Naproxen Drug Interactions

When certain medicines (such as lithium or aspirin) are taken with naproxen, drug interactions may occur. Some interactions may cause serious side effects, such as an increased risk of bleeding, stomach ulcers, or increased levels of naproxen in the blood. Other medications that can potentially cause interactions include other NSAIDs, cholestyramine, and beta blockers.

Naproxen Interactions: An Overview

Naproxen (brand names include Aleve^®, Naprosyn^®, EC-Naprosyn^®, Anaprox^®, Anaprox^® DS, and Naprelan^®) can potentially interact with a number of medicines. Some of the medicines that may cause naproxen drug interactions include:

Angiotensin-converting enzyme inhibitors (ACE inhibitors), including:
- Benazepril (Lotensin^®), benazepril-hydrochlorothiazide (Lotensin HCT^®), or benazepril-amlodipine (Lotrel^®)
- Captopril (Capoten^®) or captopril-hydrochlorothiazide (Capozide^®)
- Enalapril (Vasotec^®), enalapril-hydrochlorothiazide (Vaseretic^®), or enalapril-felodipine (Lexxel^®)
- Fosinopril (Monopril^®) or fosinopril-hydrochlorothiazide (Monopril-HCT^®)
- Lisinopril (Prinivil^®, Zestril^®) or lisinopril-hydrochlorothiazide (Prinzide^®, Zestoretic^®)
- Quinapril (Accupril^®) or quinapril-hydrochlorothiazide (Accuretic^®, Quinaretic™)
- Ramipril (Altace^®)

Angiotensin II receptor blockers (ARBs), such as:

- Azilsartan (Edarbi™) or azilsartan/chlorthalidone (Edarbyclor™)
- Candesartan (Atacand^®) or candesartan-hydrochlorothiazide (Atacand HCT^®)
- Eposartan (Teveten^®) or eposartan-hydrochlorothiazide (Teveten^® HCT)
- Irbesartan (Avapro^®) or irbesartan-hydrochlorothiazide (Avalide^®)
- Losartan (Cozaar^®) or losartan-hydrochlorothiazide (Hyzaar^®)
- Olmesartan (Benicar^®), olmesartan-hydrochlorothiazide (Benicar HCT^®), or amlodipine and olmesartan (AZOR™)
- Telmisartan (Micardis^®) or telmisartan-hydrochlorothiazide (Micardis^® HCT)
- Valsartan (Diovan^®) or valsartan-hydrochlorothiazide (Diovan HCT^®)

Beta blockers, such as:
- Acebutolol (Sectral^®)
- Atenolol (Tenormin^®)
- Betaxolol (Kerlone^®)
- Bisoprolol (Zebeta^®)
- Carvedilol (Coreg^®, Coreg CR^®)
- Esmolol (Brevibloc^®)
- Labetalol (Trandate^®)
- Metoprolol (Lopressor^®, Toprol-XL^®)
- Nadolol (Corgard^®)
- Nebivolol (Bystolic^®)
- Penbutolol (Levatol^®)
- Propranolol (Inderal^®, Inderal^® LA, InnoPran XL™)
- Sotalol (Betapace^®)
- Timolol

Bile acid sequestrant cholesterol medications, including:
- Cholestyramine (Prevalite^®, Questran^®, Questran^® Light)
- Colesevelam (WelChol^®)
- Colestipol (Colestid^®)

Corticosteroids, including (but not limited to):
- Betamethasone (Celestone^®)
- Cortisone
- Dexamethasone (Decadron^®)
- Fludrocortisone (Florinef^®)
- Hydrocortisone (Cortef^®)
- Methylprednisolone (Depo-Medrol^®, Medrol^®)
- Prednisolone (Orapred^®, Pediapred^®)
- Prednisone
- Triamcinolone (Kenalog^®, Aristospan^®)

