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Drug Overdoses during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
No specific antidote to naproxen exists. In one case of 5 g naproxen taken in overdose during pregnancy, at 35 weeks gestation, nonspecific and supportive antidote therapy was initiated eight hours later Non-specific therapy was given, and spontaneous labor ensued with a preterm infant delivered. The neonate had severe hyponatremia and water retention, but subsequently recovered with no apparent sequelae at follow-up. The mother recovered, and had no signs of hepatotoxicity or other adverse sequelae (Alon-Jones and Williams, 1986).
Headache
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Stephen Silberstein, Shuhan Zhu
For acute treatment of primary headache, acetaminophen alone (preferably) or with codeine (for refractory headache) should be the first choice during all trimesters. Naproxen and ibuprofen are safe and well tolerated in pregnancy, but should be avoided after 28 weeks. Severe unrelenting migraine responds well to parenteral antiemetics, such as metoclopramide and prochlorperazine. Beta-blockers (such as propranolol or metoprolol) or low- dose tricyclics (amitriptyline) can be considered as a prophylactic medication for the pregnant patient whose headache frequency requires daily preventive medication, and for whom non-pharmacologic approaches to headache prophylaxis have failed.
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Paracetamol should be regarded as the first-line analgesic for mild-to-moderate pain and as a component of multimodal analgesia in the treatment of moderate and severe pain. Clinically, its analgesic efficacy is comparable to low-dose naproxen (200 mg), but it is less effective than NSAIDs in therapeutic doses (Graham et al, 2013). It has become the first-line choice worldwide for pain relief across a wide range of indications and a wide range of patients and patient ages. Reasons for this popularity include its relative effectiveness in many pain conditions, its high tolerability (even for patients in whom other nonopioids are contraindicated), and the minimal risk of serious adverse effects.
Hippocampal neuroinflammation following combined exposure to cyclophosphamide and naproxen in ovariectomized mice
Published in International Journal of Neuroscience, 2023
Samantha Pavlock, Deirdre M. McCarthy, Anisha Kesarwani, Pascal Jean-Pierre, Pradeep G. Bhide
In our study CP, naproxen or ovariectomy did not produce significant effects on anxiety-like phenotype. Although there was a significant interaction among the three factors, pairwise comparisons did not reveal significant differences between the experimental groups. Therefore, we can rule out anxiety as a confounding variable in our other behavioral analyses. CP produced significant decreases in exploratory behavior in a novel environment as well as in locomotor activity. The reduction occurred in intact mice on control diet but not in intact mice on a naproxen diet. Moreover, CP produced significant decrease in spontaneous locomotor activity in intact and ovariectomized mice that were on a control diet rather than naproxen diet. These data suggest, that naproxen may modify the effects of CP on spontaneous locomotor activity, perhaps by reducing peripheral inflammation produced by CP or ovariectomy. CP is known to induce inflammation, especially cystitis.44 Naproxen, although an anti-inflammatory drug is reported to produce toxic effects on multiple organs45,46 and paradoxically, may contribute to inflammation. Further studies would be needed to address this issue.
Preparation and evaluation of transdermal naproxen niosomes: formulation optimization to preclinical anti-inflammatory assessment on murine model
Published in Journal of Liposome Research, 2020
Dibyalochan Mohanty, Miriyala Jhansi Rani, M. Akiful Haque, Vasudha Bakshi, Mohammed Asadullah Jahangir, Syed Sarim Imam, Sadaf Jamal Gilani
Naproxen (NAPR, Figure 1) is a non-steroidal anti-inflammatory drug (NSAID) used in the treatment of musculoskeletal disorders such as arthritis, traumatic contusions and dysmenorrhea (Okur et al. 2011). The chemical formula of NAPR is 6-methoxy-α-methyl-2-naphthalene acetic acid and having the clinical oral dose of 0.75–2.25 g/day. It has shown poor water solubility (approximately 15.9 mg/L at 25 °C, logP = 3.18) and the elimination half-life (12–14 h) are the main reasons for its low efficacy (Szura et al.2014). The therapeutic efficacy of NAPR could be ameliorated by improving the solubility by reducing the size and using the surfactant. The oral therapy of NAPR is very effective but their clinical use is limited because of the systemic toxicity, gastritis and peptic ulcers (Beetge et al.2000). To overcome these problems and to achieve a better therapeutic effect, the transdermal drug delivery system will be ideally possible. This administration route may help to maintain a constant plasma level for long-term therapy from a single dose (Jantharaprapap and Stagni 2007). There are several attempts have been taken to improve the skin permeation of NAPR using different formulation approaches such as liposomes (Puglia et al.2010; Szura et al. 2014), enhancer-loaded gel (Patwardhan et al. 2017; Barakat 2010), microemulsion (Okur et al. 2011, 2014) and organogels (Osmałek et al.2017).
Safety of naproxen compared with placebo, ibuprofen and acetaminophen: a pooled analysis of eight multiple-dose, short-term, randomized controlled studies
Published in Current Medical Research and Opinion, 2019
Kizito Kyeremateng, Emanuel Troullos, Alberto Paredes-Diaz
Naproxen is regularly used to relieve pain and inflammation in various acute and chronic conditions, both at prescription and lower non-prescription doses. Several meta-analyses have indicated that naproxen has a favorable safety profile compared with placebo16,17, although the risk of NSAID-induced gastrointestinal AEs with naproxen has been classed as intermediate14,18. The purpose of our post-hoc pooled analysis was to quantify the rate of adverse events reported with non-prescription doses of naproxen compared with placebo, ibuprofen and acetaminophen, using data extracted from eight multiple-dose, multi-day (7–10 days) duration, randomized, controlled trials. As some studies have not been previously published, we believe that the safety data are important to further contribute towards current knowledge regarding the safety profile of naproxen.