Indications
Sonap serves to alleviate the signs and symptoms associated with various conditions, including:
- Rheumatoid arthritis
- Osteoarthritis
- Ankylosing spondylitis
- Juvenile arthritis
- Tendonitis
- Bursitis
- Acute gout Additionally, it is effective in managing primary dysmenorrhea and pain.
Pharmacology
Similar to other non-selective NSAIDs, naproxen operates by inhibiting COX-1 and COX-2 enzymes, thereby reducing prostaglandin synthesis. While both enzymes contribute to prostaglandin production, they function differently. COX-1 is consistently active and present in normal tissues like the stomach lining, while COX-2 is inducible and produces prostaglandins responsible for pain, fever, and inflammation. Naproxen’s desirable antipyretic, analgesic, and anti-inflammatory properties stem from its inhibition of the COX-2 enzyme, while unwanted effects like gastrointestinal upset and renal issues are associated with COX-1 inhibition.
Dosage & Administration
Naproxen oral formulations should be ingested with water, preferably after meals.
Naproxen Enteric Coated Tablet:
- Adults: For rheumatoid arthritis, osteoarthritis, ankylosing spondylitis: 500-1000 mg per day in two divided doses at 12-hour intervals. The maintenance dose is typically 500 mg per day in two divided doses at 12-hour intervals, not exceeding 1000 mg daily.
- For acute gout: Initially 750 mg, followed by 250 mg every 8 hours until the attack subsides. Not recommended for children under 16.
- For dysmenorrhea: Initially 500 mg, followed by 250 mg every 6-8 hours for up to 5 days if necessary.
- For other indications like analgesia and acute musculoskeletal disorders: Initially 500 mg, followed by 250 mg every 6-8 hours if necessary. Naproxen Enteric Coated Tablet for Children: Not recommended for children under 16.
Naproxen Suspension for Children:
- For juvenile rheumatoid arthritis: The usual dose for children over 2 years is 10 mg/kg/day in two divided doses at 12-hour intervals. Therapy in children under 2 years is not recommended. Dosage guide:
- 13 kg (29 lb): 2.5 mL b.i.d.
- 25 kg (55 lb): 5 mL b.i.d.
- 38 kg (84 lb): 7.5 mL b.i.d.
Naproxen Gel: Apply 2-6 times daily as needed, not recommended for children.
Interactions
- ACE inhibitors: Diminish antihypertensive effect.
- Antacids & Sucralfate: Delay Sonap absorption.
- Aspirin: Increase adverse effects.
- Diuretics: Reduce natriuretic effect.
- Methotrexate: Enhance toxicity.
- Warfarin: Increase GI bleeding risk.
- Selective Serotonin Reuptake Inhibitors (SSRI): Increase GI bleeding risk.
Contraindications
Naproxen is contraindicated in patients with known hypersensitivity to it. Avoid in patients with asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs. Contraindicated for perioperative pain in coronary artery bypass graft (CABG) surgery.
Side Effects
Common side effects may include:
- Gastrointestinal: Heartburn, abdominal pain, nausea, diarrhea, dyspepsia.
- Central Nervous System: Headache, vertigo, drowsiness.
- Dermatological: Pruritus, purpura.
- Cardiovascular: Edema, palpitation.
- Others: Visual disturbances, hearing disturbances.
Pregnancy & Lactation
Naproxen may adversely affect the fetus and should be cautiously used in pregnancy. It’s excreted in breast milk but considered safe in small amounts.
Precautions & Warnings
Renal effects: Long-term use may lead to renal issues. Caution in patients with impaired renal function. Monitor serum creatinine and/or creatinine clearance.
Hepatic effects: Few cases of jaundice reported.
Therapeutic Class
Osteoarthritis and rheumatoid arthritis drugs, Non-steroidal Anti-inflammatory Drugs (NSAIDs).
Storage Conditions
Store below 30°C, protected from light and moisture, and out of children’s reach.
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