Cyclosporine (Gengraf^®, Neoral^®, Sandimmune^®)
Digoxin (Digitek^®, Lanoxin^®)
Diuretics, such as:
- Amiloride (Midamor^®) or amiloride-HCTZ (Moduretic^®)
- Bumetanide (Bumex^®)
- Chlorothiazide (Diuril^®)
- Chlorthalidone (Thalitone^®)
- Ethacrynic acid (Edecrin^®)
- Furosemide (Lasix^®)
- Hydrochlorothiazide (Esidrix^®, HydroDIURIL^®, Microzide^®, Oretic^®)
- Metolazone (Zaroxolyn^®)
- Spironolactone (Aldactone^®) or spironolactone-HCTZ (Aldactazide^®)
- Torsemide (Demadex^®)
- Triamterene (Dyrenium^®) or triamterene/HCTZ (Dyazide^®, Maxzide^®)

Lithium (Eskalith^®, Lithobid^®)
Medications that "thin" the blood or otherwise increase bleeding risk (such as anticoagulant and antiplatelet drugs), such as:
- Antithrombin (ATryn^®, Thrombate III^®)
- Argatroban
- Aspirin (Bayer^® and others)
- Bivalirudin (Angiomax^®)
- Cilostazol (Pletal^®)
- Clopidogrel (Plavix^®)
- Dabigatran (Pradaxa^®)
- Dipyridamole (Persantine^®)
- Drotrecogin alfa (Xigris^®)
- Eptifibatide (Integrilin^®)
- Fondaparinux (Arixtra^®)
- Heparin or heparin-like products, including dalteparin (Fragmin^®), enoxaparin (Lovenox^®), or tinzaparin (Innohep^®)
- Lepirudin (Refludan^®)
- Other nonsteroidal anti-inflammatory drugs (NSAIDs), such as:

- - Celecoxib (Celebrex^®)
  - Diclofenac (Cambia™, Cataflam^®, Flector^®, Solaraze^® Gel, Voltaren^®, Voltaren^® Gel, Voltaren^®-XR, Voltaren Ophthalmic^®, Zipsor™)
  - Etodolac (Lodine^®, Lodine^® XL)
  - Ibuprofen (Motrin^®, Advil^®, Nuprin^®)
  - Indomethacin (Indocin^®, Indocin SR^®)
  - Ketoprofen (Orudis^®, Actron^®, Oruvail^®)
  - Ketorolac (Toradol^®)
  - Meloxicam (Mobic^®)
  - Nabumetone (Relafen^®)
  - Oxaprozin (Daypro^®)
  - Piroxicam (Feldene^®)
  - Others (see List of NSAIDs for a more complete list of these medications)

- Prasugrel (Effient^®)
- Thrombolytics, such as:

- - Alteplase (Activase^®)
  - Reteplase (Retavase^®)
  - Streptokinase (Streptase^®)
  - Tenecteplase (TNKase^®)

- Ticlopidine (Ticlid^®)
- Tirofiban (Aggrastat^®)
- Warfarin (Coumadin^®, Jantoven^®)

Methotrexate (Rheumatrex^®, Trexall^®)
Probenecid (Benemid^®, Probalan^®)
SSRI or SNRI medications, including:
- Citalopram (Celexa^®)
- Duloxetine (Cymbalta^®)
- Desvenlafaxine (Pristiq^®)
- Escitalopram (Lexapro^®)
- Fluoxetine (Prozac^®, Sarafem^®, Selfemra™)
- Fluvoxamine (Luvox^®, Luvox^® CR)
- Levomilnacipran (Fetzima™)
- Milnacipran (Savella™)
- Paroxetine (Paxil^®, Paxil CR^®, Pexeva^®, Brisdelle™)
- Sertraline (Zoloft^®)
- Venlafaxine (Effexor^®, Effexor XR^®).

Several herbal and nutritional supplements can also interact with naproxen and may increase the risk of bleeding. Examples of these include but are not limited to: