Naproxen/Naproxen Sodium

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Also indexed as: Aleve, Anaprox, Apo-Napro-Na, Apo-Naproxyn, Arthrosin, Arthroxen, Napralen, Napron X, Naprosyn, Naxen, Novo-Naprox, Novo-Naprox Sodium, Nu-Naprox, Nycopren, Rhodiaprox, Synflex, Timpron

Naproxen/naproxen sodium are members of the non-steroidal anti-inflammatory drug (NSAIDs) family. NSAIDs reduce inflammation (swelling), pain, and temperature. Naproxen is used to treat mild to moderate pain, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, primary dysmenorrhoea, tendinitis, bursitis, and other conditions. Naproxen and naproxen sodium are available in prescription strength; naproxen sodium is also available in non-prescription strength.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

May Be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.	Iron
May Be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.	Copper* Liquorice
May Be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.	Copper*
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Lithium* Sodium* White willow*
Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.	Potassium
Reduced drug absorption/bioavailability	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Copper
Supplementation with copper may enhance the anti-inflammatory effects of NSAIDs while reducing their ulcerogenic effects. One study found that when various anti-inflammatory drugs were chelated with copper, the anti-inflammatory activity was increased.¹ Animal models of inflammation have found that the copper chelate of aspirin was active at one-eighth the effective dose of aspirin. These copper complexes are less toxic than the parent compounds, as well.

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.² Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

Iron
NSAIDs cause gastro-intestinal (GI) irritation, bleeding, and iron loss.³ Iron supplements can cause GI irritation.⁴ However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency. If both iron and naproxen are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

Potassium
Naproxen has caused kidney problems and increased blood potassium levels, especially in older people.⁵ ⁶ People taking naproxen should not supplement potassium without consulting with their doctor.

Sodium
Naproxen may cause sodium and water retention.⁷ It is healthy to reduce dietary salt intake by decreasing the use of table salt and avoiding heavily salted foods.

Interactions with Herbs

Liquorice (Glycyrrhiza glabra)
The flavonoids found in the extract of liquorice known as DGL (deglycyrrhizinated liquorice) are helpful for avoiding the irritating actions NSAIDs have on the stomach and intestines. One study found that 350 mg of chewable DGL taken together with each dose of aspirin reduced gastro-intestinal bleeding caused by the aspirin.⁸ DGL has been shown in controlled human research to be as effective as drug therapy (cimetidine) in healing stomach ulcers.⁹

White willow bark (Salix alba)
White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.¹⁰ Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

Interactions with Foods and Other Compounds

Food
Naproxen should be taken with food to prevent gastro-intestinal upset.¹¹

Alcohol
Naproxen may cause drowsiness, dizziness, or blurred vision.¹² Alcohol may intensify these effects and increase the risk of accidental injury. Use of alcohol during naproxen therapy increases the risk of stomach irritation and bleeding. People taking naproxen should avoid alcohol.

References
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1. Sorenson JRJ. Copper chelates as possible active forms of the antiarthritic agents. J Medicinal Chem 1976;19:135–48.

2. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

3. Bjarnason I, Macpherson AJ. Intestinal toxicity of non-steroidal anti-inflammatory drugs. Pharmacol Ther 1994;62:145–57.

4. Threlkeld DS, ed. Blood Modifiers, Iron-Containing Products. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jun 1998, 62–9a.

5. Bailie GR. Acute renal failure. In Applied Therapeutics: The Clinical Use of Drugs, 6th ed. Vancouver, WA: Applied Therapeutics, 1995, 29–33.

6. Perazella MA. Drug-induced hyperkalemia: Old culprits and new offenders. Am J Med 2000;109:307–14 [review].

7. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1993, 251n–1o.

8. Rees WDW, Rhodes J, Wright JE, et al. Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin. Scand J Gastroenterol 1979;14:605–7.

9. Morgan AG, McAdam WAF, Pascoo C, Darnborough A. Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy. Gut 1982;23:545–51.

10. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

11. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1992, 251n–1o.

12. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1992, 251n–1o.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

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Interactions with Dietary Supplements

Interactions with Herbs

Interactions with Foods and Other Compounds