Screen for NSAID allergy, GI risk, and renal status before prescribing naproxen.
Absolute: anaphylaxis or severe asthma triggered by NSAIDs. Relative: peptic ulcer disease, renal impairment, bleeding risk, cardiovascular disease, and concurrent anticoagulant therapy.
Cross-reactive urticaria, bronchospasm, or anaphylaxis are absolute exclusions; substitute a non–COX-inhibiting agent.
Use of naproxen around CABG has been associated with increased cardiovascular thrombotic events; choose alternative analgesia in this setting.
Exposure after 30 weeks gestation risks premature ductus arteriosus closure and oligohydramnios, so avoid routine use late in pregnancy.
Prostaglandin suppression can precipitate renal failure; ensure adequate hydration and monitor renal function if naproxen is necessary.
Use gastroprotection and consider alternative therapies in children with a history of ulcer, GERD complications, or concomitant anticoagulant therapy.
Naproxen may worsen fluid retention and blunt antihypertensive efficacy; monitor blood pressure and weight closely.
NSAID-associated platelet inhibition increases bleeding risk; avoid elective use or employ the lowest effective dose with careful monitoring.