NAPROXEN Drug Interactions
Also known as: Naproxen
NAPROXEN (brand name: Naproxen) is a NSAIDs. 1 INDICATIONS & USAGE Naproxen delayed-release tablets are indicated for: the relief of the signs and symptoms of: rheumatoid arthritis osteoarthritis ankylosing spondylitis Polyarticular Juvenile Idiopathic Arthritis Naproxen delayed-release tablets are non-steroidal anti-inflammatory drugs…NAPROXEN has 20 documented drug interactions in our database, including 0 contraindicated, 17 major, 3 moderate, and 0 minor interactions.
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Contraindicated
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Moderate
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Minor
Combining naproxen with aspirin 81mg significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided unless specifically directed and closely monitored by your doctor.
Mechanism
Naproxen, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Aspirin 81mg is an antiplatelet agent that irreversibly inhibits COX-1, preventing thromboxane A2 formation and platelet aggregation. The concurrent use of both drugs results in additive antiplatelet effects and increased gastrointestinal mucosal damage, leading to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding, which can manifest as ulcers, melena, hematemesis, or even life-threatening hemorrhage. The risk of major gastrointestinal bleeding is estimated to be 3-5 times higher with this combination compared to either drug alone. Other bleeding risks include bruising, epistaxis, and prolonged bleeding time. This combination should generally be avoided. If concurrent use is absolutely necessary, it must be under strict medical supervision, with the lowest effective doses for the shortest duration. Monitor closely for signs of bleeding (e.g., black stools, vomiting blood, unusual bruising). Consider gastroprotective agents (e.g., proton pump inhibitors) if the combination is unavoidable. Alternative pain relief options that do not affect platelet function (e.g., acetaminophen) should be considered instead of naproxen.
Combining naproxen with apixaban significantly increases your risk of bleeding, particularly in the stomach and intestines. This interaction can lead to serious and potentially life-threatening bleeding episodes.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Apixaban, a direct oral anticoagulant, inhibits factor Xa, preventing thrombin generation and clot formation. Their combined antihemostatic effects lead to an additive increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. Studies show that concurrent use of NSAIDs with DOACs can increase the risk of major bleeding by 1.5 to 2-fold compared to DOACs alone. Concurrent use of naproxen and apixaban should generally be avoided due to the high bleeding risk. If pain management is necessary, consider alternative analgesics such as acetaminophen. If an NSAID is absolutely required, use the lowest effective dose for the shortest possible duration, and monitor closely for signs of bleeding. Patients should be educated on bleeding symptoms and advised to seek immediate medical attention if they occur.
Combining naproxen with rivaroxaban significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to the serious potential for harm.
Mechanism
Naproxen, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation, while also causing direct gastric irritation. Rivaroxaban is a direct oral anticoagulant (DOAC) that selectively inhibits Factor Xa, preventing thrombin generation and clot formation. The concomitant use of these agents results in additive antiplatelet and anticoagulant effects, leading to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding events, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other major bleeding. Studies indicate that concomitant use of NSAIDs with DOACs can increase the risk of major bleeding by 2 to 4-fold compared to DOACs alone, with GI bleeding being particularly prominent. This combination should generally be avoided. If an NSAID is absolutely necessary, consider alternative pain management strategies or a lower-risk analgesic. If no alternative is feasible, use the lowest effective dose of naproxen for the shortest possible duration, and monitor closely for signs of bleeding (e.g., black/tarry stools, unusual bruising, blood in urine). Proton pump inhibitors (PPIs) may be considered for gastroprotection, but do not eliminate the risk. Consult a physician for alternative pain relief or anticoagulant strategies.
Combining naproxen with argatroban significantly increases your risk of bleeding, including serious internal bleeding. This combination should generally be avoided.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase (COX) enzymes, leading to decreased prostaglandin synthesis and impaired platelet aggregation. Argatroban is a direct thrombin inhibitor, which directly prevents fibrin clot formation. The concurrent use of both agents results in additive antiplatelet and anticoagulant effects, leading to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a significantly elevated risk of bleeding, which can manifest as gastrointestinal bleeding (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, hematuria, or excessive bleeding from minor injuries. The risk of serious GI bleeding with NSAIDs and anticoagulants can be several-fold higher compared to either agent alone. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is unavoidable, extreme caution, close monitoring for signs of bleeding, and the lowest effective doses for the shortest duration are essential. Consider alternative pain management strategies that do not involve NSAIDs, or alternative anticoagulants if appropriate. Monitor hemoglobin, hematocrit, and coagulation parameters closely.
Combining naproxen with bivalirudin significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to the heightened risk of serious bleeding events.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Bivalirudin is a direct thrombin inhibitor, preventing fibrin formation and platelet activation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, leading to a synergistic increase in bleeding risk.
