Naproxen in treatment of osteoarthritis

Geriatric Patients The hepatic and renal tolerability of long-term Naproxen administration was studied in two double-blind clinical trials involving patients. Of the patients studied, 98 patients were age 65 and older and 10 of the 98 patients were age 75 and older. Naproxen was administered at doses of mg twice daily or mg twice daily for up to 6 months. Transient abnormalities of laboratory tests assessing hepatic and renal function were noted in some patients, although there were no differences noted in the occurrence of abnormal values among different age groups.

Indications and Usage for Naproxen Carefully consider the potential benefits and risks of Naproxen Suspension and other treatment options before deciding to use Naproxen Suspension. Naproxen Suspension is indicated: For the relief of the signs and symptoms of rheumatoid arthritis For the relief of the signs and symptoms of osteoarthritis For the relief of the signs and symptoms of ankylosing spondylitis For the relief of the signs and symptoms of juvenile rheumatoid arthritis Naproxen Suspension is recommended for juvenile rheumatoid arthritis in order to obtain the maximum dosage flexibility based on the patient's weight.

Naproxen Suspension is also indicated: For relief of the signs and symptoms of tendonitis For relief of the signs and symptoms of bursitis For relief of the signs and symptoms of acute gout For the management of pain For the management of primary dysmenorrhea Contraindications Naproxen Suspension is contraindicated in the following patients: However, patients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic events, due to their increased baseline rate.

Some observational studies found that this increased risk of serious CV thrombotic events began as early as the first weeks of treatment. The increase in CV thrombotic risk has been observed most consistently at higher doses. To minimize the potential risk for an adverse CV event in NSAID-treated patients, use the lowest effective dose for the shortest duration possible.

Physicians and patients should remain alert for the development of such events, throughout the entire treatment course, even in the absence of previous CV symptoms.

Patients should be informed about the symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use.

Although the absolute rate of death declined somewhat after the first year post-MI, the increased relative risk of death in NSAID users persisted over at least the next 4 years of follow-up. Avoid the use of Naproxen Suspension in patients with a recent MI unless the benefits are expected to outweigh the risk of recurrent CV thrombotic events.

If Naproxen Suspension is used in patients with a recent MI, monitor patients for signs of cardiac ischemia Gastrointestinal Bleeding, Ulceration, and Perforation NSAIDs, including Naproxen, can cause serious gastrointestinal GI adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal.

These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. However, even short-term therapy is not without risk. Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include longer duration of NSAID therapy; concomitant use of oral corticosteroids, aspirin, anticoagulants, or selective serotonin reuptake inhibitors SSRIs , smoking, use of alcohol, older age, and poor general health status.

Most postmarketing reports of fatal GI events occurred in elderly or debilitated patients. Avoid use in patients at higher risk unless benefits are expected to outweigh the increased risk of bleeding.

If a serious GI adverse event is suspected, promptly initiate evaluation and treatment, and discontinue Naproxen Suspension until a serious GI adverse event is ruled out.

In addition, rare, sometimes fatal, cases of severe hepatic injury, including fulminant hepatitis, liver necrosis and hepatic failure have been reported. Inform patients of the warning signs and symptoms of hepatotoxicity e. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur e. Hypertension NSAIDs, including Naproxen Suspension, can lead to new onset of hypertension or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV events.

Use of Naproxen may blunt the CV effects of several therapeutic agents used to treat these medical conditions [e. Avoid the use of Naproxen Suspension in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure.

If Naproxen Suspension is used in patients with severe heart failure, monitor patients for signs of worsening heart failure. Each 5 mL of Naproxen Suspension contains 39 mg of sodium.

This should be considered in patients whose overall intake of sodium must be severely restricted. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of an NSAID may cause a dose-dependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation.

Patients at greatest risk of this reaction are those with impaired renal function, dehydration, hypovolemia, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors or ARBs, and the elderly. No information is available from controlled clinical studies regarding the use of Naproxen Suspension in patients with advanced renal disease.

