Side effects of naproxen – NHS

Like all medicines, naproxen can cause side effects, although not everyone gets them.

Common side effects

These common side effects of naproxen happen in more than 1 in 100 people. There are things you can do to help cope with them:

Confusion

If naproxen makes you feel confused, speak to your doctor.

Headache

Make sure you rest and drink plenty of fluids. It’s best not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Headaches should usually go away after the first week of taking naproxen. Talk to your doctor if they last longer than a week or are severe.

Ringing in the ears

If this lasts for more than 1 or 2 days, speak to your doctor as they may need to change your treatment.

Changes in vision

If naproxen causes you to have blurred vision, do not drive, cycle or use tools or machinery until this side effect has worn off. GOV.UK has more information about the law on drugs and driving.

Feeling sleepy or tired

As your body gets used to naproxen, these side effects should wear off.

Feeling dizzy

If naproxen makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better. Do not drive, cycle or use tools or machinery until this side effect has worn off. GOV.UK has more information about the law on drugs and driving.

Rashes

It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Call your doctor or contact 111 now if you have:

• severe indigestion, heartburn, pains in your stomach, feeling or being sick (nausea or vomiting) or diarrhoea – these can be signs of an ulcer or swelling (inflammation) in your stomach or gut
• vomiting blood or dark particles that look like coffee grounds, blood in your poo, or black poo that looks like tar – these could be signs of bleeding and perforation of your stomach or gut
• a frequent sore throat, nosebleeds and infections – these can be signs of problems with your blood cells, known as agranulocytosis
• feeling faint, tired or short of breath – these can be signs of anaemia
• blood in your pee, passing less pee, feeling or being sick – these can be signs of kidney damage or infection
• a yellow colour to the whites of your eyes or your skin turns yellow, although this may be less obvious on brown or black skin – these can be signs of jaundice or inflammation of the liver
• irregular, slow heartbeats – this can be a sign of high levels of potassium in the blood
• a high temperature, stomach pain and being sick – these can be signs of inflammation of the pancreas

Go to 111. nhs.uk or call 111.

Immediate action required: Call 999 if:

• you have chest pains – this could be a sign of a heart attack and needs to be checked immediately

Immediate action required: Call 999 or go to A&E if:

• you get a high temperature, feel sick or start being sick, get confused, have a headache, neck stiffness and sensitivity to light – these can be signs of aseptic meningitis

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to naproxen.

Immediate action required: Call 999 or go to A&E now if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

Long term side effects

Naproxen can cause an ulcer in your stomach or gut if you take it for a long time.

Your doctor may tell you not to take naproxen if you have a stomach ulcer or you have had one in the past. If you need to take naproxen but are at risk of getting a stomach ulcer, your doctor may prescribe another medicine for you to take alongside naproxen to protect your stomach.

The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the stomach. But stomach ulcers are not always painful and some people may have other symptoms, such as indigestion, heartburn and feeling sick.

If you’re prone to stomach ulcers or have had one before, take paracetamol instead of naproxen as it’s gentler on your stomach.

Other side effects

These are not all the side effects of naproxen. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 20 January 2022

Next review due: 20 January 2025

Allergic to NSAIDs? Use These Medications Instead

Written by
Juhi Modi

Medically reviewed by
HaVy Ngo-Hamilton, Pharm.D.
| Mar 08, 2022

Like millions of people, you have probably used an NSAID on more than one occasion before to relieve common aches and pains such as back pain, headache, fever, or stiffness and swelling during an arthritis flare.  

Nonsteroidal antiinflammatory drugs (NSAIDs) are widely available medications used to relieve pain and inflammation. They are available by prescription and over the counter. Examples of common over the counter NSAIDs include aspirin (Anacin, Excedrin), ibuprofen (Advil, Motrin), and naproxen sodium (Aleve). 

However, hypersensitivity reactions to NSAIDs occur in a small number of people (approximately 2% of the population). The risk of NSAID allergy is higher in people with asthma, nasal polyps, and chronic urticaria (hives). 

So, what medications can people with an NSAID allergy take instead? And do people with NSAID hypersensitivity need to avoid all NSAIDs or just specific drugs? Please continue reading to find out.

Understanding how nonsteroidal anti-inflammatory drugs work

Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking an enzyme called cyclooxygenase (COX) in the body. There are two types of COX enzymes: COX-1 and COX-2. These enzymes are necessary for the production of compounds called prostaglandins. Prostaglandins are key mediators of reactions such as pain, inflammation, and fever. Therefore, blocking the COX enzymes will reduce pain and inflammation. 

