Home > Medical Reference > Complementary Medicine

Naproxen


Special Alerts

Naproxen and Cardiovascular Risk - December 21, 2004

The National Institutes of Health (NIH) announced the suspension of an Alzheimer's disease prevention trial which used celecoxib, naproxen, or placebo. The Alzheimer's Disease Anti-Inflammatory Prevention Trial (ADAPT) was intended to assess the possible benefits of the nonsteroidal anti-inflammatory drug naproxen, and the COX-2 inhibitor celecoxib, in decreasing the development of Alzheimer's disease in patients 70 years of age at risk for this condition. Enrollment in ADAPT began in January 2001, and the study was expected to continue for 5-7 years.

The trial was suspended in part due to recent findings from another study which reported an increased risk of cardiovascular events in patients taking celecoxib. Preliminary data from ADAPT included some evidence that naproxen may increase the risk of cardiovascular events in this patient group when compared to placebo. The Food and Drug Administration (FDA) is reviewing this data with the NIH. These results were not observed in previous studies and no conclusions are possible without adequate review.

Until additional information is available, the FDA is reminding patients and healthcare providers to use these medications as recommended in current labeling. When used for self-medication (OTC), naproxen should not be used for >10 days or in doses >220 mg twice daily.

Refer to the following FDA and NIH websites for additional information:

http://www.fda.gov/bbs/topics/news/2004/NEW01148.html

http://www.nih.gov/news/pr/dec2004/od-20.htm


Pronunciation

 (na PROKS en)


U.S. Brand Names

 Aleve® [OTC]; Anaprox®; Anaprox® DS; EC-Naprosyn®; Naprelan®; Naprosyn®; Pamprin® Maximum Strength All Day Relief [OTC]


Synonyms

 Naproxen Sodium


Generic Available

 Yes


Canadian Brand Names

 Anaprox®; Anaprox® DS; Apo-Napro-Na®; Apo-Napro-Na DS®; Apo-Naproxen®; Apo-Naproxen SR®; Gen-Naproxen EC; Naprosyn®; Naxen®; Novo-Naproc EC; Novo-Naprox; Novo-Naprox Sodium; Novo-Naprox Sodium DS; Novo-Naprox SR; Nu-Naprox; Riva-Naproxen


Use

 Management of ankylosing spondylitis, osteoarthritis, and rheumatoid disorders (including juvenile rheumatoid arthritis); acute gout; mild to moderate pain; tendonitis, bursitis; dysmenorrhea; fever, migraine headache


Use - Dental

 Management of pain and swelling


Pregnancy Risk Factor

 C


Lactation

 Enters breast milk/not recommended (AAP rates "compatible")


Contraindications

 Hypersensitivity to naproxen, aspirin, other NSAIDs, or any component of the formulation; patients with "aspirin triad" (bronchial asthma, aspirin intolerance, rhinitis); pregnancy (3rd trimester)


Warnings/Precautions

 Fatal asthmatic and anaphylactoid reactions have occurred in patients with "aspirin triad." Use with caution in patients with CHF, hypertension, dehydration, decreased renal or hepatic function, history of GI disease (bleeding, ulcers, or previous GI symptoms with NSAID use), or those receiving anticoagulants and/or corticosteroids. Use lowest effective dose for shortest period possible; bleeding risk has been correlated to dose and duration of therapy. Gastrointestinal bleeding may occur without prior symptoms of gastrointestinal irritation. Elderly are at a high risk for adverse effects from NSAIDs. As many as 60% of elderly can develop peptic ulceration and/or hemorrhage asymptomatically.

Use of NSAIDs can compromise existing renal function especially when Clcr<30 mL/minute. CNS adverse effects such as confusion, agitation, and hallucination are generally seen in overdose or high-dose situations; however, elderly may demonstrate these adverse effects at lower doses than younger adults. Withhold for at least 4-6 half-lives prior to surgical or dental procedures.

OTC labeling: Recommended dosages should not be exceeded, due to an increased risk of GI bleeding. Consuming 3 alcoholic beverages/day may increase the risk of GI bleeding. When used for self-medication, patients should be instructed to contact healthcare provider if used for fever lasting >3 days or for pain lasting >10 days in adults or >3 days in children.


