ABC of effective therapy – 10 most important facts about naproxen Review article
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Published:
Mar 31, 2023
Keywords:
naproxen, mechanism of action, therapy
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Abstract
Naproxen is a popular non-steroidal anti-inflammatory, analgesic and antipyretic drug, which mechanism of action is based on inhibiting the synthesis of prostaglandins. The drug is effective in reducing pain of various etiology, especially in the therapy of rheumatoid arthritis. It supports the therapy of viral and bacterial infections. Its ability to deposit at the site of inflammation is also important. The paper discusses the principles of therapy, current recommendations and therapeutic possibilities of the drug.
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Sapilak , B. J. (2023). ABC of effective therapy – 10 most important facts about naproxen. Medycyna Faktow (J EBM), 16(1(58), 53-57. https://doi.org/10.24292/01.MF.0123.09
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References
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2. Kearney PM, Baigent C, Godwin J et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006; 332(7553): 1302-8.
3. Zhang H, Wu Y, Lin Z et al. Naproxen for the treatment of neoplastic fever: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2019; 98(22): e15840. http://doi.org/10.1097/MD.0000000000015840.
4. Coşkun Ö, Karakaş A, Savaşci Ü et al. The value of naproxen test as a diagnostic method to differentiate cause of fever. Taf Preventive Medicine Bulletin. 2012; 11: 779-82.
5. Kirshner JJ, McDonald MC 3rd, Kruter F et al. NOLAN: a randomized, phase 2 study to estimate the effect of prophylactic naproxen or loratadine vs no prophylactic treatment on bone pain in patients with early-stage breast cancer receiving chemotherapy and pegfilgrastim. Support Care Cancer. 2018; 26(4): 1323-34. http://doi.org/10.1007/s00520-017-3959-2.
6. Bonnesen K, Schmidt M. Re-categorization of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) according to clinical relevance: Abandoning the ´traditional NSAID´ terminology. Can J Cardiol. 2021: S0828-282X(21)00349-4. http://doi.org/10.1016/j.cjca.2021.06.014.
7. Prozzi GR, Cañás M, Urtasun MA et al. Riesgo cardiovascular de los antiinflamatorios no esteroideos [Cardiovascular risk of non-steroidal anti- inflammatory drugs]. Medicina (B Aires). 2018; 78(5): 349-355.
8. Tarp S, Bartels EM, Bliddal H et al. Effect of nonsteroidal antiinflammatory drugs on the C-reactive protein level in rheumatoid arthritis: a meta- analysis of randomized controlled trials. Arthritis Rheum. 2012; 64(11): 3511-21. http://doi.org/10.1002/art.34644.
9. Brutzkus JC, Shahrokhi M, Varacallo M. Naproxen. [Updated 2021 May 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
10. Ong CK, Lirk P, Tan CH et al. An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res. 2007; 5(1): 19-34.
11. Paglia MDG, Silva MT, Lopes LC et al. Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis. PLoS One. 2021; 16(4): e0248866. http://doi.org/10.1371/journal.pone.0248866.
12. Mendell J, Lee F, Chen S et al. The Effects of the Antiplatelet Agents, Aspirin and Naproxen, on Pharmacokinetics and Pharmacodynamics of the Anticoagulant Edoxaban, a Direct Factor Xa Inhibitor. J Cardiovascular Pharm. 2013; 62(2): 212-21. http://doi.org/10.1097/ FJC.0b013e3182970991.
13. Chong-Nguyen C, Dillinger JG, Spagnoli V et al. Naproxen as an alternat ive to aspirin for platelet inhibition in patients with cardiovascular disease requiring nonsteroidal anti-inflammatory drug? Arch Cardiovasc Dis Suppl. 2016; 8(3): 205.
14. Asadi M, Sayar S, Radmanesh E et al. Efficacy of naproxen in the management of patients hospitalized with COVID-19 infection: A randomized, double-blind, placebo-controlled, clinical trial. Diabetes Metab Syndr. 2021; 15(6): 102319. http://doi.org/10.1016/j.dsx.2021.102319.