There are different types of nonsteroidal anti-inflammatory drugs. Non-selective NSAIDs block both COX-1 and COX-2. Other NSAIDs selectively block COX-1 or COX-2.

• Non-selective NSAIDs: Ibuprofen (Motrin, Advil)
• COX-1 selective NSAIDs: Aspirin, indomethacin (Indocin), naproxen (Aleve, Naprosyn)
• COX-2 selective NSAIDs: Celecoxib (Celebrex), diclofenac (Voltaren), meloxicam (Mobic)

Blocking of COX-1 is believed to be primarily responsible for the adverse reactions associated with NSAIDs, including most hypersensitivity reactions. This leads to a decrease in prostaglandins and an increase in leukotrienes which play a key role in allergic symptoms. 

On the other hand, blocking COX-2 is responsible for the anti-inflammatory effects of NSAIDs.

In people with allergic reactions to nonsteroidal anti-inflammatory drugs (NSAIDs), doctors first see what type of adverse reactions are present based on the patient’s medical history. Once an adverse reaction is determined to be an NSAID hypersensitivity reaction, doctors then determine whether the patient is allergic to a single NSAID or all NSAIDs. 

A definitive diagnosis of NSAID hypersensitivity is made based on blood tests, skin tests, and provocation tests (the suspected drug is given by mouth in increasing doses over the course of a day under the supervision of a doctor).

Types of allergic reactions or hypersensitivity reactions to NSAIDs

An allergic reaction to nonsteroidal anti-inflammatory drugs can manifest in various ways.

Cutaneous reactions

Symptoms include skin itching, flushing, urticaria (hives or itchy red welts), and angioedema (swelling below the skin surface due to fluid accumulation). These skin reactions can occur in people with no underlying skin problems. On the other hand, worsening of chronic urticaria can occur in people who already have this condition. Rarely, a severe skin reaction called toxic epidermal necrolysis can occur in which there is blistering and peeling of the skin due to an NSAID drug reaction.

Respiratory symptoms

Respiratory reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) include symptoms such as blocked nose, runny nose, sneezing, cough, bronchospasm (asthma), and difficulty breathing. 

Aspirin exacerbated respiratory disease (AERD)

AERD, also called Samter’s Triad or Aspirin Triad, is a medical condition with three distinctive features: sinus disease with recurrent nasal polyps, asthma, and aspirin allergy or sensitivity to other non-steroidal anti-inflammatory drugs blocking the COX-1 enzyme. 

Anaphylaxis

This is a severe and potentially life-threatening, generalized allergic reaction. Symptoms of this reaction include swelling of the lips, eyes, or tongue, shortness of breath, difficulty swallowing, and fast heart rate. Patients can go into anaphylactic shock from allergic reactions, presenting with a severe drop in blood pressure, even loss of consciousness.

What can I use instead of NSAIDs?

In NSAID-sensitive patients who need to avoid aspirin or other non-aspirin NSAIDs due to allergic reactions, acetaminophen (Tylenol) is generally a safe alternative for relieving pain. This over-the-counter medication is an effective fever reducer and pain reliever. However, a single dose of acetaminophen should be less than 1,000 mg to prevent blocking of the COX-1 enzyme. This is especially true for patients with a sensitivity to aspirin, especially those with aspirin-exacerbated respiratory disease (AERD).

What pain medication can I take if I am allergic to NSAIDs?

If you are allergic to one type of NSAID, your doctor may try you on other NSAIDs. For instance, if you have an aspirin allergy (aspirin is a COX-1 inhibitor), it may be possible to relieve pain using COX-2 inhibitors like celecoxib (Celebrex), diclofenac (Voltaren), and meloxicam (Mobic) without causing adverse effects. However, there can be cross-reactivity between NSAIDs, so your doctor will likely administer a test dose in their office. 

Another option for patients with NSAID sensitivity, specifically aspirin sensitivity, is aspirin desensitization, which involves giving patients aspirin in small incremental doses. This is done when there is a compelling need for aspirin therapy, such as the need to use aspirin long-term to prevent cardiovascular disease. Aspirin desensitization is also useful for patients with ischemic heart disease or chronic arthritis. This is believed to gradually decrease the release of inflammatory compounds from mast cells.

