Naproxen (Aleve) Tablets - Uses, Dose, Side effects, Brand Names

Naproxen (Aleve) is a non-selective NSAID (non-steroidal anti-inflammatory drug) that is used to treat pain, inflammation, and fever.

Naproxen (Aleve) Uses:

  • Rheumatological Indications:

    • Used for relief of the signs & symptoms of:
      • acute flares of gout,
      • ankylosing spondylitis,
      • bursitis,
      • polyarticular juvenile idiopathic arthritis (excluding ER tablets),
      • osteoarthritis,
      • rheumatoid arthritis &
      • tendonitis.
    • It is not advised to use delayed-release naproxen for the initial management of acute pain.

  • For Pain in patients with primary dysmenorrhea (Rx and OTC products):

    • Mild to severe pain relief and primary dysmenorrhea therapy.
    • It is not advised to use delayed-release naproxen as a first line of treatment for acute pain.

  • Use: Off-Label:

    • Acute Treatment in Adult Migraine

Naproxen (Aleve) Dose in Adults

Note:

  • Dose expressed as a base of naproxen.
  • 220 mg of naproxen sodium is equal to 200 mg of naproxen base.
  • As naproxen sodium has a quicker start and absorption, it may be preferred for treating acute pain.
  • Although EC-Naprosyn is not advised, naproxen base may also be utilised.

Naproxen (Aleve) Dose in the treatment of Ankylosing spondylitis, osteoarthritis, and rheumatoid arthritis:

  • 500 to 1,000 mg taken twice daily by mouth.
  • Those who require a higher level of anti-inflammatory/analgesic activity and have tolerated lesser dosages (6 months) may temporarily raise the dose to 1,500 mg/day.

  • Naproxen extended-release tablets:

    • Initially, take 750–1,000 mg once daily.
    • Those who have tolerated lesser dosages and need a higher level of anti-inflammatory/analgesic action may temporarily increase to 1,500 mg once daily.

  • Rectal suppository [Canadian product]:

    • Use one 500 mg suppository once daily into the rectum.
    • Note: For individuals taking 1,000 mg of naproxen per day, a suppository may be used in place of one oral dose.

Naproxen (Aleve) Dose in the treatment of acute flares of Gout (alternative agent):

  • Twice day, 500 mg.
  • Start ideally within 24 to 48 hours of the start of the flare.
  • Stop the medication in two to three days after the clinical indications have disappeared.

  • Usual duration:

    •  5-7 days.

  • Manufacturer's labeling:

    • The dosage may not correspond to current clinical practise in the prescribed information.

  • Immediate release:

    • Initial:
    • 250 mg are given after 750 mg every eight hours.

  • Extended-release tablets:

    • Initial:
    • 1,000-1,500 mg once daily, then 1,000 mg once per day.

Note:

  • Delay-release pills are not advised due to the lag in absorption.

Naproxen (Aleve) Dose in the treatment of pain (mild to moderate), dysmenorrhea, acute tendonitis, and bursitis:

  • Initial:

    • 500 mg taken orally, then 250 mg every 6 to 8 hours or 500 mg every 12 hours.

  • Max daily dose:

    • Day 1:
      • 1,250 mg.
      • Daily dosages after that shouldn't go over 1,000 mg.

  • Naproxen extended-release tablets:

    • Initial:
      • Orally, 1,000 mg once daily.
      • If more pain treatment is required, the dose may be temporarily increased to 1,500 mg once daily.
      • The dosage should thereafter be lowered to a daily maximum of 1,000 mg.

Naproxen (Aleve) Dose in the prevention of Episodic migraine (off-label):

  • P/O:
    • Twice a day, 250–500 mg.
    • Continue treatment for another two to three months to assess the clinical benefit.
    • After three to six months, if headaches are under good control, think about reducing or stopping the dose.

Naproxen (Aleve) Dose in the treatment of Migraine, acute (off label):

  • Initial:
    • 750 mg.
    • Further 250-500 mg may be administered if necessary (max: 1,250 mg in 24 hours).

  • OTC labeling:

  • Pain and fever:

    • 200 mg every 8-12 hours.
    • 400 mg may be taken as the initial dose if necessary.
    • Max dose:
      • 400 mg every 8 to 12 hours or 600 mg every 24 hours

Naproxen (Aleve) Dose in Children

Note:

  • Stated as a naproxen base dosage.
  • 220 mg of naproxen sodium is equal to 200 mg of naproxen base.
  • For paediatric patients, all dosing is for formulations with an immediate release.

Naproxen (Aleve) Dose in the treatment of mild to moderate Analgesia/pain:

  • Children and Adolescents <60 kg:

  • P/O:
    • Every 12 hours, administer 5–6 mg/kg.
  • Max daily dose:
    • 1,000 mg/day.
    • Moreover, dosages as high as 10 mg/kg/dose have been suggested.

  • Children and Adolescents ≥60 kg:

  • P/O:
    • Daily, 250-375 mg twice.
  • Max daily dose:
    • 1,000 mg/day.

OTC labeling:

  • Children ≥12 years and Adolescents:

    • P/O:
      • 200 mg every 8-12 hours.
      • If necessary, the initial dose may be 400 mg.
    • Max daily dose:
      • 600 mg/day

Naproxen (Aleve) Dose in the treatment of Fever:

OTC labeling:

  • Children ≥12 years and Adolescents:

  • P/O:
    • 200 mg every 8-12 hours.
    • 400 mg may be used as the starting dose, if necessary.
  • Max daily dose:
    • 600 mg/day

Naproxen (Aleve) Dose in the treatment of Juvenile idiopathic arthritis:

  • Children and Adolescents:

    • P/O:
      • In 2 divided doses, 10-15 mg/kg/day.
    • Max daily dose:
      • 1,000 mg/day.