The renal effects of Naproxen Suspension may hasten the progression of renal dysfunction in patients with pre-existing renal disease. Correct volume status in dehydrated or hypovolemic patients prior to initiating Naproxen Suspension. Avoid the use of Naproxen Suspension in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal function. If Naproxen Suspension is used in patients with advanced renal disease, monitor patients for signs of worsening renal function.

Advanced Renal Disease Increases in serum potassium concentration, including hyperkalemia, have been reported with use of NSAIDs, even in some patients without renal impairment.

In patients with normal renal function, these effects have been attributed to a hyporeninemic-hypoaldosteronism state. When Naproxen Suspension is used in patients with preexisting asthma without known aspirin sensitivity , monitor patients for changes in the signs and symptoms of asthma.

These serious events may occur without warning. New reports on painkiller risks, based on reviews of dozens of studies including hundreds of thousands of patients, indicate most patients should try naproxen, an older nsaid drug. Why is Naproxen prescribed? Naproxen is a nonsteroidal anti-inflammatory drug used to relieve mild to moderate pain and menstrual cramps.

Naproxen is also prescribed for relief of the inflammation, swelling, stiffness, and joint pain associated with rheumatoid arthritis and osteoarthritis, and for ankylosing spondylitis spinal arthritis , tendinitis, bursitis, acute gout, and other conditions. Naproxen also may be prescribed for juvenile arthritis. If you aches and pains, and sore throat, during the common cold or flu, naproxen, at a dose of mg, , or , can be helpful in relieving the aches and pains.

Naproxen side effects, is it safe? Any concerns for danger? If you take naproxen regularly you could develop ulcers or internal bleeding. Another naproxen side effect is harm to kidneys. A long term naproxen side effect could be hearing loss. Naproxen side effects may not be anticipated.

If any naproxen side effects develop or change in intensity, inform your doctor as soon as possible. Other side effects of Naproxen may include: Abdominal pain, bruising, constipation, diarrhea, difficult or labored breathing, dizziness, drowsiness, headache, hearing disturbances, heartburn, indigestion, inflammation of the mouth, itching, light-headedness, nausea, rapid, fluttery heartbeat, red or purple spots on the skin, ringing in the ears, skin eruptions, sweating, swelling due to fluid retention, thirst, vertigo, vision changes.

Naproxen can also cause insomnia if taken later in the day or evening, especially at a dose of mg or higher. Paracetamol If you have pain caused by osteoarthritis, your GP may suggest taking paracetamol to begin with.

This is available over the counter in pharmacies without a prescription. It's best to take it regularly rather than waiting until your pain becomes unbearable. However, when taking paracetamol, always follow the dosage your GP recommends and don't exceed the maximum dose stated on the pack.

NSAIDs are painkillers that work by reducing inflammation. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints. Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it.

NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining. COX-2 drugs have a lower risk of causing stomach problems, but still need to be used with a PPI if you take them regularly. Opioids Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work.

Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation. Codeine is found in combination with paracetamol in common preparations such as co-codamol.

Other opioids that may be prescribed for osteoarthritis include tramadol brand names include Zamadol and Zydol , and dihydrocodeine brand name DF Forte.

Both come in tablet form and as an injection. Tramadol isn't suitable if you have uncontrolled epilepsy , and dihydrocodeine isn't recommended for patients with chronic obstructive pulmonary disease COPD.

If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation. Capsaicin cream Your GP may prescribe capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs haven't been effective in easing your pain. Capsaicin cream works by blocking the nerves that send pain messages in the treated area.

You may have to use it for a while before it has an effect. You should experience some pain relief within the first 2 weeks of using the cream, but it may take up to a month for the treatment to be fully effective. Apply a pea-sized amount of capsaicin cream to your affected joints up to 4 times a day, but not more often than every 4 hours.

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