Naproxen Use in Elderly Patients

Introduction to Naproxen Use

The American Geriatrics Society recommends that naproxen should be used rarely and with extreme caution in elderly patients, reserved only for highly selected individuals after safer therapies have failed, and always co-prescribed with a proton pump inhibitor for gastrointestinal protection 1

The American Geriatrics Society suggests that naproxen may only be considered when safer therapies have failed, evidence of continuing therapeutic goals not met with alternative agents, and no absolute contraindications are present 1
Absolute contraindications for naproxen in elderly patients include active peptic ulcer disease, heart failure, and chronic kidney disease or creatinine clearance <30 mL/min 1

The American Geriatrics Society strongly recommends that all elderly patients taking naproxen must receive concurrent proton pump inhibitor or misoprostol for gastrointestinal protection, with high-quality evidence supporting this recommendation 1
Elderly patients on naproxen should be routinely assessed for gastrointestinal toxicity, renal function deterioration, blood pressure elevation, heart failure exacerbation, and drug-drug and drug-disease interactions 1

The American Geriatrics Society recommends prioritizing alternatives such as acetaminophen up to 4 grams daily, topical NSAIDs, and opioids before considering naproxen 1, 3, 7, 8
Naproxen may interact with other medications, including ACE inhibitors, diuretics, and antiplatelets, requiring close monitoring 5, 6

NSAIDs, including naproxen, were implicated in 23.5% of hospitalizations due to adverse drug reactions in older adults, with gastrointestinal toxicity increasing in frequency and severity with age 2, 3, 4
The gastrointestinal toxicity of naproxen is both dose-related and time-dependent, with long-term use substantially increasing the risk of serious complications 2, 3, 4