15. Khodavirdipour A. Inclusion of Cephalexin in COVID-19 Treatment Combinations May Prevent Lung Involvement in Mild Infections: A Case Report with Pharmacological Genomics Perspective. Glob Med Genet. 2021; 8(2): 78-81. http://doi.org/10.1055/s-0041-1726461.
16. Terrier O, Dilly S, Pizzorno A et al. Antiviral Properties of the NSAID Drug Naproxen Targeting the Nucleoprotein of SARS-CoV-2 Coronavirus. Molecules. 2021; 26(9): 2593. http://doi.org/10.3390/molecules26092593.
17. Kiani P, Scholey A, Dahl TA et al. In Vitro Assessment of the Antiviral Activity of Ketotifen, Indomethacin and Naproxen, Alone and in Combination, against SARS-CoV-2. Viruses. 2021; 13(4): 558. http://doi.org/10.3390/v13040558.
18. Al-Horani RA, Kar S. Potential Anti-SARS-CoV-2 Therapeutics That Target the Post-Entry Stages of the Viral Life Cycle: A Comprehensive Review. Viruses. 2020; 12(10): 1092. http://doi.org/10.3390/v12101092.
19. Adnet F, Slama Schwok A. Efficacy of addition of naproxen in the treatment of critically ill patients hospitalized for COVID-19 infection (ENACOVID). ClinicalTrials. gov (2020).
20.Robb CT, Goepp M, Rossi AG et al. Non-steroidal anti-inflammatory drugs, prostaglandins, and COVID-19. Br J Pharmacol. 2020; 177(21): 4899-920. http://doi.org/10.1111/bph.15206.
21. Chiou WC, Hsu MS, Chen YT et al. Repurposing existing drugs: identification of SARS-CoV-2 3C-like protease inhibitors. J Enzyme Inhib Med Chem. 2021; 36(1): 147-53. http://doi.org/10.1080/14756366.2020.1850710.
22. Hui M, Carr A, Cameron S et al. The British Society for Rheumatology guideline for the management of gout. Rheumatology. 2017; 56(7): e1-e20.
23. Weisman S. Naproxen for Post-Operative Pain. J Pharm Pharm Sci. 2021; 24: 62-70. http://doi.org/10.18433/jpps31629.
24. Moideen S, Anver PC, Uvais NA et al. Positive Naproxen Test in Psychogenic Fever. Prim Care Companion CNS Disord. 2021; 23(3): 20l02630. http://doi.org/10.4088/PCC.20l02630.
25. Han Mİ, Küçükgüzel ŞG. Anticancer and Antimicrobial Activities of Naproxen and Naproxen Derivatives. Mini Rev Med Chem. 2020; 20(13): 1300-10. http://doi.org/10.2174/1389557520666200505124922.
26. Grassi G, Cecchelli C, Vignozzi L et al. Investigational and Experimental Drugs to Treat Obsessive-Compulsive Disorder. J Exp Pharmacol. 2021; 12: 695-706. http://doi.org/10.2147/JEP.S255375.
27. Kumar G, Madka V, Singh A et al. Naproxen inhibits spontaneous lung adenocarcinoma formation in KrasG12V mice. Neoplasia. 2021; 23(6): 574-83. http://doi.org/10.1016/j.neo.2021.05.010.
28. Mohammed A, Janakiram NB, Madka V et al. Intermittent Dosing Regimens of Aspirin and Naproxen Inhibit Azoxymethane--Induced Colon Adenoma Progression to Adenocarcinoma and Invasive Carcinoma. Cancer Prev Res (Phila). 2019; 12(11): 751-62. http://doi.org/10.1158/1940-6207.CAPR-19-0312.
29. Athamneh T, Amin A, Benke E et al. Pulmonary drug delivery with aerogels: engineering of alginate and alginate-hyaluronic acid microspheres. Pharm Dev Technol. 2021; 26(5): 509-21. http://doi.org/10.1080/10837450.2021.1888979.