Naproxen (Aleve) Dose in the treatment of Ankylosing spondylitis:

  • Children and Adolescents:

    • P/O:
      • 15-20 mg/kg/day, divided into two dosages.
    • Max daily dose:
      • 1,500 mg/day.
      • Adult dosage advises keeping this maximum daily dose to no more than six months of treatment.

Naproxen (Aleve) Prgnancy Riiskc Category: C (D in 3rd Trimester)

  • Naproxen crosses over the placenta.
  • Some studies have shown that birth defects can be caused by in utero NSAID use.
  • The data are however contradictory.
  • Following in utero NSAID use, nonteratogenic effects such as prenatal constriction, persistent pulmonary hypertension, oligohydramnios and necrotizing enterocolitis have been seen in the fetus/neonate.
  • Additionally, postnatal nonclosure of ductus arteriosus may occur and be resistant to medical treatment.
  • Because NSAIDs can cause premature closure of ductus arteriosus, naproxen's product label specifically states that you should avoid using it starting at 30 weeks gestation.
  • Pregnant women may be able to use NSAIDs for mild rheumatoid-arthritis flares.
  • It should be avoided or minimized during pregnancy.
  • Women of reproductive age who have been using NSAIDs for a long time may experience infertility. This can be reversed by stopping the medication.
  • Women who have difficulty conceiving or are undergoing fertility treatment should consider quitting.
  • The possibility of miscarriage may increase if NSAIDs are used close to the time of conception.

Naproxen use during breastfeeding:

  • Breast milk contains Naproxen.
  • The naproxen relative infant dose (RID) is 3.3%. This was computed using the maximum amount of breast milk concentration and compared to a daily dose of 750 mg for the mother.
  • When the RID is less than 10%, breastfeeding is acceptable.
  • The highest possible milk concentration (2.37 mg/mL) is used to calculate the infant's daily dose of breast milk. It is 0.36mg/kg/day.
  • Following maternal administration of oral naproxen (375 mg twice daily), the milk concentration was assessed.
  • The urine of the infant who was breastfeeding contained Naproxen (Jamali 1982; Jamali83).
  • In a study that included 20 mothers-infant couples, there were two cases each of drowsiness or vomiting among breastfed infants.
  • Postpartum women who want to breastfeed may use NSAIDs.
  • Other agents may be preferable, but women who breastfeed infants with platelet dysfunction and thrombocytopenia should avoid them.
  • Naproxen can be used for short-term (1 week) when needed.
  • Because naproxen has a lower risk profile, other agents are better for migraine treatment in breastfeeding women (Amundsen 2015).
  • According to the manufacturer, when deciding whether to breastfeed during therapy, you should consider the risks to infants, the benefits to breastfeeding for the mother, and the benefits to the mother.

Naproxen (Aleve) Dose in Kidney Disease:

  • CrCl ≥30 mL/min:
    • No particular dosage modifications are mentioned in the manufacturer's labelling.
    • Use cautiously and consider using a reduced dose.
  • CrCl <30 mL/min:
    • Use is not recommended.
    • Avoid use in patients with advanced renal disease.
  • Hemodialysis:
    • Not dialyzable (NCS/SCCM [Frontera 2016])

  • KDIGO 2012 guidelines provide the following recommendations for NSAIDs:

    • eGFR 30 to <60 mL/min/1.73 m :
      • Temporarily discontinue in patients with intercurrent disease that increases the risk of acute kidney injury.
    • eGFR <30 mL/minute/1.73 m :
      • Avoid use.

Naproxen (Aleve) Dose in Liver disease:

  • No particular dosage modifications are mentioned in the manufacturer's labelling.
  • Use cautiously and consider using a reduced dose.

Side Effects of Naproxen (Aleve):

  • Cardiovascular:

    • Edema
    • Palpitations

  • Central Nervous System:

    • Dizziness
    • Drowsiness
    • Headache
    • Vertigo

  • Dermatologic:

    • Pruritus
    • Skin Rash
    • Ecchymoses
    • Diaphoresis

  • Endocrine & Metabolic:

    • Fluid Retention
    • Increased Thirst

  • Gastrointestinal:

    • Abdominal Pain
    • Constipation
    • Nausea
    • Heartburn
    • Diarrhea
    • Dyspepsia
    • Stomatitis
    • Flatulence
    • Gastrointestinal Hemorrhage
    • Gastrointestinal Perforation
    • Gastrointestinal Ulcer
    • Vomiting

  • Hematologic & Oncologic:

    • Hemolysis
    • Purpura
    • Anemia
    • Prolonged Bleeding Time

  • Hepatic:

    • Increased Liver Enzymes

  • Ophthalmic:

    • Visual Disturbance

  • Otic:

    • Tinnitus
    • Auditory Disturbance

  • Renal:

    • Renal Function Abnormality

  • Respiratory:

    • Dyspnea

Contraindications to Naproxen (Aleve):

  • Naproxen crosses over the placenta.
  • Some studies have shown that birth defects can be caused by in utero NSAID use.
  • The data are however contradictory.
  • Following in utero NSAID use, nonteratogenic effects such as prenatal constriction, persistent pulmonary hypertension, oligohydramnios and necrotizing enterocolitis have been seen in the fetus/neonate.
  • Additionally, postnatal nonclosure of ductus arteriosus may occur and be resistant to medical treatment.
  • Because NSAIDs can cause premature closure of ductus arteriosus, naproxen's product label specifically states that you should avoid using it starting at 30 weeks gestation.
  • Pregnant women may be able to use NSAIDs for mild rheumatoid-arthritis flares.
  • It should be avoided or minimized during pregnancy.
  • Women of reproductive age who have been using NSAIDs for a long time may experience infertility. This can be reversed by stopping the medication.
  • Women who have difficulty conceiving or are undergoing fertility treatment should consider quitting.
  • The possibility of miscarriage may increase if NSAIDs are used close to the time of conception.