Adverse Reactions

1% to 10%:

Cardiovascular: Edema (3% to 9%), palpitations (<3%)

Central nervous system: Dizziness (3% to 9%), drowsiness (3% to 9%), headache (3% to 9%), lightheadedness (<3%), vertigo (<3%)

Dermatologic: Pruritus (3% to 9%), skin eruption (3% to 9%), rash, ecchymosis (3% to 9%), purpura (<3%)

Endocrine & metabolic: Fluid retention (3% to 9%)

Gastrointestinal: Abdominal pain (3% to 9%), constipation (3% to 9%), nausea (3% to 9%), heartburn (3% to 9%), diarrhea (<3%), dyspepsia (<3%), stomatitis (<3%), heartburn (<3%), flatulence, gross bleeding/perforation, indigestion, ulcers, vomiting

Genitourinary: Abnormal renal function

Hematologic: Hemolysis (3% to 9%), ecchymosis (3% to 9%), anemia, bleeding time increased

Hepatic: LFTS increased

Ocular: Visual disturbances (<3%)

Otic: Tinnitus (3% to 9%), hearing disturbances (<3%)

Respiratory: Dyspnea (3% to 9%)

Miscellaneous: Diaphoresis (<3%), thirst (<3%)

<1%: Agranulocytosis, alopecia, anaphylactic/anaphylactoid reaction, angioneurotic edema, arrhythmia, aseptic meningitis, asthma, blurred vision, cognitive dysfunction, colitis, coma, confusion, CHF, conjunctivitis, cystitis, depression, dream abnormalities, dysuria, eosinophilia, eosinophilic pneumonitis, erythema multiforme, exfoliative dermatitis, glossitis, granulocytopenia, hallucinations, hematemesis, hepatitis, hyper-/hypoglycemia, hyper-/hypotension, infection, interstitial nephritis, melena, jaundice, leukopenia, liver failure, lymphadenopathy, menstrual disorders, malaise, MI, myalgia, muscle weakness, oliguria, pancreatitis, paresthesia,pancytopenia, photosensitivity, pneumonia, polyuria, proteinuria, pyrexia, rectal bleeding, renal failure, renal papillary necrosis, respiratory depression, sepsis, Stevens-Johnson syndrome, tachycardia, seizure, syncope, thrombocytopenia, toxic epidermal necrolysis ulcerative stomatitis, vasculitis


Overdosage/Toxicology

 Symptoms of overdose include drowsiness, heartburn, vomiting, CNS depression, leukocytosis, and renal failure. Management is supportive and symptomatic. Seizures tend to be very short-lived and often do not require drug treatment.


Drug Interactions

 Substrate (minor) of CYP1A2, 2C8/9

ACE inhibitors: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure.

Angiotensin II antagonists: Antihypertensive effects may be decreased by concurrent therapy with NSAIDs; monitor blood pressure.

Anticoagulants (warfarin, heparin, LMWHs) in combination with NSAIDs can cause increased risk of bleeding.

Antiplatelet drugs (ticlopidine, clopidogrel, aspirin, abciximab, dipyridamole, eptifibatide, tirofiban) can cause an increased risk of bleeding.

Corticosteroids may increase the risk of GI ulceration; avoid concurrent use.

Cyclosporine: NSAIDs may increase serum creatinine, potassium, blood pressure, and cyclosporine levels; monitor cyclosporine levels and renal function carefully.

Hydralazine's antihypertensive effect is decreased; avoid concurrent use.

Lithium levels can be increased; avoid concurrent use if possible or monitor lithium levels and adjust dose. Sulindac may have the least effect. When NSAID is stopped, lithium will need adjustment again.

Loop diuretics efficacy (diuretic and antihypertensive effect) is reduced. Indomethacin reduces this efficacy, however, it may be anticipated with any NSAID.

Methotrexate: Severe bone marrow suppression, aplastic anemia, and GI toxicity have been reported with concomitant NSAID therapy. Avoid use during moderate or high-dose methotrexate (increased and prolonged methotrexate levels). NSAID use during low-dose treatment of rheumatoid arthritis has not been fully evaluated; extreme caution is warranted.

Thiazides antihypertensive effects are decreased; avoid concurrent use.

Warfarin's INRs may be increased by naproxen. Other NSAIDs may have the same effect depending on dose and duration. Monitor INR closely. Use the lowest dose of NSAIDs possible and for the briefest duration.