Clinical Management
Patients are at a substantially increased risk of serious bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other site-specific bleeding. The risk of major bleeding can be several-fold higher compared to monotherapy, potentially leading to hospitalization, transfusions, or even fatal outcomes. This combination should generally be avoided. If both agents are absolutely necessary, carefully weigh the benefits against the profound bleeding risks, use the lowest effective doses for the shortest duration, and monitor closely for any signs of bleeding. Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen or opioids, if appropriate. Regular monitoring of hemoglobin and hematocrit is crucial.
Concomitant use of warfarin and naproxen significantly increases the risk of bleeding, including serious gastrointestinal bleeding. Patients may experience bruising, epistaxis, hematuria, or more severe hemorrhagic events.
Mechanism
Naproxen, an NSAID, inhibits platelet aggregation and can cause gastrointestinal irritation and ulceration. Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors. The combined antiplatelet and anticoagulant effects, along with GI mucosal damage from naproxen, lead to an additive increase in bleeding risk.
Clinical Management
Avoid concomitant use if possible. If co-administration is necessary, monitor patients closely for signs of bleeding, especially GI bleeding. Adjust warfarin dose as needed, and consider a proton pump inhibitor for GI protection.
Taking naproxen with warfarin significantly increases your risk of serious bleeding, including stomach bleeding. This combination should generally be avoided.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Warfarin, an anticoagulant, inhibits vitamin K-dependent clotting factors. The combined effect is a synergistic impairment of hemostasis, increasing the risk of bleeding.
Clinical Management
This interaction can lead to severe bleeding complications, including gastrointestinal bleeding, intracranial hemorrhage, and other forms of internal bleeding. The risk of major gastrointestinal bleeding can be 3 to 15 times higher when NSAIDs are combined with warfarin. This combination is generally not recommended. If an NSAID is absolutely necessary, consider alternative pain relief options or a COX-2 selective inhibitor with caution and close monitoring. If co-administration is unavoidable, monitor INR frequently, educate the patient on bleeding signs, and consider gastroprotective agents. The lowest effective doses for the shortest duration should be used.
Combining naproxen, an NSAID, with dabigatran, an anticoagulant, significantly increases the risk of serious bleeding, including internal bleeding. This combination should generally be avoided.
Mechanism
Naproxen inhibits cyclooxygenase (COX-1 and COX-2), leading to reduced prostaglandin synthesis, which impairs gastric mucosal protection and inhibits platelet aggregation. Dabigatran directly inhibits thrombin, preventing clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, severely compromising hemostasis.
Clinical Management
Patients are at a substantially increased risk for major bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other site-specific bleeding. The risk of gastrointestinal bleeding can be 3-5 times higher compared to dabigatran alone, with potential for life-threatening outcomes. This combination should be avoided due to the high risk of bleeding. If an analgesic is required, consider acetaminophen as a safer alternative. If NSAID use is absolutely necessary, use the lowest effective dose for the shortest duration, and monitor closely for signs of bleeding. Proton pump inhibitor co-therapy may reduce GI bleeding risk but does not eliminate it.
Combining naproxen with edoxaban greatly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to serious safety concerns.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis. This leads to decreased platelet aggregation and can cause direct gastric mucosal damage. Edoxaban is a direct oral anticoagulant (DOAC) that inhibits Factor Xa, preventing thrombin generation and clot formation. The combination results in additive antiplatelet and anticoagulant effects, significantly impairing hemostasis.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other serious bleeding events. Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by 2-3 fold compared to DOACs alone, with GI bleeding being particularly prevalent. This combination should generally be avoided. If an NSAID is absolutely necessary, consider alternative pain management strategies first. If no alternatives exist, use the lowest effective dose of the NSAID for the shortest possible duration, and closely monitor for signs of bleeding. Proton pump inhibitors (PPIs) should be co-prescribed to reduce GI bleeding risk. Consider alternative analgesics such as acetaminophen.
Taking naproxen and heparin together significantly increases your risk of bleeding, including serious internal bleeding. This combination should generally be avoided unless specifically directed and closely monitored by your doctor.
Mechanism
Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. This leads to impaired platelet aggregation and can cause gastrointestinal mucosal damage, increasing bleeding risk. Heparin is an anticoagulant that directly inhibits clotting factors, further impairing the blood's ability to clot. The combined antiplatelet effect of naproxen and anticoagulant effect of heparin result in an additive and synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, which can range from minor bruising or nosebleeds to severe, life-threatening hemorrhage, particularly gastrointestinal bleeding. Studies show that concurrent use of NSAIDs with anticoagulants can increase the risk of serious GI bleeding by 3 to 15 times compared to anticoagulants alone. Other potential bleeding sites include intracranial, genitourinary, and surgical sites. This combination should generally be avoided. If concurrent use is absolutely necessary, it must be done under strict medical supervision with frequent monitoring for signs of bleeding (e.g., blood in stool, unusual bruising, dizziness). Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen. If an NSAID is required, a COX-2 selective inhibitor might be considered, though it still carries significant risk.