Naproxen use during breastfeeding:

  • Breast milk contains Naproxen.
  • The naproxen relative infant dose (RID) is 3.3%. This was computed using the maximum amount of breast milk concentration and compared to a daily dose of 750 mg for the mother.
  • When the RID is less than 10%, breastfeeding is acceptable.
  • The highest possible milk concentration (2.37 mg/mL) is used to calculate the infant's daily dose of breast milk. It is 0.36mg/kg/day.
  • Following maternal administration of oral naproxen (375 mg twice daily), the milk concentration was assessed.
  • The urine of the infant who was breastfeeding contained Naproxen (Jamali 1982; Jamali83).
  • In a study that included 20 mothers-infant couples, there were two cases each of drowsiness or vomiting among breastfed infants.
  • Postpartum women who want to breastfeed may use NSAIDs.
  • Other agents may be preferable, but women who breastfeed infants with platelet dysfunction and thrombocytopenia should avoid them.
  • Naproxen can be used for short-term (1 week) when needed.
  • Because naproxen has a lower risk profile, other agents are better for migraine treatment in breastfeeding women (Amundsen 2015).
  • According to the manufacturer, when deciding whether to breastfeed during therapy, you should consider the risks to infants, the benefits to breastfeeding for the mother, and the benefits to the mother.

Naproxen: Drug Interaction

Risk Factor C (Monitor therapy)

5-Aminosalicylic Acid Derivatives

Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of 5-Aminosalicylic Acid Derivatives.

Agents with Antiplatelet Properties (e.g., P2Y12 inhibitors, NSAIDs, SSRIs, etc.)

May enhance the antiplatelet effect of other Agents with Antiplatelet Properties.

Alcohol (Ethyl)

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination.

Aliskiren

Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Aliskiren. Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Aliskiren. Management: Monitor renal function periodically in patients receiving aliskiren and any nonsteroidal anti-inflammatory agent. Patients at elevated risk of renal dysfunction include those who are elderly, are volume depleted, or have pre-existing renal dysfunction.

Aminoglycosides

Nonsteroidal Anti-Inflammatory Agents may decrease the excretion of Aminoglycosides. Data only in premature infants.

Aminolevulinic Acid (Topical)

Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical).

Angiotensin II Receptor Blockers

May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Angiotensin II Receptor Blockers. The combination of these two agents may also significantly decrease glomerular filtration and renal function.

Angiotensin-Converting Enzyme Inhibitors

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors.

Anticoagulants

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.

Anticoagulants

Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Anticoagulants. Exceptions: Bemiparin; Enoxaparin; Heparin.

Beta-Blockers

Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Beta-Blockers. Exceptions: Levobunolol; Metipranolol.

Bisphosphonate Derivatives

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Bisphosphonate Derivatives. Both an increased risk of gastrointestinal ulceration and an increased risk of nephrotoxicity are of concern.

Cephalothin

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Cephalothin. Specifically, the risk for bleeding may be increased.

Collagenase (Systemic)

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Collagenase (Systemic). Specifically, the risk of injection site bruising and/or bleeding may be increased.

Corticosteroids (Systemic)

May enhance the adverse/toxic effect of Nonsteroidal AntiInflammatory Agents (Nonselective).

Dasatinib

May enhance the anticoagulant effect of Agents with Antiplatelet Properties. Management: Drugs listed as exceptions to this monograph are discussed in further detail in separate drug interaction monographs.

Deferasirox

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Deferasirox. Specifically, the risk for GI ulceration/irritation or GI bleeding may be increased.

Deoxycholic Acid

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Deoxycholic Acid. Specifically, the risk for bleeding or bruising in the treatment area may be increased.

Desmopressin

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Desmopressin.

Digoxin

Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Digoxin.

Drospirenone

Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Drospirenone.

Eplerenone

Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Eplerenone. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Eplerenone.

Fat Emulsion (Fish Oil Based)

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.

Felbinac

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Glucosamine

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Haloperidol

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Haloperidol. Specifically including drowsiness and confusion.

HydrALAZINE

Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of HydrALAZINE.

Ibritumomab Tiuxetan

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Ibritumomab Tiuxetan. Both agents may contribute to impaired platelet function and an increased risk of bleeding.

Ibrutinib

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties.

Inotersen

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Limaprost

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Multivitamins/Fluoride (with ADE)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Multivitamins/Minerals (with ADEK, Folate, Iron)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Multivitamins/Minerals (with AE, No Iron)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Naftazone

May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents.

Obinutuzumab

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Obinutuzumab. Specifically, the risk of serious bleeding-related events may be increased.

Omega-3 Fatty Acids

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Pentosan Polysulfate Sodium

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Specifically, the risk of bleeding may be increased by concurrent use of these agents.