Ethanol/Nutrition/Herb Interactions

Ethanol: Avoid or limit ethanol (may enhance gastric mucosal irritation).

Food: Naproxen absorption rate may be decreased if taken with food.

Herb/Nutraceutical: Avoid cat's claw, dong quai, evening primrose, feverfew, garlic, ginger, ginkgo, red clover, horse chestnut, green tea, ginseng (all have additional antiplatelet activity).


Stability

 Store oral suspension and tablet at 15°C to 30°C (59°F to 86°F).


Mechanism of Action

 Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin precursors


Pharmacodynamics/Kinetics

Onset of action: Analgesic: 1 hour; Anti-inflammatory: ~2 weeks

Peak effect: Anti-inflammatory: 2-4 weeks

Duration: Analgesic: 7 hours; Anti-inflammatory: 12 hours

Absorption: Almost 100%

Protein binding: >99%; increased free fraction in elderly

Half-life elimination: Normal renal function: 12-17 hours; End-stage renal disease: No change

Time to peak, serum: 1-4 hours

Excretion: Urine (95%)


Dosage

 Oral:

Children >2 years: Juvenile arthritis: 10 mg/kg/day in 2 divided doses

Adults:

Acute gout: Initial: 750 mg, followed by 250 mg every 8 hours until attack subsides; Note: EC-Naprosyn® is not recommended

Rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis: 500-1000 mg/day in 2 divided doses; may increase to 1.5 g/day of naproxen base for limited time period

Mild-to-moderate pain, dysmenorrhea, acute tendonitis, bursitis: Initial: 500 mg, then 250 mg every 6-8 hours; maximum: 1250 mg/day naproxen base

OTC labeling: Pain/fever:

Children 12 years and Adults 65 years: 200 mg naproxen base every 8-12 hours; if needed, may take 400 mg naproxen base for the initial dose; maximum: 600 mg naproxen base/24 hours

Adults >65 years: 200 mg naproxen base every 12 hours

Dosing adjustment in renal impairment: Clcr<30 mL/minute: use is not recommended


Administration

 Administer with food, milk, or antacids to decrease GI adverse effects

Suspension: Shake suspension well before administration.

Tablet, extended release: Swallow tablet whole; do not break, crush, or chew.


Monitoring Parameters

 Occult blood loss, periodic liver function test, CBC, BUN, serum creatinine; urine output


Dietary Considerations

 Drug may cause GI upset, bleeding, ulceration, perforation; take with food or milk to minimize GI upset.


Patient Education

 Take this medication exactly as directed; do not increase dose without consulting prescriber. Do not crush tablets. Take with food or milk to reduce GI distress. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. Do not use alcohol, aspirin or aspirin-containing medication, or any other anti-inflammatory medications without consulting prescriber. You may experience drowsiness, dizziness, lightheadedness, or headache (use caution when driving or engaging in tasks requiring alertness until response to drug is known); anorexia, nausea, vomiting, or heartburn (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or fluid retention (weigh yourself weekly and report unusual (3-5 lb/week) weight gain). GI bleeding, ulceration, or perforation can occur with or without pain; or discontinue medication and contact prescriber if persistent abdominal pain or cramping, or blood in stool occurs. Report breathlessness, respiratory difficulty, or unusual cough; chest pain, rapid heartbeat, palpitations; unusual bruising/bleeding; blood in urine, stool, mouth, or vomitus; swollen extremities; skin rash or itching; acute fatigue; or changes in eyesight (double vision, color changes, blurred vision), hearing, or ringing in ears. Breast-feeding precautions: Notify prescriber if you are or intend to become pregnant. Do not take this drug during last trimester of pregnancy.


Anesthesia and Critical Care Concerns/Other Considerations

 The 2002 ACCM/SCCM guidelines for analgesia (critically-ill adult) suggest that NSAIDs may be used in combination with opioids in select patients for pain management. Concern about adverse events (increased risk of renal dysfunction, altered platelet function and gastrointestinal irritation) limits its use in patients who have other underlying risks for these events.

In short-term use, NSAIDs vary considerably in their effect on blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema; may precipitate renal failure in dehydrated patients.