Another option for relieving pain in people with adverse effects from NSAIDs is opioid drugs such as hydrocodone (Vicodin) and oxycodone (OxyContin). These drugs control pain in a completely different way than NSAIDs by binding to opioid receptors in the nervous system. However, opiates are reserved as the last line of treatment for chronic pain due to the dependence risk.  

Are there anti-inflammatory drugs that are not NSAIDs? What anti-inflammatory can I take if I’m allergic to ibuprofen?

Corticosteroids (steroid hormones), glucocorticoids specifically, are powerful anti-inflammatory drugs. They are commonly used to treat inflammatory conditions such as osteoarthritis, rheumatoid arthritis, bronchitis, asthma, colitis, and allergic skin rashes. However, corticosteroids can have many serious side effects, especially when used at high doses or for long periods of time.

Wrapping Up

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in people of all ages to treat pain, inflammation, and fever. Allergy or hypersensitivity to NSAIDs can manifest as cutaneous reactions (hives, swelling), respiratory reactions (breathing trouble, runny nose, blocked nose), or a serious and potentially life-threatening allergic reaction called anaphylaxis. There are various options to manage pain and inflammation in people who develop allergic reactions to an NSAID, including other NSAIDs and other drugs like acetaminophen, opioids, and steroids. If you cannot take aspirin or other NSAIDs, you should work with your health professional to identify to which drugs the reaction occurs and then discuss a possible alternative treatment option.

References

1. https://www.practicalpainmanagement.com/treatments/pharmacological/non-opioids/special-report-return-nsaids
2. https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004000/

what are and how they arise

• Main
• All about allergies
• Allergy manifestations
• NSAID Allergy and Adverse Reactions: What and How They Occur

Contents

What are the dangers of NSAIDs?

Aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs or drugs (NSAIDs or NSAIDs) are among the best remedies for fever and various types of pain today. And at the same time, NSAIDs are one of the most common groups of drugs that cause skin and gastrointestinal side effects. Most of these reactions are not allergies, but that doesn’t make them any less unpleasant.

The history of aspirin

Although mankind has been using various plants for antipyretic or analgesic purposes since prehistoric times, the history of aspirin is actually relatively recent. In the 18th century, the Englishman Edward Stone drew the attention of the medical world to the certain efficacy of willow bark in the treatment of malaria . He expressed the opinion that its medicinal properties are not worse than those of cinchona bark. But the truth was that it was quinine that fought the infection, but salicin, obtained from willow bark, only alleviated the symptoms of the disease. But attention to salicylic acid was again drawn and in 1897 year. Then chemist Felix Hoffmann invented a way to synthesize salicylic acid in a pure and stable form suitable for further use in the pharmaceutical industry. Subsequently, the name “aspirin” appeared.

Today it is known that aspirin can not only have an analgesic and antipyretic effect, but also prevent thrombosis and angina pectoris.

In addition to aspirin, a number of synthetic NSAIDs still exist.

They are most commonly used systemically, usually as oral preparations. But they can also be applied topically as suppositories or injected intramuscularly. There are also NSAID creams and gels that can be used for joint pain, sports injuries, and keratosis.

Mechanism of action of NSAIDs

NSAIDs such as aspirin, ibuprofen and others are inhibitors of the cyclooxygenase enzymes (COX-1 and COX-2). These enzymes play a key role in the synthesis of substances such as thromboxane, prostaglandins and prostacyclin from arachidonic acid. COX1-produced prostanoids are important in regulating kidney function, platelet aggregation, and gastric mucosal integrity. COX-2 can be synthesized in the cell background, as well as in response to inflammatory stimuli. It is responsible for the formation of prostaglandins, which are important in the response to inflammation.

NSAIDs bind reversibly to COX-1 and COX-2 receptors and inhibit the binding of arachidonic acid to these receptor sites. This mechanism prevents the conversion of arachidonic acid to various inflammatory prostaglandins. One of their properties is the ability to irritate pain nerves. Its prevention explains the analgesic effect of NSAIDs.

Different NSAIDs differ markedly in their ability to inhibit COX-1 and COX-2, which not only affects their clinical efficacy, but explains the different ability to generate side effects and cause hypersensitivity reactions.

For example, aspirin and most “classic” NSAIDs (eg, indomethacin, naproxen, and diclofenac) predominantly inhibit COX-1 and, to a lesser extent, COX-2, which inhibit the synthesis of protective prostaglandins. This leads to common adverse side effects of their action on the gastrointestinal tract.

