naproxen

AKA

Aleve®, Anaprox®, Anaprox DS®, Maxidol®, Mediproxen®, Naprelan®, Naprosyn®, Vimovo®, Apo-Napro-Na®, Apo-Napro-Na DS®, Apo-Naproxen®, Apo-Naproxen EC®, Naproxen Menstrual Pain Relief®, Naproxen EC®, Naproxen Sodium DS®, Naproxen-NA®, Naproxen-NA DF®, Pediapharm Naproxen Suspension®,PRO-Naproxen EC®, Teva-Naproxen®, Teva-Naproxen EC®, Teva-Naproxen Sodium®, and others.

Purpose [+] Analgesic, Anti-inflammatory

HIDE ALL

SHOW ALL

Alcohol

Booze, ethyl or ethanol, adult beverage, brew, brewski, liquor, drink, shot, sauce, rot gut, hooch, giggle juice, moonshine, jello shots, wobbly pop

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Interaction
a) A case-control study found that NSAID use by individuals who regularly consume more than 5 drinks at a time increased their risk of gastrointestinal complications (e.g. stomach bleeds, ulceration) from 2.8 to 6-fold (odds ratio of GI complications of NSAID alone was 3.8 compared to NSAID non-users).

b) Another case-control study examined the effects associated with the use of prescription NSAIDs or non-prescription naproxen or ibuprofen in individuals with a history of alcohol abuse. Investigators found that the risk ratio of gastrointestinal-associated adverse effects was greater than was predicted by additive risk.

c) A case report describes an alcohol dependent patient who developed methemoglobinemia after taking naproxen sodium for the common cold.

Mechanism
a,b) The mechanism of the increased risk of GI bleed is not well understood but it appears that it is due to the fact NSAIDs and alcohol affect platelet function and bleeding risk.

c) The mechanism is not well understood, nor could the methemoglobinemia be definitively linked to naproxen use, as the patient took other medications as well. It is hypothesized that the methemoglobinemia occurred because alcohol reduces glucose-6-phosphate-dehydrogenase activity, and naproxen causes oxidative stress.

Significance
a,b) Patients should be counselled to avoid binge drinking while taking naproxen.

As both excessive alcohol use and NSAID use are associated with risks for gastrointestinal adverse effects, use of NSAIDs in heavy drinkers is cautioned.

c) The significance of this single case report is unknown. Naproxen should be used cautiously in patients with frequent or heavy alcohol intake.

Serious Risk for Harm

Alcohol can irritate the stomach lining. So can naproxen. Together, they may increase the risk of nausea, stomach pain, or stomach bleeding.

Rarely, binge drinking of alcohol in patients taking medications similar to naproxen has led to severe kidney damage.

Think First

There was a medical case report of a person who frequently drank large amounts of alcohol who developed a condition called methemoglobinemia after taking naproxen. This is when your red blood cells are not able to carry enough oxygen, and can cause you to have a headache, be dizzy, have shortness of breath and your skin to have a bluish color temporarily.

Think First

Mixing naproxen with alcohol doesn't change the risk of drinking alcohol. This means, your usual dose of naproxen and 1 or 2 drinks.

remember, 1 drink = 1 beer, 1 glass of wine or 1 shot of liquor.

Tobacco

smokes, butts, cigs, cigars, darts, stogies, cancer sticks, chew, dip

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Interaction
According to the product monograph, smokers may be at an increased risk of GI complications of NSAIDs such as ulceration and bleeding.

Significance
NSAIDs should be used with caution in patients who have risk factors for GI complications, such as smoking. If they are used regularly, patients should be monitored for abdominal pain, blood in the stool or vomit, and other signs of GI ulceration or bleeding.

Serious Risk for Harm

People who smoke tobacco are more likely to experience stomach or intestinal problems (like an ulcer or bleeding) when taking naproxen.

Caffeine

coffee, java, joe, soda, pop, tea, energy drinks (Red Bull®, Monster®, Rock Star®, Amp®, NOS®, Full Throttle®, 5-hour Energy Drink®, Beaver Buzz®), chocolate, cocoa

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Interaction
Other NSAIDs (e.g. ibuprofen) are sometimes used in combination with caffeine for increased pain relief.

Significance
There is currently no research regarding naproxen/caffeine combinations for this purpose.

Think First

Caffeine can make you more likely to get side effects from naproxen like an upset stomach or heartburn.

