Naproxen Safety and Efficacy Considerations

Special Population Adjustments and Critical Safety Considerations

The American Academy of Family Physicians recommends using the lowest effective dose in elderly patients, and dose adjustment may be required when using higher doses, especially when combining with ACE inhibitors or beta blockers due to additive renal effects 1
The American Academy of Family Physicians advises that naproxen is NOT recommended for patients with moderate to severe renal impairment (creatinine clearance <30 mL/min), and use with caution when combining with ACE inhibitors or beta blockers due to additive renal effects 1

The American Academy of Family Physicians states that 10-20% of patients experience dyspepsia or GI discomfort, and the risk of GI bleeding is age-dependent: 1 in 2,100 for adults <45 years vs. 1 in 110 for adults >75 years 1
The American Academy of Family Physicians recommends combining naproxen with PPI or H2 blocker for gastroprotection in high-risk patients, and avoiding its use in patients with history of NSAID-associated upper GI bleeding 1
The American Academy of Family Physicians advises avoiding naproxen in patients with congestive heart failure, and using it with caution in hypertension (mean BP increase of 5 mmHg) 1
The American Academy of Family Physicians states that NSAIDs cause 3.5 excess cardiac ischemic events per 1,000 persons compared to placebo 1

The American Academy of Family Physicians recommends avoiding combining naproxen with anticoagulants (increases GI bleeding risk 3-6 fold and INR by up to 15%), and risk increases with concurrent antiplatelet agents 1
The American Academy of Family Physicians advises monitoring baseline and every 3 months: blood pressure, BUN, creatinine, liver function tests, CBC, and fecal occult blood 1

The National Comprehensive Cancer Network recommends that if two NSAIDs tried in succession show no efficacy, use another approach to analgesia 2