Pentoxifylline

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Porfimer

Photosensitizing Agents may enhance the photosensitizing effect of Porfimer.

Potassium-Sparing Diuretics

Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Potassium-Sparing Diuretics. Nonsteroidal Anti-Inflammatory Agents may enhance the hyperkalemic effect of Potassium-Sparing Diuretics.

PRALAtrexate

Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of PRALAtrexate. More specifically, NSAIDS may decrease the renal excretion of pralatrexate. Management: Closely monitor for increased pralatrexate serum levels and/or toxicity if used concomitantly with an NSAID. Monitor for decreased pralatrexate serum levels with NSAID discontinuation.

Probenecid

May increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents.

Prostacyclin Analogues

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Prostaglandins (Ophthalmic)

Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Prostaglandins (Ophthalmic). Nonsteroidal Anti-Inflammatory Agents may also enhance the therapeutic effects of Prostaglandins (Ophthalmic).

Quinolones

Nonsteroidal Anti-Inflammatory Agents may enhance the neuroexcitatory and/or seizure-potentiating effect of Quinolones. Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Quinolones.

Salicylates

Agents with Antiplatelet Properties may enhance the adverse/toxic effect of Salicylates. Increased risk of bleeding may result.

Serotonin/Norepinephrine Reuptake Inhibitors

May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).

Tacrolimus (Systemic)

Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tacrolimus (Systemic).

Thiazide and Thiazide-Like Diuretics

May enhance the nephrotoxic effect of Nonsteroidal AntiInflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics.

Thrombolytic Agents

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Thrombolytic Agents.

Tipranavir

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Tolperisone

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Tolperisone. Specifically, the risk of hypersensitivity reactions may be increased. Tolperisone may enhance the therapeutic effect of Nonsteroidal Anti-Inflammatory Agents.

Tricyclic Antidepressants (Tertiary Amine

May enhance the antiplatelet effect of Nonsteroidal Anti-Inflammatory Agents (Nonselective).

Vancomycin

Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Vancomycin.

Verteporfin

Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin.

Vitamin E (Systemic)

May enhance the antiplatelet effect of Agents with Antiplatelet Properties.

Risk Factor D (Consider therapy modification)

Apixaban

Naproxen may intensify Apixaban's harmful or hazardous effects. In particular, there may be an elevated risk of bleeding. Apixaban's serum levels may rise in response to naproxen.

Bemiparin

Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin and nonsteroidal anti-inflammatory agents (NSAIDs) due to the increased risk of bleeding. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.

Bemiparin

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Bemiparin. Management: Avoid concomitant use of bemiparin with antiplatelet agents. If concomitant use is unavoidable, monitor closely for signs and symptoms of bleeding.

Bile Acid Sequestrants

May decrease the absorption of Nonsteroidal Anti-Inflammatory Agents.

CycloSPORINE (Systemic)

Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of CycloSPORINE (Systemic). Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of CycloSPORINE (Systemic). CycloSPORINE (Systemic) may increase the serum concentration of Nonsteroidal Anti-Inflammatory Agents. Management: Consider alternatives to nonsteroidal anti-inflammatory agents (NSAIDs). Monitor for evidence of nephrotoxicity, as well as increased serum cyclosporine concentrations and systemic effects (eg, hypertension) during concomitant therapy with NSAIDs.

Dabigatran Etexilate

Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Dabigatran Etexilate. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of dabigatran and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.

Diclofenac (Systemic)

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Seek alternatives to the combined use of diclofenac with other nonsteroidal anti-inflammatory agents (NSAIDs). Avoid the use of diclofenac/misoprostol with other NSAIDs.

Edoxaban

Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Edoxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of edoxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.

Enoxaparin

Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue nonsteroidal anti-inflammatory agents (NSAIDs) prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.

Enoxaparin

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Enoxaparin. Management: Discontinue antiplatelet agents prior to initiating enoxaparin whenever possible. If concomitant administration is unavoidable, monitor closely for signs and symptoms of bleeding.

Heparin

Nonsteroidal Anti-Inflammatory Agents may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or nonsteroidal anti-inflammatory agents (NSAIDs) if coadministration is required.

Heparin

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Heparin. Management: Decrease the dose of heparin or agents with antiplatelet properties if coadministration is required.

Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry)

May enhance the adverse/toxic effect of Agents with Antiplatelet Properties. Bleeding may occur. Management: Avoid combination when possible. If used, monitor more closely for evidence of bleeding. Discontinue herbal products with anticoagulant or antiplatelet actions 2 weeks prior to surgical, dental, or invasive procedures.

Herbs (Anticoagulant/Antiplatelet Properties) (eg, Alfalfa, Anise, Bilberry

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Bleeding may occur. Management: Concomitant treatment with these agents should generally be avoided. If used concomitantly, increased diligence in monitoring for adverse effects (eg, bleeding, bruising, altered mental status due to CNS bleeds) must be employed.

Lithium

Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Lithium.

Loop Diuretics

Nonsteroidal Anti-Inflammatory Agents may diminish the diuretic effect of Loop Diuretics. Loop Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Management: Monitor for evidence of kidney injury or decreased therapeutic effects of loop diuretics with concurrent use of an NSAID. Consider avoiding concurrent use in CHF or cirrhosis. Concomitant use of bumetanide with indomethacin is not recommended.

Methotrexate

Nonsteroidal Anti-Inflammatory Agents may increase the serum concentration of Methotrexate. Management: Alternative anti-inflammatory therapy should be considered whenever possible, especially if the patient is receiving higher, antineoplastic doses of methotrexate.

