Naproxen
Brand names: Aleve, Naprosyn
Class: 🤕 NSAIDs & Analgesics
When a vignette puts you on a chronic NSAID, naproxen is often the right pick because it has the most favorable cardiovascular profile of the non-selective NSAIDs. It inhibits COX-1 and COX-2 and treats osteoarthritis, rheumatoid arthritis, acute gout flares, dysmenorrhea, and mild-to-moderate musculoskeletal pain. Twice-daily dosing improves adherence over ibuprofen. The harm profile is the NSAID-class set: GI bleeding, AKI, hypertension worsening, fluid retention, and platelet inhibition. Avoid in CKD, heart failure, peptic ulcer disease, and third-trimester pregnancy. Naproxen blunts the antiplatelet effect of low-dose aspirin if taken first — separate by two hours or pick a different agent if aspirin matters.
✅ Indications
Mild-moderate pain, fever, OA, RA, gout acute, dysmenorrhea.
⚙️ Mechanism of Action
Non-selective COX inhibitor; longer t½ than ibuprofen.
📏 Dosing
250–500 mg PO BID (max 1500 mg/day).
🚫 Contraindications
Same as ibuprofen.
⚠️ Adverse Effects
Same class effects; slightly lower CV event risk than ibuprofen (naproxen is the "preferred" NSAID in high-CV-risk patients who need one).
🔬 Monitoring
BP, renal function.
💎 Board Pearls
- 🫀 LOWEST CV event risk among NSAIDs — preferred if an NSAID is necessary in patients with CVD.
- ⏳ Longer half-life (12–17 h) → BID dosing (vs ibuprofen QID).
Practice Questions
A 70-year-old woman with chronic osteoarthritis of the hips and stable coronary artery disease (last event 5 years ago, on aspirin 81 mg) has failed acetaminophen and topical therapy. Which of the following is the MOST appropriate NSAID regimen?
Related Drugs in This Class
- Ibuprofen — Motrin, Advil
- Acetaminophen — Tylenol, APAP, Paracetamol
- Ketorolac — Toradol
Sources
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