Naproxen: uses, stomach protection and cautions

Naproxen belongs to the non-steroidal anti-inflammatory drugs. The NHS names period pain, joint and muscle pain, gout, osteoarthritis and rheumatoid arthritis as conditions it can help. Some pharmacy types are available without prescription, while others need one.

In day-to-day practice it is often a prescriber who decides between naproxen, ibuprofen and diclofenac. Diclofenac guidance on the NHS says that if someone needs an NSAID long term, ibuprofen or naproxen may be preferred over diclofenac because it is less likely to cause heart problems.

Naproxen comes as tablets, a liquid, or effervescent tablets that you dissolve in water. The NHS says it is usually taken up to three times a day. Swallow tablets whole with water, and do not chew or crush those labelled gastro-resistant or film-coated. Use the spoon or cup supplied with the liquid.

Taking it with or after food is advised to help protect the stomach. Your doctor may also prescribe omeprazole or a similar medicine for that purpose. The principle of using the smallest dose for the shortest time applies to every NSAID.

If you forget a dose, take it when you remember, unless the next one is close, in which case skip the missed dose. Never double up. An extra dose is unlikely to cause problems, but the NHS says to seek advice from a pharmacist or doctor if you have taken more than your packet, leaflet or prescription says. If you cannot reach a pharmacist or took too much on purpose, call NHS 111.

The NHS lists constipation or diarrhoea, dizziness, sleepiness or tiredness, bloating and stomach pain, headaches, nausea or vomiting, a rash and ringing in the ears as common effects. If you feel dizzy, tired or have vision problems, wait until they pass before driving or using machinery.

Serious effects are rarer and become more likely with high doses or long use. They include stomach ulcers or bleeding (black tarry stools, vomiting blood, paleness), kidney problems (breathlessness, blood in urine, swollen ankles), blood problems (repeated sore throats, nosebleeds, infections), heart failure and anaphylaxis. Get medical help promptly if you think you are having one.

The NHS lists previous reactions to naproxen, ibuprofen, aspirin or another NSAID, a past or current stomach ulcer, heart, liver or kidney conditions, asthma or allergies, clotting problems, a previous stroke, Crohn disease or ulcerative colitis, and pregnancy or trying for a baby among reasons it may be unsuitable.

Pregnancy: avoid unless a doctor or pharmacist advises it; paracetamol is usually the best choice. Breastfeeding: naproxen is not usually used because it passes into milk in small amounts, and other NSAIDs such as ibuprofen are described as safer, though a doctor may still recommend it if benefits outweigh risks.

Medicines that may not mix well include anticoagulants such as warfarin, steroids such as prednisolone, antidepressants such as citalopram, diuretics such as furosemide, heart and blood pressure medicines such as enalapril, and methotrexate. It can be used with paracetamol or co-codamol for a short time after talking to a doctor or pharmacist, but not with other NSAIDs such as ibuprofen or aspirin.

The NHS advises limiting alcohol because it can add to the risk of stomach ulcers or bleeding. If naproxen is not suitable, a prescriber can discuss other options, which may include different anti-inflammatories, paracetamol or non-drug measures.