pustular.renal failure (more common in patients with pre-
existing renal impairment).renal papillary necrosis.
respiratory disorders.seizure.severe cutaneous adverse
reactions (SCARs).skin reactions.sleep disorders.thirst.
thrombocytopenia.vasculitis.vertigo.visual impairment
.vomiting
SIDE-EFFECTS, FURTHER INFORMATIONFor information
about cardiovascular and gastrointestinal side-effects, and
a possible exacerbation of symptoms in asthma, see Non-
steroidal anti-inflammatory drugs p. 650.
lALLERGY AND CROSS-SENSITIVITYContra-indicated in
patients with a history of hypersensitivity to aspirin or any
other NSAID—which includes those in whom attacks of
asthma, angioedema, urticaria or rhinitis have been
precipitated by aspirin or any other NSAID.
lPREGNANCYAvoid unless the potential benefit outweighs
the risk. Avoid during the third trimester (risk of closure of
fetal ductus arteriosusin uteroand possibly persistent
pulmonary hypertension of the newborn); onset of labour
may be delayed and duration may be increased.
lBREAST FEEDINGUse with caution during breast-feeding.
Amount too small to be harmful but manufacturer advises
avoid.
lHEPATIC IMPAIRMENTUse with caution; there is an
increased risk of gastro-intestinal bleeding andfluid
retention. Avoid in severe liver disease.
lRENAL IMPAIRMENTAvoid if possible or use with caution.
Avoid if estimated glomerularfiltration rate less than
30 mL/minute/ 1. 73 m^2.
Dose adjustmentsThe lowest effective dose should be used
for the shortest possible duration.
MonitoringIn renal impairment monitor renal function;
sodium and water retention may occur and renal function
may deteriorate, possibly leading to renal failure.
lEXCEPTIONS TO LEGAL CATEGORYCan be sold to the public
for the treatment of primary dysmenorrhoea in women
aged 15 – 50 years subject to max. single dose of 500 mg,
max. daily dose of 750 mg for max. 3 days, and a max. pack
size of 96250 mg tablets.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Gastro-resistant tablet
CAUTIONARY AND ADVISORY LABELS5, 25
▶Naproxen (Non-proprietary)
Naproxen 250 mgNaproxen 250 mg gastro-resistant tablets|
56 tabletP£ 7. 00 DT = £ 2. 19
Naproxen 375 mgNaproxen 375 mg gastro-resistant tablets|
56 tabletP£ 26. 82 DT = £ 26. 82
Naproxen 500 mgNaproxen 500 mg gastro-resistant tablets|
56 tabletP£ 7. 34 DT = £ 4. 89
▶Naprosyn EC(Atnahs Pharma UK Ltd)
Naproxen 250 mgNaprosyn EC 250 mg tablets| 56 tabletP
£ 4. 29 DT = £ 2. 19
Naproxen 375 mgNaprosyn EC 375 mg tablets| 56 tabletP
£ 6. 42 DT = £ 26. 82
Naproxen 500 mgNaprosyn EC 500 mg tablets| 56 tabletP
£ 8. 56 DT = £ 4. 89
Tablet
CAUTIONARY AND ADVISORY LABELS 21
▶Naproxen (Non-proprietary)
Naproxen 250 mgNaproxen 250 mg tablets| 28 tabletP£ 2. 10
DT = £ 0. 70 | 56 tabletP£ 2. 33
Naproxen 500 mgNaproxen 500 mg tablets| 28 tabletP£ 4. 27
DT = £ 1. 13 | 56 tabletP£ 3. 99
▶Naprosyn(Atnahs Pharma UK Ltd)
Naproxen 250 mgNaprosyn 250 mg tablets| 56 tabletP£ 4. 29
Naproxen 500 mgNaprosyn 500 mg tablets| 56 tabletP£ 8. 56Oral suspension
▶Naproxen (Non-proprietary)
Naproxen 25 mg per 1 mlNaproxen 25 mg/ml oral suspension sugar
free sugar-free| 100 mlP£ 110. 00 DT = £ 119. 00
Naproxen 125 mg/ 5 ml oral suspension sugar free sugar-free|
100 mlP£ 110. 00 – £ 128. 00 DT = £ 119. 00
Naproxen 50 mg per 1 mlNaproxen 50 mg/ml oral suspension|
100 mlP£ 45. 00 – £ 75. 00 DT = £ 75. 00
Effervescent tablet
▶Stirlescent(Stirling Anglian Pharmaceuticals Ltd)
Naproxen 250 mgStirlescent 250 mg effervescent tablets sugar-free
| 20 tabletP£ 52. 72 DT = £ 52. 72Piroxicam
lINDICATIONS AND DOSE
Relief of pain and inflammation in juvenile idiopathic
arthritis
▶BY MOUTH
▶Child 6–17 years (body-weight up to 15 kg): 5 mg daily
▶Child 6–17 years (body-weight 15–25 kg): 10 mg daily
▶Child 6–17 years (body-weight 26–45 kg): 15 mg daily
▶Child 6–17 years (body-weight 46 kg and above): 20 mg
dailylUNLICENSED USENot licensed for use in children.IMPORTANT SAFETY INFORMATION
CHMP ADVICE—PIROXICAM (JUNE 2007)
The CHMP has recommended restrictions on the use of
piroxicam because of the increased risk of gastro-
intestinal side effects and serious skin reactions. The
CHMP has advised that:
.piroxicam should be initiated only by physicians
experienced in treating inflammatory or degenerative
rheumatic diseases
.piroxicam should not be used asfirst-line treatment
.in adults, use of piroxicam should be limited to the
symptomatic relief of osteoarthritis, rheumatoid
arthritis, and ankylosing spondylitis
.piroxicam dose should not exceed 20 mg daily
.piroxicam should no longer be used for the treatment
of acute painful and inflammatory conditions
.treatment should be reviewed 2 weeks after initiating
piroxicam, and periodically thereafter
.concomitant administration of a gastro-protective
agent should be considered.
Topical preparations containing piroxicam are not
affected by these restrictions.lCONTRA-INDICATIONSActive gastro-intestinal bleeding.
active gastro-intestinal ulceration.history of gastro-
intestinal bleeding.history of gastro-intestinal
perforation.history of gastro-intestinal ulceration.
inflammatory bowel disease.severe heart failure
lCAUTIONSAllergic disorders.cardiac impairment (NSAIDs
may impair renal function).cerebrovascular disease.
coagulation defects.connective-tissue disorders.Crohn’s
disease (may be exacerbated).heart failure.ischaemic
heart disease.peripheral arterial disease.risk factors for
cardiovascular events.ulcerative colitis (may be
exacerbated).uncontrolled hypertension
lINTERACTIONS→Appendix 1 : NSAIDs
lSIDE-EFFECTS
▶Common or very commonAnaemia.appetite decreased.
constipation.diarrhoea.dizziness.drowsiness.
eosinophilia.gastrointestinal discomfort.gastrointestinal
disorders.headache.hearing impairment.
hyperglycaemia.leucopenia.nausea.oedema.rash
(discontinue).skin reactions.thrombocytopenia.vertigo.
vomiting.weight changes660 Pain and inflammation in musculoskeletal disorders BNFC 2018 – 2019
Musculoskeletal system10