In this short post, I will explain the rationale for naproxen use in the management of pain and inflammation and answer if naproxen and paracetamol can be taken together.
What is naproxen?
Naproxen is commonly prescribed nonsteroidal anti-inflammatory (NSAID) drug. In 2018, Naproxen was prescribed more than 7 mln times (OpenPrescribing.net, 2019), making it one of the most commonly prescribed drugs in the UK. Naproxen is used for the treatment of various conditions including:
- Rheumatoid arthritis
- Acute musculoskeletal (muscle & bone) problems
The ability of NSAID to help with analgesia, inflammation, and to produce antipyretic effects comes from inhibition of cyclo-oxygenase-1 (COX-1) and COX-2 enzymes. COX 1 and COX 2 enzymes are responsible for the synthesis of prostaglandins, which are produced in response to injury or infection (BMJ, 2013). One subtype of prostaglandins acts on ‘sensory neurons’ and this results in pain (Ricciotti & FizGerald, 2011).
Naproxen is one of the first choices when NSAIDs are considered in prescribing. This is because naproxen has good efficacy and low occurrence of side effects, but higher than ibuprofen (BNF, 2019).
Patients should benefit from pain relief straight away after taking the first dose of naproxen, however, it may take a week to achieve full pain relief effect, whereas maximum anti-inflammatory effect may not be achieved up to three weeks after starting the treatment (ibid).
Can I take naproxen and paracetamol together?
Naproxen and paracetamol can be taken together. Both drugs can be taken to help with pain, however, only naproxen works to reduce inflammation. Paracetamol does not have anti-inflammatory properties and does not belong to a NSAID class of drugs.
Furthermore, summary product characteristics (SPC) for naproxen do not indicate any interactions between naproxen and paracetamol.
What other pain killers can be taken with naproxen?
Opioids such as codeine, tramadol or morphine and other codeine-containing products such as co-codamol (paracetamol and codeine) can be taken together with naproxen. Occasionally naproxen is prescribed together with diazepam and co-codamol.
What should not be taken with naproxen?
Other NSAIDS such as aspirin, ibuprofen and combination products containing ibuprofen (for example Nurofen Plus: codeine and ibuprofen) should not be taken with naproxen unless advised by your GP.
Certain medical conditions require some patients to take a low dose of aspirin 75mg and in those circumstances concomitant use with naproxen may be permitted by their GP.
BMJ (2013; 346:f3195). Non-steroidal anti-inflammatory drugs (NSAIDs). Available at: https://www.bmj.com/content/346/bmj.f3195 Accessed on 31/05/2019
OpenPrescribing.net (2019). Naproxen (10010110P0). Available at: https://openprescribing.net/chemical/1001010P0/ Accessed on 30/05/2019
Emanuela Ricciotti, PhD and Garret A. FitzGerald (2011). Prostaglandins and Inflammation. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081099/ Accessed on 30/05/2019