30. Chirikov VV, Walker C, Stephens JM et al. Evaluating the Cost-Effectiveness of Celecoxib versus Ibuprofen and Naproxen in Patients with Osteoarthritis in United Arab Emirates Based on the PRECISION Trial. Clinicoecon Outcomes Res. 2021; 13: 409-20. http://doi.org/10.2147/CEOR.S280556.
2. Kearney PM, Baigent C, Godwin J et al. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006; 332(7553): 1302-8.
3. Zhang H, Wu Y, Lin Z et al. Naproxen for the treatment of neoplastic fever: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2019; 98(22): e15840. http://doi.org/10.1097/MD.0000000000015840.
4. Coşkun Ö, Karakaş A, Savaşci Ü et al. The value of naproxen test as a diagnostic method to differentiate cause of fever. Taf Preventive Medicine Bulletin. 2012; 11: 779-82.
5. Kirshner JJ, McDonald MC 3rd, Kruter F et al. NOLAN: a randomized, phase 2 study to estimate the effect of prophylactic naproxen or loratadine vs no prophylactic treatment on bone pain in patients with early-stage breast cancer receiving chemotherapy and pegfilgrastim. Support Care Cancer. 2018; 26(4): 1323-34. http://doi.org/10.1007/s00520-017-3959-2.
6. Bonnesen K, Schmidt M. Re-categorization of non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) according to clinical relevance: Abandoning the ´traditional NSAID´ terminology. Can J Cardiol. 2021: S0828-282X(21)00349-4. http://doi.org/10.1016/j.cjca.2021.06.014.
7. Prozzi GR, Cañás M, Urtasun MA et al. Riesgo cardiovascular de los antiinflamatorios no esteroideos [Cardiovascular risk of non-steroidal anti- inflammatory drugs]. Medicina (B Aires). 2018; 78(5): 349-355.
8. Tarp S, Bartels EM, Bliddal H et al. Effect of nonsteroidal antiinflammatory drugs on the C-reactive protein level in rheumatoid arthritis: a meta- analysis of randomized controlled trials. Arthritis Rheum. 2012; 64(11): 3511-21. http://doi.org/10.1002/art.34644.
9. Brutzkus JC, Shahrokhi M, Varacallo M. Naproxen. [Updated 2021 May 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
10. Ong CK, Lirk P, Tan CH et al. An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res. 2007; 5(1): 19-34.
11. Paglia MDG, Silva MT, Lopes LC et al. Use of corticoids and non-steroidal anti-inflammatories in the treatment of rheumatoid arthritis: Systematic review and network meta-analysis. PLoS One. 2021; 16(4): e0248866. http://doi.org/10.1371/journal.pone.0248866.
12. Mendell J, Lee F, Chen S et al. The Effects of the Antiplatelet Agents, Aspirin and Naproxen, on Pharmacokinetics and Pharmacodynamics of the Anticoagulant Edoxaban, a Direct Factor Xa Inhibitor. J Cardiovascular Pharm. 2013; 62(2): 212-21. http://doi.org/10.1097/ FJC.0b013e3182970991.
13. Chong-Nguyen C, Dillinger JG, Spagnoli V et al. Naproxen as an alternat ive to aspirin for platelet inhibition in patients with cardiovascular disease requiring nonsteroidal anti-inflammatory drug? Arch Cardiovasc Dis Suppl. 2016; 8(3): 205.
14. Asadi M, Sayar S, Radmanesh E et al. Efficacy of naproxen in the management of patients hospitalized with COVID-19 infection: A randomized, double-blind, placebo-controlled, clinical trial. Diabetes Metab Syndr. 2021; 15(6): 102319. http://doi.org/10.1016/j.dsx.2021.102319.
15. Khodavirdipour A. Inclusion of Cephalexin in COVID-19 Treatment Combinations May Prevent Lung Involvement in Mild Infections: A Case Report with Pharmacological Genomics Perspective. Glob Med Genet. 2021; 8(2): 78-81. http://doi.org/10.1055/s-0041-1726461.