Cardiovascular Considerations

 In short-term use, NSAIDs vary considerably in their effect on blood pressure. A recent meta-analysis (see References) showed that indomethacin and naproxen had the largest effect on blood pressure. Other NSAIDs, including piroxicam, ibuprofen, and sulindac had less of an effect. Ibuprofen combined with captopril or losartan may attenuate the antihypertensive effects of ACE inhibition or receptor blockade on sitting or 24-hour ambulatory diastolic blood pressure. When NSAIDs are used in patients with hypertension, appropriate monitoring of blood pressure responses should be completed and the duration of therapy, when possible, kept short. The use of NSAIDs in the treatment of patients with congestive heart failure may be associated with an increased risk for fluid accumulation and edema. One study showed that NSAID use in elderly patients had an increased risk of hospitalization for heart failure. This study gives compelling reasons to avoid or limit the use of NSAIDs in patients with congestive heart failure, particularly in the elderly population.


Dental Health: Effects on Dental Treatment

 Key adverse event(s) related to dental treatment: Stomatitis. NSAID formulations are known to reversibly decrease platelet aggregation via mechanisms different than observed with aspirin. The dentist should be aware of the potential of abnormal coagulation. Caution should also be exercised in the use of NSAIDs in patients already on anticoagulant therapy with drugs such as warfarin (Coumadin®).


Dental Health: Vasoconstrictor/Local Anesthetic Precautions

 No information available to require special precautions


Mental Health: Effects on Mental Status

 Dizziness is common; may cause nervousness; may rarely cause drowsiness, confusion, insomnia, depression, or hallucinations


Mental Health: Effects on Psychiatric Treatment

 May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels


Dosage Forms

Caplet, as sodium (Aleve®, Pamprin® Maximum Strength All Day Relief): 220 mg [equivalent to naproxen 200 mg and sodium 20 mg]

Gelcap, as sodium (Aleve®): 220 mg [equivalent to naproxen 200 mg and sodium 20 mg]

Suspension, oral (Naprosyn®): 125 mg/5 mL (480 mL) [contains sodium 0.3 mEq/mL; orange-pineapple flavor]

Tablet (Naprosyn®): 250 mg, 375 mg, 500 mg

Tablet, as sodium: 220 mg [equivalent to naproxen 200 mg and sodium 20 mg]; 275 mg [equivalent to naproxen 250 mg and sodium 25 mg]; 550 mg [equivalent to naproxen 500 mg and sodium 50 mg]

Aleve®: 220 mg [equivalent to naproxen 200 mg and sodium 20 mg]

Anaprox®: 275 mg [equivalent to naproxen 250 mg and sodium 25 mg]

Anaprox® DS: 550 mg [equivalent to naproxen 500 mg and sodium 50 mg]

Tablet, controlled release, as sodium: 550 mg [equivalent to naproxen 500 mg and sodium 50 mg]

Naprelan®: 421.5 mg [equivalent to naproxen 375 mg and sodium 37.5 mg]; 550 mg [equivalent to naproxen 500 mg and sodium 50 mg]

Tablet, delayed release (EC-Naprosyn®): 375 mg, 500 mg


References

Alun-Jones E and Williams J, "Hyponatremia and Fluid Retention in a Neonate Associated With Maternal Naproxen Overdosage," J Toxicol Clin Toxicol , 1986, 24(3):257-60.

Berde C, Ablin A, Glazer J, et al, "American Academy of Pediatrics Report of the Subcommittee on Disease-Related Pain in Childhood Cancer," Pediatrics , 1990, 86(5 Pt 2):818-25.

Brooks PM and Day RO, "Nonsteroidal Anti-inflammatory Drugs - Differences and Similarities," N Engl J Med , 1991, 324(24):1716-25.

Clinch D, Banerjee AK, and Ostick G, "Absence of Abdominal Pain in Elderly Patients With Peptic Ulcer," Age Ageing , 1984, 13(2):120-3.

Clive DM and Stoff JS, "Renal Syndromes Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med , 1984, 310(9):563-72.

Conlin P, Moore T, Swartz S, et al, "Effect of Indomethacin on Blood Pressure Lowering by Captopril and Losartan in Hypertensive Patients," Hypertension , 2000, 36(3):461-5.

Court H and Volans GN, "Poisoning After Overdose With Nonsteroidal Anti-inflammatory Drugs," Adverse Drug React Acute Poisoning Rev , 1984, 3(1):1-21.

"Drugs for Pain," Med Lett Drugs Ther , 2000, 42(1085):73-8.