Rivaroxaban

Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Rivaroxaban. Specifically, the risk of bleeding may be increased. Management: A comprehensive risk to benefit assessment should be done for all patients before any concurrent use of rivaroxaban and nonsteroidal anti-inflammatory drugs (NSAIDs). If combined, monitor patients extra closely for signs and symptoms of bleeding.

Salicylates

Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the adverse/toxic effect of Salicylates. An increased risk of bleeding may be associated with use of this combination. Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the cardioprotective effect of Salicylates. Salicylates may decrease the serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Exceptions: Choline Magnesium Trisalicylate.

Selective Serotonin Reuptake Inhibitors

May enhance the antiplatelet effect of Nonsteroidal AntiInflammatory Agents (Nonselective). Nonsteroidal Anti-Inflammatory Agents (Nonselective) may diminish the therapeutic effect of Selective Serotonin Reuptake Inhibitors. Management: Consider alternatives to NSAIDs. Monitor for evidence of bleeding and diminished antidepressant effects. It is unclear whether COX-2-selective NSAIDs reduce risk.

Sincalide

Drugs that Affect Gallbladder Function may diminish the therapeutic effect of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction.

Sodium Phosphates

May enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with NSAIDs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely.

Tenofovir Products

Nonsteroidal Anti-Inflammatory Agents may enhance the nephrotoxic effect of Tenofovir Products. Management: Seek alternatives to these combinations whenever possible. Avoid use of tenofovir with multiple NSAIDs or any NSAID given at a high dose.

Vitamin K Antagonists (eg, warfarin)

Nonsteroidal Anti-Inflammatory Agents (Nonselective) may enhance the anticoagulant effect of Vitamin K Antagonists.

Risk Factor X (Avoid combination)

Acemetacin

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Aminolevulinic Acid (Systemic)

Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic).

Dexibuprofen

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Dexibuprofen.

Dexketoprofen

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Floctafenine

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Ketorolac (Nasal)

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Ketorolac (Systemic)

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Macimorelin

Nonsteroidal Anti-Inflammatory Agents may diminish the diagnostic effect of Macimorelin.

Mifamurtide

Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Mifamurtide.

Morniflumate

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective)

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective).

Omacetaxine

Nonsteroidal Anti-Inflammatory Agents may enhance the adverse/toxic effect of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs) with omacetaxine in patients with a platelet count of less than 50,000/uL.

Pelubiprofen

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Phenylbutazone

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Talniflumate

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Tenoxicam

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Urokinase

Agents with Antiplatelet Properties may enhance the anticoagulant effect of Urokinase.

Zaltoprofen

May enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents.

Monitoring parameters:

  • CBC (if hemoglobin ≤10 g at initiation, continue to examine hemoglobin periodically during long-term therapy)
  • Chemistry profile (periodically during long-term therapy)
  • LFTs
  • RFTs (urine output, serum BUN and creatinine)
  • BP (at initiation and during therapy)
  • Signs/symptoms of fluid retention
  • Periodic ophthalmic exam (with any vision changes occurring during long-term therapy)
  • Signs of bleeding (occult or gross blood loss).

How to administer Naproxen (Aleve)?

  • P/O:
    • To lessen GI side effects, administer with food, milk, or antacids.
  • Suspension:
    • Before administering, thoroughly shake the suspension.
  • Delayed or extended-release Tablets:
    • Take the tablet whole.
    • Do not chew, shatter, or crush.
  • Rectal suppository [Canadian product]:
    • Suppository into the abdomen.

Mechanism of action of Naproxen (Aleve):

  • Reversibly inhibits COX-1 and COX-2 enzymes. This results in lower formation of prostaglandin precursors.
  • Antipyretic, analgesic and anti-inflammatory properties
  • Other proposed mechanisms not fully elucidated (and possibly contributing to the anti-inflammatory effect to varying degrees), include inhibiting chemotaxis, altering lymphocyte activity, inhibiting neutrophil aggregation/activation & decreasing proinflammatory cytokine levels.

The onset of action:

  • Analgesic:
    • 30-60 mins

Duration:

  • Analgesic:
    • <12 hours

Absorption:

  • P/O:
    • Almost 100%

Protein binding:

  • >99% to albumin.
  • An increased free fraction in elderly

Metabolism:

  • Extensively transformed into 6-0-desmethyl naproxen in the liver.
  • Desmethyl and the parent medication are further metabolised to produce their corresponding acylglucuronide conjugated metabolites.

Bioavailability:

  • 95%

Half-life elimination:

  • Children:
    • Range:
      • 8-17 hours
    • Children 8 to 14 years:
      • 8-10 hours
  • Adults:
    • Normal renal function:
      • 12-17 hours.
    • Moderate-to-severe renal impairment:
      • ~15-21 hours.