Think First

For some medical reasons your doctor may suggest you take naproxen and caffeine together, but taking them together without your doctor knowing may be a risk.

Cannabis/ Hash

Marijuana, mary jane, BC bud, blunt, chronic, J, jay, joint, hemp, pot, grass, herb, 420, dope, THC, weed, reefer, ganja, gangster, skunk, hydro, hash oil, weed oil, hash brownies, grease, boom, honey oil, K2, spice, poppers, shatter, budder

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Interaction
a) Marijuana may theoretically increase the risk of bleeding when used with naproxen.

b) Cannabidiol (CBD) and 9-THC may theoretically result in reduced naproxen metabolism and thus increased adverse effects of naproxen (GI upset, GERD, risk of GI ulcer or bleed).

Mechanism
a) 9-THC and cannabidiol may inhibit platelet aggregation.

b) CBD and 9-THC may inhibit CYP2C9, although this has not yet been proven at doses used in human studies. Naproxen is a substrate for CYP2C9.

Significance
a) Caution patients that using marijuana while taking naproxen increases the risk of bleeding.

b) Until more is known about the enzyme inhibition caused by CBD and 9-THC, caution patients that naproxen use with cannabis may increase the risk of adverse effects such as GI upset or bleeding.

Think First

When taking naproxen there is a small risk of you bleeding more than normal. Using cannabis can increase this risk and make it more likely for you to bleed more than you should.

Think First

Cannabis may slow down the removal of naproxen from the body. This might give you more side effects from naproxen like an upset stomach or heartburn.

Cocaine/ Crack

coke, snow, flake, nose candy, blow, lady white, stardust, rock, crystal, bazooka, moon rock, tar

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Opioids

codeine, Tylenol #3®, cody, meperidine, Demerol®, DXM, dextromethorphan, robo, skittles, morphine, morph, monkey, methadone, bupe, sub, or dollies, oxycodone, Oxycontin®, hillbilly heroin, OxyNeo®, OC, oxy, roxy, percs, fentanyl, Sublimaze®, Duragesic®, china white, hydrocodone, Hycodan®, Vicodin®, suboxone®, buprenorphine, vike, heroin, H, horse, junk, smack, brown sugar, black tar, down, china white, purple drank, W18, carfentanil, elephant tranquilizer, loperamide, lope, lean

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Interaction

OPIOIDS: Various studies have demonstrated reduced opioid requirements when NSAIDs are given peri- or post-operatively. One systematic review showed a mean 10.2 mg decrease in morphine consumption when patients were on NSAIDs compared to placebo.

However, a study that added acetaminophen/oxycodone to naproxen for low-back pain did not show any improvement in pain compared to naproxen alone.

CODEINE: A study that combined naproxen with codeine found this combination to be more effective for pain, edema, and trismus compared to diclofenac and benzydamine alone.

MORPHINE: a) In a study of cancer patients who were receiving high-dose morphine, researchers found that patients were more likely to experience myoclonus if the patients were also receiving antidepressants, antipsychotics, or NSAIDs (including naproxen).

b) There may be an increased risk of respiratory depression when morphine is used with an NSAID.

TAPENTADOL: Naproxen 500 mg was given twice daily x 4 doses to 34 healthy subjects. The AUC of a single 80 mg dose of tapentadol (given after the third naproxen dose) increased by 17% but the maximum concentration was unchanged.

Mechanism

OPIOIDS: NSAIDs are opioid sparing medications.

CODEINE: NSAIDs provide reduction in pain via peripheral mechanisms, and codeine is thought to have an additive effect when used in combination through central mechanisms.

MORPHINE: b) This interaction occurred with related NSAID diclofenac and morphine, but may generalize to other NSAIDs. It is thought to be a result of the elevated concentrations of morphine-6-glucuronide which remained elevated for several hours.

Significance

OPIOIDS: NSAIDs may reduce opioid requirements and possibly some opioid-induced adverse effects. However, there is some conflicting evidence about the benefit of adding opioids to NSAIDs.

CODEINE: Naproxen combined with codeine may decrease pain and the amount of medication used post-operatively.

MORPHINE: a)The significance of these results is not understood and the results have been questioned.

b) Although the use of morphine and NSAIDs may be clinically appropriate, patients should be monitored for respiratory depression for several hours after receiving the NSAID.

TAPENTADOL: Due to the lack of change in maximum concentration, no dose adjustment of tapentadol is required when used with naproxen.