Forbes JA, Keller CK, Smith JW, et al, "Analgesic Effect of Naproxen Sodium, Codeine, a Naproxen-Codeine Combination and Aspirin on the Postoperative Pain of Oral Surgery," Pharmacotherapy , 1986, 6(5):211-8.

Fredell EW and Strand LJ, "Naproxen Overdose," JAMA , 1977, 238(9):938.

Graham DY, "Prevention of Gastroduodenal Injury Induced by Chronic Nonsteroidal Anti-inflammatory Drug Therapy," Gastroenterology , 1989, 96(2 Pt 2 Suppl):675-81.

Gurwitz JH, Avorn J, Ross-Degnan D, et al, "Nonsteroidal Anti-Inflammatory Drug-Associated Azotemia in the Very Old," JAMA , 1990, 264(4):471-5.

Hawkey CJ, Karrasch JA, Szczepa&ntilde;ski L, et al, "Omeprazole Compared With Misoprostrol for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med , 1998, 338(11):727-34.

Heerdink ER, Leufkens HG, Herings RM, et al, "NSAIDs Associated With Increased Risk of Congestive Heart Failure in Elderly Patients Taking Diuretics," Arch Intern Med , 1998, 158(10):1108-12.

Hoppmann RA, Peden JG, and Ober SK, "Central Nervous System Side Effects of Nonsteroidal Anti-inflammatory Drugs. Aseptic Meningitis, Psychosis, and Cognitive Dysfunction," Arch Intern Med , 1991, 151(7):1309-13.

Jacobi J, Fraser GL, Coursin DB, et al, "Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult," Crit Care Med , 2002, 30(1):119-41. Available at: http://www.sccm.org/pdf/sedatives.pdf. Accessed August 2, 2003.

Knodel LC, "Preventing NSAID-Induced Ulcers: The Role of Misoprostol," Consult Pharm , 1989, 4:37-41.

Kulling EJ, Beckman EA, and Skagius AS, "Renal Impairment After Acute Diclofenac, Naproxen, and Sulindac Overdoses," J Toxicol Clin Toxicol , 1995, 33(2):173-7.

Lang BA and Finlayson LA, "Naproxen-Induced Pseudoporphyria in Patients With Juvenile Rheumatoid Arthritis," J Pediatr , 1994, 124(4):639-42.

Martinez R, Smith DW, and Frankel LR, "Severe Metabolic Acidosis After Acute Naproxen Sodium Ingestion," Ann Emerg Med , 1989, 18(10):1102-4.

Morgan TO, Anderson A, and Bertram D, "Effect of Indomethacin on Blood Pressure in Elderly People With Essential Hypertension Well Controlled on Amlodipine or Enalapril," Am J Hypertens , 2000, 13(11):1161-7.

Nader DA and Schillaci RF, "Pulmonary Infiltrates With Eosinophilia Due to Naproxen," Chest , 1983, 83(2):280-2.

Page J and Henry D, "Consumption of NSAIDs and the Development of Congestive Heart Failure in Elderly Patients: An Underrecognized Public Health Problem," Arch Intern Med , 2000, 160(6):777-84.

Pope JE, Anderson JJ, and Felson DT, "A Meta-analysis of the Effects of Nonsteroidal Anti-inflammatory Drugs on Blood Pressure," Arch Intern Med , 1993, 153(4):477-84.

Pounder R, "Silent Peptic Ulceration: Deadly Silence or Golden Silence?" Gastroenterology , 1989, 96(2 Pt 2 Suppl):626-31.

Shaunak S, Brown P, and Morgan-Hughes JA, "Exacerbation of Idiopathic Parkinson's Disease by Naproxen," BMJ , 1995, 311(7002):422.

Smolinske SC, Hall AH, Vandenberg SA, et al, "Toxic Effects of Nonsteroid Anti-inflammatory Drugs in Overdose. An Overview of Recent Evidence on Clinical Effects and Dose-Response Relationships," Drug Saf , 1990, 5(4):252-74.

Vale JA and Meredith TJ, "Acute Poisoning Due to Nonsteroidal Anti-inflammatory Drugs," Med Toxicol , 1986, 1(1):12-31.

Verbeeck RK, "Pharmacokinetic Drug Interactions With Nonsteroidal Anti-inflammatory Drugs," Clin Pharmacokinet , 1990, 19(1):44-66.

