How often do you need pain relief? If you suffer from low back pain, an aching knee, strained muscles, arthritis, throbbing headaches, or any other myriad of painful conditions, you are not alone. According to the Institute of Medicine, over 100 million people in the U.S. suffer from chronic pain, four times the number of people who have diabetes. In fact, pain affects more Americans than diabetes, heart disease and cancer combined.
Medications in the class of drugs known as NSAIDs (nonsteroidal anti-inflammatory drugs) are the workhorse of pain and fever relief for millions of Americans. Not surprisingly, NSAIDs are one of the most commonly used class of drugs in the world.
Available in various formulations with or without a prescription, NSAIDs work to relieve inflammation and pain by inhibiting cyclooxygenase and reducing prostaglandin production – in other words, blocking the mechanism of pain. However, this pain relief does not come without important warnings for effective and safe use of naproxen products, including facts on dosage and costs.
1. Naproxen and Naproxen Sodium are Available in Many Forms
You can take naproxen orally by tablet or as a liquid suspension, in an extended-release formulation, surrounded by an enteric coating or combined with a proton pump inhibitor to help protect your stomach. Naproxen comes in two forms – either as the base naproxen or as the salt form naproxen sodium. You can get it with a prescription, or without.
Both the base and salt forms work the same way to relieve pain. There is one difference — naproxen base on a milligram-per-milligram basis is slightly stronger than naproxen sodium. Here’s how it works out — 220, 275, or 550 mg of naproxen sodium equals 200, 250, and 500 mg of naproxen, respectively. However, you don’t need to worry about any conversion as these slight differences are already taken into account when doses are determined.
2. Familiar Naproxen Products:
Over-the-counter (OTC) naproxen sodium:
- Pamprin All Day
- Midol Extended Relief
- Aleve-D Sinus & Cold (naproxen sodium/pseudoephedrine)
Prescription-only brands of naproxen sodium include:
- Anaprox DS
Prescription-only brands of naproxen include:
- Vimovo (esomeprazole/naproxen) – helps protect against ulcers
- Treximet (naproxen sodium/sumatriptan) – for acute migraine headache
3. Save Money: Naproxen and Naproxen Sodium Come in Generic Formulations
Naproxen and its salt formulation have been around for a long time. In fact, the FDA approved the first formulations of naproxen sodium in 1980. That’s good news, because formulations of many (but not all) naproxen and naproxen sodium drugs are now available generically, saving you health care dollars at the pharmacy.
For example, the brand name drug Anaprox is roughly equivalent to the OTC naproxen sodium (Aleve) you can buy at the drugstore. You can easily use the generic OTC naproxen sodium to get the same pain relief as you would from the more expensive Anaprox. Just be sure to ask your doctor what the equivalent OTC dose would be based on your indication. Anaprox is available generically by prescription, too.
For example, 60 tablets of 275 milligram (mg) brand name Anaprox would vary between $30.00 and $70.00 cash price depending upon pharmacy, but the generic OTC version costs around $6.00.
Many pharmacies have the generic prescription version of Anaprox on their $4.00 list of medications, too, so be sure to check and get a prescription from your doctor, if needed. Just remember, pay cash for the $4 prescription, because if you run your prescription through insurance it will probably cost you more.
Naproxen is available over-the-counter for relief of menstrual cramps, but generics work just as well and save you money. For menstrual cramps, it may be less expensive to use the generic or store brand naproxen sodium than the branded products like Midol Extended Relief or Pamprin All Day, so it’s worth a comparison. Be sure to check the package size, too, to be sure you are getting a good deal.
4. Naproxen Has Many Uses in Many Different Age Groups
Naproxen and its sodium salt are used for many different types of pain, and it is an excellent fever reducer, too. Below are just some of the common uses for naproxen:
- Rheumatoid Arthritis
- Dental work and toothache
- Ankylosing Spondylitis
- Acute gout
- Dysmenorrhea (menstrual cramps)
- General muscle pain and inflammation, like back pain
Children can use naproxen, too. The OTC products are only labeled for children 12 years and older, but some prescription formulations can be used in children as young as 2 years of age for fever, mild to moderate pain, and juvenile rheumatoid arthritis. You must check with your doctor to use any form of naproxen in children under 12 years of age.
