R, adventitious sounds; liver evaluation; CBC, clotting times, LFTs, renal function tests; serum electrolytes; stool guaiac

Interventions

• BLACK BOX WARNING: Be aware that patient may be at increased risk for CV event, GI bleeding; monitor accordingly.
• Give with food or after meals if GI upset occurs.
• Arrange for periodic ophthalmologic examination during long-term therapy.
• WARNING: If overdose occurs, institute emergency procedures—gastric lavage, induction of emesis, supportive therapy.

Teaching points

• Take drug with food or meals if GI upset occurs; take only the prescribed dosage.
• Dizziness, drowsiness can occur (avoid driving or the use of dangerous machinery).
• Report sore throat; fever; rash; itching; weight gain; swelling in ankles or fingers; changes in vision; black, tarry stools.