Wallace CA, Farrow D, and Sherry DD, "Increased Risk of Facial Scars in Children Taking Nonsteroidal Anti-inflammatory Drugs," J Pediatr , 1994, 125(5 Pt 1):819-22.

Wells TG, Mortensen ME, Dietrich A, et al, "Comparison of the Pharmacokinetics of Naproxen Tablets and Suspension in Children," J Clin Pharmacol , 1994, 34(1):30-3.

Yeomans ND, Tulassay Z, Juhasz L, et al, "A Comparison of Omeprazole With Ranitidine for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs," N Engl J Med , 1998, 338(11):719-26.


International Brand Names

 Acroxen® (EC); Acusprain® (ZA); Adco-Naproxen® (ZA); Agilxen® (CO); Alacetan® (DE); Aleve® (AR, BE, CH, DE, ES, FR, IT, NL, PL, ZA); Aleve Roche® (AT); Algioprux® (AR); Algonapril® (IT); Alidase® (AR); Alinax® (CO); Aliviomas® (ES); Alpoxen® (FI, NO, SE); Anaflex® (BD); Anapran® (PL); Anaprox® (AU, BE, BG, CA, CH, CR, DK, ES, FI, FR, GB, HK, IE, IS, MY, NL, NZ, PH, SG, TH, VE, VN, ZA); Anaprox® DS (CA); Annoxen-S® (TH); A-Nox® (TR); Antalgin® (ES); Aperdan P® (IT); Apo-Napro-Na® (CA, SG); Apo-Napro-Na DS® (CA); Apo-Naproxen® (CA, PL); Apo-Naproxen SR® (CA); Apra-Gel® (BE, LU); Apranax® (BE, CH, CZ, FR, HU, LU, PL, TR); Aprol® (TR); Apronax® (CO); Aprowell® (TR); Aproxen® (EC); Arthrosin® (GB); Arthroxen® (GB); Artron® (MX); Atren® (TR); Bipronyl® (SG); Boloxen® (PL); Bonmin® (TR); Bonyl® (DK); Bumaflex N® (AR); Causalon Pro® (AR); Compu Naproxen® (ZA); Congex® (AR); Cunaxen® (AR); Dafloxen® [caps, tabs] (MX); Dafloxen® [syrup] (MX); Debril® (AR); Denaxpren® (ES); Deucoval 275 mg® (CL); Deucoval Infantil® (CL); Diparene® (BE, LU); Dolormin f&uuml;r Frauen® (DE); Dorel® (AR); Dysmenalgit® (DE); Emochol® (PL); Eurogesic® (CL); Eurogesic Forte® (CL); Fabralgina® (AR); Fadalivio® (AR); Femex® (NL); Fibroxyn® (ZA); Flanax® (BR, CR, DO, EC, GT, HN, MX, PA, SV); Flogen® [caps] (MX); Floginax® (IT); Floneks® (TR); Floxalin® (IT); Fuxen® (MX); Gen-Naproxen EC (CA); Genoxen® (HK); Gerinap® (IE); Gesiprox® (SG); Gibixen® (IT); Gynestrel® (IT); Huma-Naprox® (HU); Infor® (EC); Inveoxel® (CL); Inza® (AU, SG); Kapnax® (TR); Karoksen® (TR); Laser® (IT); Ledox® (NO); Lundiran® (ES); Malexin® (DE); Melgar® (AR); Merck-Naproxen® (ZA); Miranax® (AT, DK, FI); Momendol® (IT); Monarit® (AR); Nafasol EC® (ZA); Nafasol® (ZA); Naixan® (JP); Naksetol® (YU); Naksin® (TR); Nalgesin® (CZ, HR, PL, RU, SI); Napflam® (ZA); Napmel® (HK, HU, IE); Naponal® (TR); Napradol® (TR); Naprel® (ZA); Napren® (NO, RO, TR); Napren-S® (TR); Naprex® (IE); Naprius® (IT); Napro-A® (BD); Napro® (BD); Naprobene® (AT, CZ); Naprocet® (IT); Naprocoat® (NL); Naprocutan® (DE); Naprodex® (EC); Naprodex