Combining naproxen with enoxaparin significantly increases your risk of bleeding, which can be serious or even life-threatening. This includes bleeding from the stomach, intestines, or other body parts.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Enoxaparin is a low molecular weight heparin that directly inhibits Factor Xa, preventing clot formation. The concurrent use results in an additive antiplatelet and anticoagulant effect, profoundly increasing the risk of hemorrhage.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal hemorrhage, intracranial hemorrhage, and other major bleeding events. Studies show that combining NSAIDs with anticoagulants can increase the risk of serious GI bleeding by 3 to 15 times compared to anticoagulants alone. Symptoms may include black, tarry stools, vomiting blood, unusual bruising, or prolonged bleeding from cuts. This combination should generally be avoided due to the high bleeding risk. If concurrent use is absolutely necessary, it should be done with extreme caution under close medical supervision, with frequent monitoring for signs and symptoms of bleeding. Consider alternative pain management strategies that do not involve NSAIDs, or use the lowest effective dose of naproxen for the shortest possible duration. Proton pump inhibitors may be co-prescribed to reduce GI bleeding risk.
Combining naproxen with fondaparinux significantly increases your risk of bleeding, including serious and life-threatening bleeding episodes. This combination should generally be avoided.
Mechanism
Naproxen, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal defense and inhibit platelet aggregation. Fondaparinux is a synthetic selective inhibitor of activated factor Xa (anti-Xa), which prevents thrombin generation and clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, alongside increased gastrointestinal mucosal damage from the NSAID.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, but also intracranial hemorrhage or other major bleeding events. Studies show that NSAID use with anticoagulants can increase the risk of serious GI bleeding by 3 to 15 times compared to anticoagulants alone. Symptoms may include black, tarry stools, vomiting blood, unusual bruising, or prolonged bleeding from cuts. This combination should generally be avoided due to the high bleeding risk. If pain relief is necessary, consider alternative analgesics such as acetaminophen. If an NSAID is absolutely required, use the lowest effective dose for the shortest duration possible, and closely monitor for signs of bleeding. Proton pump inhibitors (PPIs) may be considered for gastroprotection, but do not eliminate the bleeding risk. Regular monitoring of hemoglobin and hematocrit is recommended.
Combining naproxen with dipyridamole significantly increases your risk of bleeding, especially in the stomach or intestines. You should avoid taking these medications together unless specifically instructed by your doctor.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Dipyridamole is an antiplatelet agent that also inhibits platelet function. The co-administration of these two drugs leads to an additive antiplatelet effect, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can manifest as stomach pain, black or bloody stools, or vomiting blood. Other bleeding risks include bruising, nosebleeds, and prolonged bleeding from cuts. The risk of serious GI bleeding can be several-fold higher compared to either drug alone. Concomitant use of naproxen and dipyridamole should generally be avoided due to the high bleeding risk. If anti-inflammatory or analgesic therapy is required, consider alternative pain relief options such as acetaminophen. If antiplatelet therapy is essential, re-evaluate the need for naproxen or consider a gastroprotective agent if co-administration is unavoidable and closely monitor for signs of bleeding.
Combining naproxen with ticagrelor significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided due to the serious potential for harm.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase (COX-1 and COX-2), reducing prostaglandin synthesis, which impairs gastric mucosal protection and platelet aggregation. Ticagrelor is a P2Y12 inhibitor that prevents platelet activation and aggregation through a different mechanism. The concurrent use of both agents leads to an additive antiplatelet effect and increased gastrointestinal mucosal damage, profoundly elevating bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other major bleeding. Patients may experience symptoms like black, tarry stools, vomiting blood, unusual bruising, or prolonged bleeding from minor cuts. The risk of major bleeding is significantly elevated compared to either drug alone. This combination should generally be avoided. If an NSAID is absolutely necessary for a patient on ticagrelor, consider alternative pain management strategies or a short course of a COX-2 selective NSAID with a proton pump inhibitor (PPI) for gastric protection, though bleeding risk remains high. Closely monitor for any signs or symptoms of bleeding, and educate the patient on these risks. Discuss with the prescribing physician to determine the best course of action.
Combining naproxen with clopidogrel significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase-1 (COX-1), reducing prostaglandin synthesis and impairing platelet aggregation. Clopidogrel is an antiplatelet agent that irreversibly blocks the P2Y12 receptor on platelets, preventing platelet activation and aggregation. The concurrent use of these agents results in an additive antiplatelet effect, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially elevated risk of bleeding, particularly gastrointestinal bleeding, which can be severe or life-threatening. Studies indicate that the combination of NSAIDs with antiplatelets can increase the risk of upper GI bleeding by 3-5 times compared to antiplatelet therapy alone. This combination should generally be avoided due to the high bleeding risk. If concurrent use is unavoidable, patients should be closely monitored for signs of bleeding (e.g., black stools, easy bruising, nosebleeds). Consider alternative pain management strategies or gastroprotective agents (e.g., proton pump inhibitors) if NSAID use is essential. Evaluate the need for both medications carefully.