16. Terrier O, Dilly S, Pizzorno A et al. Antiviral Properties of the NSAID Drug Naproxen Targeting the Nucleoprotein of SARS-CoV-2 Coronavirus. Molecules. 2021; 26(9): 2593. http://doi.org/10.3390/molecules26092593.
17. Kiani P, Scholey A, Dahl TA et al. In Vitro Assessment of the Antiviral Activity of Ketotifen, Indomethacin and Naproxen, Alone and in Combination, against SARS-CoV-2. Viruses. 2021; 13(4): 558. http://doi.org/10.3390/v13040558.
18. Al-Horani RA, Kar S. Potential Anti-SARS-CoV-2 Therapeutics That Target the Post-Entry Stages of the Viral Life Cycle: A Comprehensive Review. Viruses. 2020; 12(10): 1092. http://doi.org/10.3390/v12101092.
19. Adnet F, Slama Schwok A. Efficacy of addition of naproxen in the treatment of critically ill patients hospitalized for COVID-19 infection (ENACOVID). ClinicalTrials. gov (2020).
20.Robb CT, Goepp M, Rossi AG et al. Non-steroidal anti-inflammatory drugs, prostaglandins, and COVID-19. Br J Pharmacol. 2020; 177(21): 4899-920. http://doi.org/10.1111/bph.15206.
21. Chiou WC, Hsu MS, Chen YT et al. Repurposing existing drugs: identification of SARS-CoV-2 3C-like protease inhibitors. J Enzyme Inhib Med Chem. 2021; 36(1): 147-53. http://doi.org/10.1080/14756366.2020.1850710.
22. Hui M, Carr A, Cameron S et al. The British Society for Rheumatology guideline for the management of gout. Rheumatology. 2017; 56(7): e1-e20.
23. Weisman S. Naproxen for Post-Operative Pain. J Pharm Pharm Sci. 2021; 24: 62-70. http://doi.org/10.18433/jpps31629.
24. Moideen S, Anver PC, Uvais NA et al. Positive Naproxen Test in Psychogenic Fever. Prim Care Companion CNS Disord. 2021; 23(3): 20l02630. http://doi.org/10.4088/PCC.20l02630.
25. Han Mİ, Küçükgüzel ŞG. Anticancer and Antimicrobial Activities of Naproxen and Naproxen Derivatives. Mini Rev Med Chem. 2020; 20(13): 1300-10. http://doi.org/10.2174/1389557520666200505124922.
26. Grassi G, Cecchelli C, Vignozzi L et al. Investigational and Experimental Drugs to Treat Obsessive-Compulsive Disorder. J Exp Pharmacol. 2021; 12: 695-706. http://doi.org/10.2147/JEP.S255375.
27. Kumar G, Madka V, Singh A et al. Naproxen inhibits spontaneous lung adenocarcinoma formation in KrasG12V mice. Neoplasia. 2021; 23(6): 574-83. http://doi.org/10.1016/j.neo.2021.05.010.
28. Mohammed A, Janakiram NB, Madka V et al. Intermittent Dosing Regimens of Aspirin and Naproxen Inhibit Azoxymethane--Induced Colon Adenoma Progression to Adenocarcinoma and Invasive Carcinoma. Cancer Prev Res (Phila). 2019; 12(11): 751-62. http://doi.org/10.1158/1940-6207.CAPR-19-0312.
29. Athamneh T, Amin A, Benke E et al. Pulmonary drug delivery with aerogels: engineering of alginate and alginate-hyaluronic acid microspheres. Pharm Dev Technol. 2021; 26(5): 509-21. http://doi.org/10.1080/10837450.2021.1888979.
30. Chirikov VV, Walker C, Stephens JM et al. Evaluating the Cost-Effectiveness of Celecoxib versus Ibuprofen and Naproxen in Patients with Osteoarthritis in United Arab Emirates Based on the PRECISION Trial. Clinicoecon Outcomes Res. 2021; 13: 409-20. http://doi.org/10.2147/CEOR.S280556.