Fort® (TR); Naprodil® [tabs] (MX); Naprofidex® (AR); Naproflam® (BE); Naprogesic® (AU); Naproksen® (YU); Naprometin® (FI); Napromex® (FI); Naprontag® (AR); Naprorex® (IT, RO); Naproscript® (ZA); Naprosian® (TH); Naproson® (BD); Naprosyn® (AU, BR, CA, CZ, DK, EC, ES, FI, GB, HK, HR, HU, IE, IN, IT, NO, NZ, PL, PT, RO, RU, SE, SI, TH, TR, ZA); Naprosyn CR® (TR); Naprosyne® (BE, FR, LU, NL); Naprosyn EC® (GB, IE, PT, TR); Naproval® (ES); Naprovite® (NL); Naprox® (BD); Naproxen-Akri® (RU); Naproxen AL® (DE); Naproxen AstraZeneca® (SE); Naproxen Beacons® (SG); Naproxen® (BG, CZ, EC, GB, NO, PL, RO, RU, YU); Naproxen-B® (HU); Naproxene EG® (BE); Naproxene-Eurogenerics® (LU); Naproxene sodico Dorom® (IT); Naproxen Genericon® (AT); Naproxen Hexal® (DE); Naproxen-Mepha® (CH); Naproxen Natrium-B® (HU); Naproxen NM® (DK); Naproxen NM Pharma® (SE); Naproxeno® (AR, EC, ES); Naproxeno Belmac® (ES); Naproxeno Genfar® (EC); Naproxeno MK® (CO, CR, DO, GT, HN, PA, SV); Naproxeno Ratiopharm® (ES); Naproxeno Sodico® (CL); Naproxeno Sodico L.CH.® (CL); Naproxeno Sodico MK® (CO); Naproxen-ratiopharm® (DE); Naproxen Sandoz® (DE); Naproxen Stada® (DE); Naproxen von ct® (DE, LU); Naproxi® (IL); Naproxin® (BD); Naproxiwieb® (DE); Naprux® (AR); Naprux Gesic® (AR); Naps® (TR); Napsyn® (CZ); Napxen® (TH); Narocin® (IL); Narzen® (TH); Naxen® (AU, CA, ID, MX, NZ); Naxin® (BD); Naxopren® (FI); Naxyn® (IL); Neo Eblimon® (IT); Neonaxil® (MX); Neuralprona 250® (AR); Nimesel® (IN); Nitens® (IT); Nixal® (MX); Noflam-N® (NZ, SG); Nopain® (EG, KW, LB, RO, SY); Novaxen® (MX); Novo-Naproc EC (CA); Novo-Naprox (CA); Novo-Naprox Sodium (CA); Novo-Naprox Sodium DS (CA); Novo-Naprox SR (CA); Nu-Naprox (CA); Nuprafen® (BD); Nycopren® (AT, BE, CH, GB, LU, NL, RO); Odontogesic® (EC); Opraks® (TR); Oxeno® (AR); Pactens® (MX); Painflex® (GT); Paraflaxan® (EC); Paraxflan® (EC); Patropan® (EC); Point® (IL); Polyxen® (TH); Prexan® (IT); Priaxen® (CY); Prodexin® (EG); Prodolor® (DE); Pronaxen® (FI, SE); Pronaxil® (MX); Proxagol® (IT); Proxen® (AT, AU, BD, CH, DE, TH, VN); Relokap® (TR); Reprost® (CL); Reuxen® (PT, RO); Riva-Naproxen (CA); Rolab-Naproxen® (ZA); Romaksen® (TR); Roxen® (TH); Sanaprox® (PL, RO); Seladin YSP® (SG); Servinaprox® (BD); Serviproxan® (TH); Sicadentol Plus® (AR); Sindolan® (EC); Soden® (SG); Sodinax® (TR); Sonap® (BD); Soproxen® (SG, TH); Synalgo® (IT); Synax® (TR); Synflex® (GB, HK, ID, IE, IT, NZ, TH, ZA); Tacron® (ES); Tandax® (MX); Tarproxen® (PL); Ticoflex® (IT); Timpron® (GB); Traumox Tablets® (ZA); Tundra® (AR); U-Proxyn® (TH); Valrox® (GB); Veradol® (AR); Vero® (PL); Vinsen® (TH); Xenar® (IT); Xenobid Gel® (IN); Xenobid® (IN); Xicane® (AR); Zynal® (SG)


A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
adam.com