Naproxen should be used cautiously and at the lowest possible dose in the elderly, especially those at risk for, or with a history of stomach and intestinal bleeding.
5. Is Naproxen a Safer NSAID for the Heart?
You may have heard that naproxen is safer for the heart compared to other NSAIDs like ibuprofen, diclofenac, meloxicam, or celecoxib; however, this is a controversial topic. A recent FDA advisory committee voted 16 to 9 that the clinical trial evidence was not strong enough to deem naproxen a safer NSAID for the heart. This vote was important because it could have resulted in label changes in favor of naproxen products over other NSAIDs for patients with heart disease. Some expert physicians still feel naproxen might be safer. The FDA has not yet made their final decision on this topic.
Since 2005, labeling laws have required a boxed heart warning on NSAIDs. That warning was a result of the withdrawal of the NSAID Vioxx (rofecoxib) from the market in 2004 because of a notable increased risk of heart attack among Vioxx users.
The heart warning on all NSAID labels warn that they may cause an increased risk of serious and sometimes fatal heart and blood vessel problems (eg, a heart attack, stroke). The risk may be greater if you already have heart problems or if you take NSAIDs for a long period of time. Additionally, the label warns that NSAIDs should not be used right before or after bypass heart surgery.
6. Your Stomach Is Also at Risk with NSAID Use
Boxed warnings on naproxen labels also alert patients to important risks for stomach and/or intestine bleeding. NSAIDs may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients may be at greater risk, and this effect may occur without any warning signs.
You should avoid using aspirin and other anticoagulants — like warfarin, Eliquis, Xarelto, or Pradaxa — with any NSAID. Check with your doctor before you combine these medications, as you may increase your risk for serious internal bleeding.
7. Join the Naproxen Support Group
Support groups on Drugs.com may be helpful for patients who use medications for pain relief, have multiple conditions, and who are searching for news. In fact, pain is one of the top medical condition support groups on Drugs.com. Joining one or more support groups is a great way to discover others with similar conditions and using related medications and to share your own experience.
There are over 200 reviews for naproxen from people who use this drug for arthritis, back pain, headache and other various conditions (some of which may be off-label use, meaning the drug is not approved by the FDA for that particular use). Here you can ask a question, share an experience, browse through the latest blog posts and questions, and see other ratings from patients who are using naproxen.
Remember, the information is NOT intended to endorse naproxen or recommend therapy. While these reviews might be helpful to you, they are NOT a substitute for the expertise, skill, knowledge and judgement of healthcare practitioners in patient care.
8. Be Sure: Check Your Naproxen Drug Interactions
Be sure to alert your pharmacist and physician of all of the medications you take, so that they can screen for clinically significant drug interactions with naproxen, even if you buy it over-the-counter.
Over 400 drugs are known to interact with naproxen. Naproxen also has three food and alcohol interactions you should take note of and discuss with your pharmacist. You can also review significant disease interactions that may be affected by the use of naproxen, like high blood pressure.
Be sure to check drug interactions with all of your prescription, over-the-counter, and vitamin or herbal products, too.
9. Avoid All NSAIDs Late in Pregnancy
It is important that you ask your doctor for advice before taking any drug in pregnancy. For mild pain and headaches in pregnant women, most physicians usually recommend acetaminophen (Tylenol). Naproxen (and all other NSAIDs) should be avoided in late pregnancy (usually during the third trimester) because it may cause premature closure of the ductus arteriosus.
What does this mean?
Before birth, the baby is supplied with nutrients and oxygen from the mother through a blood vessel called the ductus arteriosus. This blood vessel needs to stay open before birth, but closes right after birth when the baby starts breathing on its own. If the vessel closes before birth when the baby is still in the womb it is called “premature closure of the ductus arteriosus.”
Taking naproxen or other NSAIDs in the third trimester may require that the baby needs to be delivered early. Tell your doctor immediately if you have taken any NSAID in the third trimester of pregnancy, especially if you have used it for more than one dose or have used high doses.