Serious Risk for Harm

MORPHINE: Taking morphine together with naproxen may cause slowed breathing. This can be very dangerous.

Think First

OPIOIDS: For some medical reasons, your doctor may prescribe you naproxen and an opioid together. But, using opioids without your doctor knowing is a risk.

Amphetamines/ Stimulants

uppers, ecstasy, E, X, Molly, mesc, XTC, love drug, MDA, MDE, Eve, MDMA, adam, disco biscuit, bennies, black beauties, Dexedrine®, Adderall®, dexies, Ritalin®, speed, crystal, meth, ice, glass, crank, tweak, cat, qat, kat, khat, bath salts, Ivory Wave, Vanilla Sky, Cloud 9

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Phencyclidine/ Ketamine

PCP, angel dust, PeaCe Pill, rocket fuel, love boat, embalming fluid, elephant tranquilizer, hog, illy, wet, wet stick, dipper, toe tag, cadillac, snorts, or surfer, Special K, vitamin K, CVR, cat tranquilizer, cat valium, jet, kit kat, Ketalar®

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

LSD/ Hallucinogens

acid, blotter, cartoon acid, hit, purple haze, trip, white lightning, raggedy ann, sunshine, window-pane, microdot, boomers, buttons, mesc, peyote, salvia, morning glory seeds, flying saucers, licorice drops, pearly gates, magic mushrooms, shrooms

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Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Benzodiazepines

benzos, downers, tranquilizers, tranks, Ativan®, Halcion®, Klonopin®, Rivotril®, Restoril®, Serax®, Valium®, Xanax®, Rohypnol® (roofies, rope, the forget or date rape pill)

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Interaction
a) A double-blind, crossover study found no clinically important changes in mood or attention in subjects given naproxen and diazepam.

b) In a study of 10 healthy participants, who received a single dose of naproxen 500 mg and diazepam 10 mg, investigators found the naproxen peak serum levels decreased by 23%, the time to peak levels increased from 1.36 hours to 2 hours, and the diazepam absorption rate constant was reduced by 40%. No other pharmacokinetic changes were observed. Despite these changes, the investigators concluded that it did not appear that any special precautions were required when naproxen and diazepam were used concurrently.

Significance
b) This study suggests that the effects of naproxen may be diminished in the presence of diazepam. However, this is a very small study so until more data is available no dose adjustment of naproxen is required.

Unknown Dangers

Unknown dangers.

References

[+]

ALSO SEE IBUPROFEN

Bali C, Ergenoglu P, Ozmete O, et al. Comparison of the postoperative analgesic effects of naproxen sodium and naproxen sodium-codeine phosphate for arthroscopic meniscus surgery. Rev Bras Anestesiol 2016; 66: 151-6.

Cigerim L, Eroglu CN. Comparison of Clinical Efficacies of Preoperatively Initiated Naproxen Sodium-Codeine Phosphate in Combination, Diclofenac Potassium, and Benzydamine Hydrochloride for Pain, Edema, and Trismus After Extraction of Impacted Lower Third Molar: A Randomized Double-Blind Study. J Oral Maxillofac Surg 2018; 76: 495-502.

e-CPS [Internet]. Canadian Pharmacists Association; 2021. Nonsteroidal Anti-inflammatory Drugs (NSAIDs) [CPhA Monograph]; [updated 2020 Dec; cited 2021 July 25].

Frazer K, Stevermer J. More isn't better with acute low back pain treatment. J Fam Pract 2016; 65: 404-6.

Lee WS, Lee JY, Sung WY, et al. Naproxen-induced methemoglobinemia in an alcohol-dependent patient. Am J Emerg Med 2014; 32: 1439.e9-10.

Lexi-Comp ONLINE, Lexi-Comp ONLINE Interaction Analysis, Hudson, Ohio: Lexi-Comp, Inc.; 2021; July 25, 2021.

Neutel CI, Appel WC. The effect of alcohol abuse on the risk of NSAID-related gastrointestinal events. Ann Epidemiol 2000; 10: 246-50.

Potter JM, Reid DB, Shaw RJ, et al. Myoclonus associated with treatment with high doses of morphine: the role of supplemental drugs. Br Med J 1989; 299: 150-3.

Preston CL (Ed), Stockley’s Interactions Checker. [online] London: Pharmaceutical Press. (accessed on July 25, 2021).

Therapeutic Research Center. Natural Medicines [Internet]. Somerville (MA): Naproxen; [cited July 25, 2021].

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naproxen

References

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