At the same time, for example, nimesulide and meloxicam predominantly inhibit COX-2. And selective COX-2 inhibitors (for example, celecoxib, rofecoxib) are strong inhibitors of inflammatory prostaglandins, but only slightly affect the production of protective prostaglandins.

Allergy to NSAIDs

Allergic reactions to NSAIDs are immunologically mediated reactions in which immunoglobulin E (IgE) is released or a T cell response occurs. These reactions are independent of COX-1 inhibition and may be caused by a single NSAID or by a class of NSAIDs with a similar chemical structure. It is believed that hypersensitivity reactions to NSAIDs account for approximately 20-30% of all drug-related reactions. But if the reactions are not immunologically mediated, they are called non-allergic.

True allergy to NSAIDs is relatively rare. But if you have a tendency to hives, nasal polyps, or asthma, the risk of an aspirin allergy rises from 1% (in people without these conditions) to about 10-30%. In turn, the presence of an allergy to aspirin increases the likelihood of allergies to other drugs, in particular, ibuprofen.

Allergic reactions to NSAIDs can be divided into two types, which differ in form and timing of manifestation (immediate – SNIUAA or delayed – SNIDR).

SNIUAA reactions account for over 20% of all NSAID reactions. These conditions are characterized by urticaria, angioedema, or a particularly dangerous form of allergic reaction – anaphylaxis after taking one or more drugs with similar chemical structures.

NSAID Allergy Symptoms

The symptoms of an immediate allergic reaction usually come on suddenly and appear fairly quickly, within seconds to minutes. The timing and range of symptoms associated with SNIUAA reactions are indicative of a type 1 immunological reaction. In this case, specific IgE antibodies can be detected in molecular tests of patients.

The most common causes (US data) of this allergy are diclofenac and aspirin.

In contrast to SNIUAA reactions, delayed reactions (SNIDR) occur 24-48 hours after exposure to ingestion or topical application of NSAIDs. The exact prevalence of SNIDR reactions is not known, but the proportion is believed to be low, less than 5%.

The most common symptoms associated with this reaction are maculopapular rash, contact dermatitis, and photosensitivity reactions.

Severe skin reactions – Stevens-Johnson syndrome / toxic epidermal necrolysis and drug reaction with eosinophilia, are recorded less often. But in general, clinical symptoms depend on the specific NSAID. For example, ibuprofen and naproxen are most commonly associated with maculopapular rashes, while diclofenac and ketoprofen are most commonly associated with contact dermatitis.

In general, if you are allergic to NSAIDs, you may experience the following symptoms:

urticaria

Swelling of the face

Rash

Exacerbation of asthma (wheezing)

Shortness of breath

Shock

redness of the skin.

As noted, severe and life-threatening anaphylaxis can also develop. This condition is characterized by low blood pressure, fainting, urticaria, breathing problems, and so on. With the development of anaphylaxis, a person must immediately enter epinephrine.

Adverse reactions to NSAIDs

Side effects of NSAIDs are much more common than allergic reactions and are usually manifested by stomach pain, ulcers or high blood pressure.

Some NSAIDs, such as aspirin, should not be given to children and teenagers to treat chickenpox or the flu, as they can lead to Reye’s syndrome (a condition with inflammation of the liver and swelling of the brain).

The side effect of NSAIDs may be classified as a hypersensitivity reaction. According to some reports, this reaction occurs in about 0.3% – 6% of the population. It is believed that these reactions occur mainly due to the inhibition of COX-1. It may result in the induction or exacerbation of respiratory and/or skin reactions.

There are three types of non-allergic reactions to NSAIDs.

The first type of – the so-called NECD reactions, occurs in patients with underlying chronic spontaneous urticaria, which may be present in a person at the time of taking NSAIDs or aggravated due to their use. These reactions account for approximately 8% of all cases of hypersensitivity to NSAIDs.

Symptoms usually appear within 30 minutes to 4 hours after drug use and are usually limited to the skin and subcutaneous layer of the skin, not affecting the respiratory tract. However, sometimes symptoms may not appear immediately, but with a delay of up to 24 hours after ingestion. The severity of symptoms depends on the dose. However, they usually resolve within a few hours, although they can last up to several days.