Time to peak, serum:

  • Tablets, naproxen:
    • 2-4 hours
  • Tablets, naproxen sodium:
    • 1-2 hours
  • Tablets, delayed-release (empty stomach):
    • 4-6 hours.
  • Range:
    • 2-12 hours
  • Tablets, delayed-release (with food):
    • 12 hours.
  • Range:
    • 4-24 hours
  • Suspension:
    • 1-4 hours
  • Suppository [Canadian product]:
    • 2-3 hours

Excretion:

    • Urine (95%; primarily as metabolites).
    • Feces (≤3%)

International Brands of Naproxen:

  • Aleve
  • All Day Relief
  • Anaprox DS
  • EC-Naprosyn
  • EC-Naproxen
  • Flanax Pain Relief
  • Flanax Pain Relief
  • GoodSense Naproxen Sodium
  • Mediproxen
  • Naprelan
  • Naprosyn
  • Naproxen Comfort Pac
  • Naproxen DR
  • Naproxen Kit
  • Anaprox
  • Anaprox DS
  • APO-Napro-Na
  • APO-Naproxen
  • APO-Naproxen EC
  • APO-Naproxen SR
  • MYLAN-Naproxen EC
  • MYLAN-Naproxen
  • Naprelan
  • Naprosyn
  • Naproxen-Na
  • Naxen EC
  • Pediapharm Naproxen
  • PMS-Naproxen
  • PMS-Naproxen EC
  • PRO-Naproxen EC
  • RATIO-Naproxen E
  • TEVA-Naproxen
  • TEVA-Naproxen EC
  • TEVA-Naproxen Sodium
  • TEVANaproxen Sodium DS
  • TEVA-Naproxen SR
  • Acusprain
  • Aflamax
  • Aleve
  • Anaflex
  • Anexopen
  • Antalgin
  • Apranax
  • Aprelax
  • Apronax
  • Artagen
  • Artroxen
  • Bei Li
  • Bonyl
  • Bumaflex N
  • Cefecon N
  • Clerinax
  • Crysanal
  • Daprox
  • Dysmenalgit
  • Emox
  • Flanax
  • Floginax
  • Gibixen
  • Inza
  • Iraxen
  • Laser
  • Leniartil
  • Licorax
  • Lundiran
  • Mobilon
  • Momen
  • Momendol
  • Myoprox
  • Nafasol
  • Naflax
  • Naldorex
  • Nalgedol
  • Nalgesin
  • Naposin
  • Napoxen
  • Napren E
  • Naprex
  • Naprium
  • Naprius
  • Napro
  • Napro A
  • Naprodil
  • Naprofazt Clearcap
  • Naproff
  • Naproflex
  • Naprontag
  • Naproplat
  • Naprorex
  • Naproscript
  • Naprosyn
  • Naprosyn LE
  • Naprosyn LLE
  • Naprosyn LLE Forte
  • Naprosyn SR
  • Naprosyne
  • Naprox
  • Naproxavi
  • Naprux
  • Naxen
  • Naxen F
  • Naxen-F CR
  • Naxopren
  • Naxyn 250
  • Naxyn 500
  • Noflam
  • Noken
  • Nopain
  • Nopen
  • Norswel
  • Novaxen
  • Nycopren
  • Pairox
  • Penles
  • Prexan
  • Priaxen
  • Primeral
  • Prodexin
  • Progend
  • Proken
  • Pronaxen
  • Propain
  • Proxen
  • Proxidol D.S.
  • Reuxen
  • Safrosyn S
  • Seladin
  • Sindolan
  • Snofin
  • Soden
  • Sutolin
  • Synflex
  • Tormax
  • U-Ritis
  • Ultranax
  • Vadaxena
  • Veradol
  • Xenar
  • Xenifar
  • Xynap

Naproxen Brand Names in Pakistan:

Naproxen Gel 10 % W/W
Arthrox Topical Swiss Pharmaceuticals (Pvt) Ltd.
Artic Shrooq Pharmaceuticals
Napreben Pacific Pharmaceuticals Ltd.
Naprosyn Roche Pakistan Ltd.
Nepra Shrooq Pharmaceuticals
Otengel Neutro Pharma (Pvt) Ltd.
Oxigen Biogen Pharma
Tormax Platinum Pharmaceuticals (Pvt.) Ltd.

Naproxen Gel 0.1 % W/W
Zenap Valor Pharmaceuticals

Naproxen Tablets 50 Mg
Volkum Delta Pharma (Pvt) Ltd.