Combining naproxen with prasugrel significantly increases your risk of serious bleeding, especially from the stomach or intestines. Your doctor will likely avoid this combination.
Mechanism
Naproxen, an NSAID, inhibits cyclooxygenase, reducing prostaglandin synthesis and impairing platelet aggregation. Prasugrel is an antiplatelet agent that irreversibly inhibits the P2Y12 receptor on platelets. The concurrent use of these two drugs leads to additive antiplatelet effects and increased gastrointestinal mucosal damage, significantly elevating bleeding risk.
Clinical Management
Patients are at a substantially increased risk of serious bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other site-specific bleeding. The risk of major GI bleeding can be several-fold higher compared to antiplatelet therapy alone. This combination should generally be avoided due to the high risk of bleeding. If an NSAID is absolutely necessary, consider alternative pain management strategies or use the lowest effective dose for the shortest duration, with close monitoring for bleeding signs. Proton pump inhibitor co-prescription is recommended if NSAID use is unavoidable.
Combining naproxen with cilostazol greatly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided due to severe bleeding potential.
Mechanism
Naproxen, a non-selective NSAID, inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that also directly inhibits platelet aggregation. The concurrent use of these agents results in additive antiplatelet effects and increased gastrointestinal mucosal damage, significantly elevating bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding, particularly gastrointestinal hemorrhage, which can manifest as black, tarry stools, vomiting blood, or severe abdominal pain. The risk of major bleeding can be several-fold higher compared to either drug alone, potentially leading to anemia, hospitalization, or even death. This combination should generally be avoided. If both drugs are deemed absolutely necessary, close monitoring for signs and symptoms of bleeding is critical, including regular blood counts and stool occult blood tests. Consider alternative pain management strategies that do not involve NSAIDs, such as acetaminophen, or alternative antiplatelet agents if appropriate. If an NSAID is unavoidable, a COX-2 selective inhibitor might be considered with extreme caution and gastric protection, but the overall risk remains high.
NSAIDs can reduce the antihypertensive effect of ACE inhibitors and increase the risk of acute kidney injury.
Mechanism
NSAIDs inhibit prostaglandin synthesis, reducing renal afferent arteriole dilation and blunting the renal protective effects of ACE inhibitors.
Clinical Management
Monitor blood pressure and renal function. Use acetaminophen as an alternative when possible.
Concomitant use of ibuprofen and naproxen, both non-steroidal anti-inflammatory drugs (NSAIDs), is generally not recommended due to an increased risk of gastrointestinal (GI) adverse effects, including ulcers, bleeding, and perforation, as well as renal toxicity. While they may offer additive analgesic effects, the increased risk of side effects typically outweighs the benefits.
Mechanism
Both ibuprofen and naproxen exert their therapeutic and adverse effects primarily through the non-selective inhibition of cyclooxygenase (COX) enzymes, COX-1 and COX-2. Concurrent administration leads to an additive pharmacological effect, resulting in a higher degree of prostaglandin inhibition and, consequently, an increased risk of dose-dependent adverse events.
Clinical Management
Avoid co-administration of ibuprofen and naproxen. If an NSAID is required, use a single agent at the lowest effective dose for the shortest duration necessary. If pain relief is inadequate with one NSAID, consider switching to an alternative analgesic class or adding a different modality rather than combining NSAIDs.
Concomitant use of celecoxib and naproxen, both non-steroidal anti-inflammatory drugs (NSAIDs), significantly increases the risk of gastrointestinal adverse events, including ulcers, bleeding, and perforation, as well as renal toxicity and cardiovascular events. There is no evidence of increased efficacy with this combination compared to monotherapy with either drug.
Mechanism
Both celecoxib (a selective COX-2 inhibitor) and naproxen (a non-selective COX inhibitor) exert their therapeutic and adverse effects by inhibiting prostaglandin synthesis. Concurrent administration leads to an additive pharmacological effect, increasing the suppression of protective prostaglandins in the gastrointestinal tract and kidneys, and potentially increasing prothrombotic effects.
Clinical Management
The concomitant use of celecoxib and naproxen is generally not recommended due to the increased risk of adverse effects without additional therapeutic benefit. If NSAID therapy is required, clinicians should opt for monotherapy and consider gastroprotective agents or alternative pain management strategies. Patients should be monitored closely for signs of gastrointestinal bleeding, renal dysfunction, and cardiovascular events.
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