Second type – NIUA reactions that occur in healthy individuals (without a history of urticaria) after the administration of at least two non-chemically related NSAIDs and are manifested by the development of urticaria and / or angioedema. About 60% of non-immunologic reactions are thought to be NIUA reactions.

In most cases, with this type of reaction, symptoms appear within 30 to 90 minutes after taking the medication.

The third type of reactions – NERD is characterized by the development of predominantly respiratory symptoms, such as:

chest tightness,

bronchospasm,

rhinitis,

nasal polyposis and/or nasal congestion.

Usually, in this case, symptoms appear 30 minutes to 3 hours after taking the NSAID.

This condition occurs in patients with underlying chronic respiratory diseases of the lower or upper respiratory system. Because NERD is also considered a chronic eosinophilic inflammatory disorder, these patients have elevated blood eosinophils after a NERD exacerbation. The prevalence of NERD varies from 4% to 20% depending on the country. Patients with severe asthma and middle-aged women have a high prevalence of such reactions.

Information sources:

https://www. ncbi.nlm.nih.gov/pmc/articles/PMC4446629/

3. https://www.news-medical.net/amp/health/Ibuprofen-Allergy-Symptoms-Diagnosis-Treatment.aspx

4. https ://dermnetnz.org/topics/non-steroidal-anti-inflammatory-drugs-and-their-skin-side-effects/

5. https://www.bsaci.org/professional-resources/allergy-management / drug-allergy / non-steroidal-anti-inflammatory-drugs-nsaids /

6.https://www.allergy.org.au/patients/drug-allergy/allergic-reactions-to-aspirin-and-other-pain-killers

7.https://www.news-medical .net/amp/health/Ibuprofen-Allergy-Symptoms-Diagnosis

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“Naproxen” in the Optimum medical laboratory in Sochi

1. Home
2. Analyzes and prices
3. Complex of studies for the detection of allergen: “Naproxen IgE”

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Deadline for
(working days):
up to 3 days.

Price:

599 ₽ ^*

* Biomaterial collection is paid separately

Blood test using solid phase immunofluorescence to detect and measure specific IgE antibodies to the allergen “Naproxen” , is carried out to diagnose drug allergies and determine its causes.

Naproxen refers to anti-inflammatory, analgesic and antipyretic drugs, its main field of application is diseases of the musculoskeletal system. The mechanism of action of this drug is based on the inhibition of the activity of cyclooxygenase isoenzymes, which entails the suppression of the synthesis of mediators of biochemical processes – prostaglandins.

Naproxen helps to eliminate pain in the joints, reduce swelling of their tissues, increase the volume of motor functions, and suppress platelet aggregation. It is prescribed for: arthritis, neuralgia, ankylosing spondylitis, myalgia, osteoarthritis, sciatica, oncological and gynecological pathologies, febrile syndrome, recovery from injuries and surgical interventions, infectious and inflammatory diseases occurring in the upper respiratory tract.

When using Naproxen, an allergic reaction may occur due to the increased susceptibility of the patient’s body to its components. The pathological reaction of the immune system manifests itself a few minutes after taking the medication and is characterized by heartburn, bitterness in the mouth, nausea, stomach cramps, flatulence, redness and swelling of the skin, itchy rash, lowering blood pressure, rhino-conjunctivitis, suffocation. In severe cases, angioedema and anaphylaxis develop – life-threatening conditions that require immediate medical attention.

To prevent the occurrence of drug allergy , an immunological blood test is carried out, during which it is possible to determine the level of specific isotype E immunoglobulin proteins present in the body of a patient sensitized to the components of medications.

Indications for the appointment of a blood test

Blood test for IgE to the allergen: Naproxen is carried out if:

• there are clinical signs of intolerance to pharmacological agents;
• family history of allergic reactions;
• contraindications for performing elimination tests;
• choosing rational therapeutic measures and monitoring their effectiveness.

Rules for preparing for analysis

The biological material is a blood sample from a vein, it is taken in the morning (from 8.00 to 11.00), on an empty stomach.

Before the procedure, the patient should avoid:

• drinking alcohol;
• smoking;
• changes in diet;
• physical, psycho-emotional and nutritional stress.

Deciphering the blood test

Normally, the amount of specific class E antibodies in the blood reaches 0.351 IU / ml . This analysis result is typical for:

• absence of hypersensitivity of the patient to Naproxen;
• allergen exclusion;
• the success of the treatment.