Naproxen Tablets 250 Mg
Alnapro Macquins International
Alren Alson Pharmaceuticals
Anex Pharmevo (Pvt) Ltd.
Apranax Roche Pakistan Ltd.
Aprolex Alliance Pharmaceuticals (Pvt) Ltd.
Aproxen The Schazoo Laboratories Ltd.
Arthrox Swiss Pharmaceuticals (Pvt) Ltd.
Athroxen Don Valley Pharmaceuticals (Pvt) Ltd.
Bio Prox Bio Labs (Pvt) Ltd.
Dolonap Platinum Pharmaceuticals (Pvt.) Ltd.
Eranap Medera Pharmaceuticals (Pvt) Ltd.
Eroxen English Pharmaceuticals Industries
Eziflam Danas Pharmaceuticals (Pvt) Ltd
Flexin Abbott Laboratories (Pakistan) Limited.
Hinap Zanctok Pharmaceuticals
Loprex Lowitt Pharmaceuticals (Pvt) Ltd
Lowxen Lowitt Pharmaceuticals (Pvt) Ltd
Malprox Adamjee Pharmaceuticals (Pvt) Ltd.
Maprol Miracle Pharmaceuticals(Pvt) Ltd
Mb-Roxen Multinational Buisness Link
Menogesic Biogenics Pakistan (Pvt) Ltd.
Nabromax Ottoman Pharma
Naerex Unipharma (Pvt) Ltd.
Nap Medicraft Pharmaceuticals (Pvt) Ltd.
Napgesic Harmann Pharmaceutical Laboratories (Pvt) Ltd.
Napoli Wilshire Laboratories (Pvt) Ltd.
Naprocil Mediceena Pharma (Pvt) Ltd.
Naprodin Ardin Pharmaceuticals
Naprosyn Roche Pakistan Ltd.
Naprox Pharmedic (Pvt) Ltd.
Naproxen Millinium Pharmaceutical Company
Naprozen Davis Pharmaceutical Laboratories
Naprozone Flow Pharmaceuticals (Pvt) Ltd.
Naptrol Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Napxen Regent Laboratories Ltd.
Naverox Munawar Pharma (Pvt) Ltd.
Naxen Paramount Pharmaceuticals
Naxen Paramount Pharmaceuticals
Naxpro Wellborne Pharmachem And Biologicals
Neoprox Merck Private Ltd.
Neosaid Neo Medix
Nepexen Reko Pharmacal (Pvt) Ltd.
Niproyan Roryan Pharmaceutical Industries (Pvt) Ltd
No-Ache S.J. & G. Fazul Ellahie (Pvt) Ltd.
Novigesic Novins International
Noxron Nawan Laboratories (Pvt) Ltd.
Nycopren Gray`S Pharmaceuticals
Orthoxen Albro Pharma
Prosyn Pearl Pharmaceuticals
Proxen Ici Pakistan Ltd.
Repigesic Hygeia Pharmaceuticals
Roman Mega Pharmaceuticals (Pvt) Ltd
Safprox Saaaf Pharmaceuticals
Sonac Saydon Pharmaceutical Industries (Pvt) Ltd.
Sonum Roryan Pharmaceutical Industries (Pvt) Ltd
Synovax Orta Labs. (Pvt) Ltd.
Xaprox Parke Davis & Company Ltd.
Xepropan Pakistan Pharmaceutical Products (Pvt) Ltd.
Zenap Valor Pharmaceuticals

Naproxen Tablets 275 Mg
Alligesic Alied Medical
Dephlog Standpharm Pakistan (Pvt) Ltd.
Mayoflex Bryon Pharmaceuticals (Pvt) Ltd.
Naporine Polyfine Chempharma (Pvt) Ltd.
Naprofast Mass Pharma (Private) Limited
Naprofed Fedro Pharmaceutical
Nexronap Leads Pharma (Pvt) Ltd
Nothrox Well & Well Pharma (Pvt) Ltd
Nyco-P Fozan Pharmaceuticals Industriers (Pvt) Ltd
Oxigen Biogen Pharma
Propex Noa Hemis Pharmaceuticals
Roxen Nova Med Pharmaceuticals
Xanbid Martin Dow Pharmaceuticals (Pak) Ltd.
Zebroxin Jawa Pharmaceuticals(Pvt) Ltd.

