Alcohol
Contraindicated
Textbook-cited
Increased risk of gastric bleeding
Concurrent use is contraindicated
Source: KDT 7e · p950
Drug reference
Naproxen
NSAID (non-selective COX inhibitor, propionic acid derivative) · Analgesic
Also known as Naproxen sodium
START
250-500 mg BD with food; check baseline renal function, BP, and GI history; use PPI gastroprotection if GI risk factors; lowest effective dose for shortest duration
TYPICAL MAX
1000 mg/day (arthritis); 1250 mg/day (short-term pain)
STOP IF
GI bleeding, severe rash, jaundice, eGFR <30, signs of heart failure, CV event
WATCH
BP, renal function, LFTs, GI symptoms, signs of bleeding
CDSCO approvedSchedule HJan AushadhiATC M01AE02
KDIGO 2024 + manufacturer label
- ONSET
- 1h · 1 hour (analgesic)
- PEAK
- 3h · 2-4 hours
- t½
- 13.5h · 12-15 hours
- DURATION
- 12h · 8-12 hours (BD dosing)
EXCRETION
Renal (95%, metabolites)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid in third trimester; use only if clearly needed in first and second trimesters
FDA category + note
Top interactionssee all 12 →
- AlcoholContraindicatedTextbook-citedKDT 7e · p950
- MethylprednisoloneContraindicatedTextbook-citedKDT 7e · p950
- CiprofloxacinSevereTextbook-citedKDT 7e · p949
- DexamethasoneSevereTextbook-citedKDT 7e · p950
Available in India
26 branded formulations and 142 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Non-selective inhibition of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2), reducing prostaglandin synthesis. Potent anti-inflammatory, analgesic, and antipyretic activity. Long half-life allows twice-daily dosing.
Indications
OsteoarthritisRheumatoid arthritisAnkylosing spondylitisAcute goutDysmenorrheaMild to moderate painFeverTendinitis / bursitis
Dosing
- Adult
- Pain/dysmenorrhea: 500 mg loading then 250 mg q6-8h PRN (max 1250 mg/day). Arthritis: 250-500 mg BD (max 1000 mg/day). EC formulation: 375-500 mg BD. Suspension: 25 mg/mL
- Pediatric
- >2 years (JIA): 5 mg/kg BD (max 1000 mg/day). <2 years: not recommended
- Renal adjustment
- Avoid if eGFR <30; use lowest effective dose if eGFR 30-60
- Hepatic adjustment
- Avoid in severe hepatic impairment; reduce dose in mild-moderate
- Geriatric
- Start 250 mg BD; increased risk of GI bleeding and renal impairment
- Max dose
- 1000 mg/day (arthritis); 1250 mg/day (short-term pain)
Pharmacokinetics
Onset
1 hour (analgesic); days (anti-inflammatory)
Peak effect
2-4 hours (Tmax); 1 hour (fasting)
Duration
8-12 hours
Half-life
12-15 hours (long half-life enables BD dosing)
Bioavailability
95%
Protein binding
99%
Metabolism
Hepatic CYP1A2 and CYP2C9 (6-O-demethylation); extensive glucuronidation
Excretion
Renal (95%, primarily as metabolites)
Contraindications
- Active peptic ulcer disease or GI bleeding
- History of GI perforation/ulcer/bleeding with NSAIDs
- Severe heart failure
- Severe renal impairment (eGFR <30)
- Severe hepatic impairment
- Third trimester pregnancy
- Hypersensitivity to naproxen or other NSAIDs
- Aspirin-induced asthma
- Peri-operative pain in CABG surgery (black box warning)
Side effects
Common
DyspepsiaNauseaAbdominal painConstipationDiarrheaHeadacheDizzinessDrowsinessEdema
Serious
- GI bleeding, ulceration, perforation (black box warning)
- Cardiovascular thrombotic events (MI, stroke)
- Nephrotoxicity
- Hepatotoxicity
- Severe skin reactions (Stevens-Johnson, TEN)
- Anaphylaxis
- Agranulocytosis
Pregnancy & lactation
Pregnancy
Avoid in third trimester; use only if clearly needed in first and second trimesters
Lactation
Excreted in breast milk in small amounts; compatible with breastfeeding per AAP; use lowest effective dose
Drug interactions
Methylprednisolone
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Ciprofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity including seizures.
Avoid concurrent use
Source: KDT 7e · p949
Dexamethasone
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Glibenclamide
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Gliclazide
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glimepiride
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glipizide
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Heparin
Severe
Textbook-cited
Increased bleeding risk.
Avoid concurrent use
Source: KDT 7e · p949
Hydrocortisone
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Levofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity, seizure risk.
Avoid concurrent use
Source: KDT 7e · p949
Moxifloxacin
Severe
Textbook-cited
Enhanced CNS toxicity, seizure risk.
Avoid concurrent use
Source: KDT 7e · p949
Related guidelines
Ask House about Naproxen
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19