Naproxen Tablets 500 Mg
Alidase Olive Laboratories
Alnapro Macquins International
Alren Alson Pharmaceuticals
Anaprox Jinnah Pharmaceuticals
Anex Pharmevo (Pvt) Ltd.
Apranax Roche Pakistan Ltd.
Aprogesic Aries Pharmaceuticals (Pvt) Ltd
Aprolex Alliance Pharmaceuticals (Pvt) Ltd.
Aproxen The Schazoo Laboratories Ltd.
Arthrox Swiss Pharmaceuticals (Pvt) Ltd.
Artic Shrooq Pharmaceuticals
Athroxen Don Valley Pharmaceuticals (Pvt) Ltd.
Bio Prox Bio Labs (Pvt) Ltd.
Bloxen Bloom Pharmaceuticals (Pvt) Ltd.
Calgesic Raazee Theraputics (Pvt) Ltd.
Compan Z-Jans Pharmaceutical (Pvt) Ltd.
Dolonap Platinum Pharmaceuticals (Pvt.) Ltd.
Dolonap Ec Platinum Pharmaceuticals (Pvt.) Ltd.
Dolosyn Akson Pharmaceuticals (Pvt) Ltd.
Dolotec Serene Pharmaceuticals
Eranap Medera Pharmaceuticals (Pvt) Ltd.
Esmov Medisave Pharmaceuticals
Eziflam Danas Pharmaceuticals (Pvt) Ltd
Flexen Opal Laboratories (Pvt) Ltd.
Flexin Abbott Laboratories (Pakistan) Limited.
Flexoren Friends Pharma (Pvt) Ltd
Fonza Xenon Pharmaceuticals (Pvt) Ltd.
Gaproxin Olive Laboratories
Genoxen Genix Pharma (Pvt) Ltd
Genprox Envoy Pharma
Hizexin Hizat Pharmaceutical Industries (Pvt) Ltd.
Loprex Lowitt Pharmaceuticals (Pvt) Ltd
Lowxen Lowitt Pharmaceuticals (Pvt) Ltd
Maprol Miracle Pharmaceuticals(Pvt) Ltd
Medipyretic Medicon Pharmaceuticals Industries (Pvt) Ltd
Miramax Delux Chemical Industries
Nabromax Ottoman Pharma
Nap Medicraft Pharmaceuticals (Pvt) Ltd.
Napex Candid Pharmaceuticals
Napium Webros Pharmaceuticals
Naplex Global Pharmaceuticals
Napnor Zesion Pharmaceutical (Pvt) Ltd
Napoli Wilshire Laboratories (Pvt) Ltd.
Naprical Dyson Research Laboratories
Naprin Umersons
Napro Heim Pakheim Internanational Pharma
Naprodin Ardin Pharmaceuticals
Naprosyn Roche Pakistan Ltd.
Naprowel Welmark Pharmaceuticals
Naprox Pharmedic (Pvt) Ltd.
Naproxit Pharmacare Laboratories (Pvt) Ltd.
Naprozen Davis Pharmaceutical Laboratories
Naptil Genome Pharmaceuticals (Pvt) Ltd
Naptrol Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Napxen Regent Laboratories Ltd.
Naverox Munawar Pharma (Pvt) Ltd.
Nax Cherwel Pharmaceuticals (Pvt) Ltd
Naxen Paramount Pharmaceuticals
Naxpro Wellborne Pharmachem And Biologicals
Neoprox Merck Private Ltd.
Neosaid Neo Medix
Nepexen-Dd Reko Pharmacal (Pvt) Ltd.
Nepox Batala Pharmaceuticals.
Neprobid Medicineco Pharmaceuticals
Nepromak Makson Pharmaceuticals
Nepsil Silver Oak Corporation.
Nevotic Dr. Raza Pharma (Private) Limited
Niproyan Roryan Pharmaceutical Industries (Pvt) Ltd
No-Ache S.J. & G. Fazul Ellahie (Pvt) Ltd.
Noral Alson Pharmaceuticals
Novigesic Novins International
Noxron Nawan Laboratories (Pvt) Ltd.
Nycopren Gray`S Pharmaceuticals
Orthoxen Albro Pharma
Promig Global Pharmaceuticals
Pronap Goodman Laboratories
Pronax Zinta Pharmaceuticals Industries
Prosyn Pearl Pharmaceuticals
Proxen Ici Pakistan Ltd.
Qinex Qintar Pharmacuticals
Rd-Cam Unison Chemical Works
Repigesic Hygeia Pharmaceuticals
Rheprox Epla Laboratories (Pvt) Ltd.
Rhynox Bloom Pharmaceuticals (Pvt) Ltd.
Roman Mega Pharmaceuticals (Pvt) Ltd
Rox-S Fynk Pharmaceuticals
Sanprox Syntex Pharmaceuticals
Santosa Wise Pharmaceuticals (Pvt) Ltd
Sonac Saydon Pharmaceutical Industries (Pvt) Ltd.
Sonum Roryan Pharmaceutical Industries (Pvt) Ltd
Synflex Ici Pakistan Ltd.
Synovax Orta Labs. (Pvt) Ltd.
Synprox Ambrosia Pharmaceuticals
Torex Ir Platinum Pharmaceuticals (Pvt.) Ltd.
Tormax Platinum Pharmaceuticals (Pvt.) Ltd.
Xaprox Parke Davis & Company Ltd.
Xepropan Pakistan Pharmaceutical Products (Pvt) Ltd.
Xynap Medisure Laboratories Pakistan (Pvt.) Ltd.
Zelprox Shazals Pharmaceuticals
Zenap Valor Pharmaceuticals

Naproxen Tablets 550 Mg
Achfer Medifine Laboratories
Alligesic Alied Medical
Dephlog Standpharm Pakistan (Pvt) Ltd.
Dolocid Crest Pharmaceuticals
Dolocid Crest Pharmaceuticals
Ephanax Epharm Laboratories
Everneo Everest Pharmaceuticals
Everprox Everest Pharmaceuticals
Gia Opal Laboratories (Pvt) Ltd.
Lotoproxen Lotus Pharmaceuticals (Pvt) Ltd
M-Nexum Mediate Pharmaceuticals (Pvt) Ltd
Maprolex Alliance Pharmaceuticals (Pvt) Ltd.
Mayoflex Bryon Pharmaceuticals (Pvt) Ltd.
Nalium Sayyed Pharmaceuticals
Naporine Polyfine Chempharma (Pvt) Ltd.
Naprobid Genome Pharmaceuticals (Pvt) Ltd
Naprofast Mass Pharma (Private) Limited
Naprofed Fedro Pharmaceutical
Naproflex Winilton Pharmaceuticals (Pvt) Ltd
Naro Jaens Pharma
Neepro Healers Laboratories
Nexronap Leads Pharma (Pvt) Ltd
Nothrox Well & Well Pharma (Pvt) Ltd
Nyco-P Fozan Pharmaceuticals Industriers (Pvt) Ltd
Oxigen Biogen Pharma
Panarodin Gray`S Pharmaceuticals
Propex Noa Hemis Pharmaceuticals
Provin Pharmix Laboratories (Private) Limited.
Roxen Nova Med Pharmaceuticals
Sadoxin Rogen Pharmaceuticals
Xanbid Martin Dow Pharmaceuticals (Pak) Ltd.
Xeron Shawan Pharmaceuticals
Zebroxin Jawa Pharmaceuticals(Pvt) Ltd.

Naproxen Tablets 750 Mg
Nexronap Leads Pharma (Pvt) Ltd
Xenar Cr Scharper Pharmaceuticals (Pvt) Ltd.

Naproxen Tablets Sr 750 Mg
Calgesic Raazee Theraputics (Pvt) Ltd.
Nap Medicraft Pharmaceuticals (Pvt) Ltd.
Noral Alson Pharmaceuticals
Provin Pharmix Laboratories (Private) Limited.

Naproxen Capsules 250 Mg
Napreben Pacific Pharmaceuticals Ltd.

Naproxen Capsules 550 Mg
Napreben Pacific Pharmaceuticals Ltd.
Naproser Panacea Pharmaceuticals
Vorsaz Webros Pharmaceuticals
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