Can a 45-year-old male patient with right knee pain, currently taking ibuprofen (Ibuprofen) 400 mg, be switched to naproxen (Naproxen) 500 mg twice daily (BID) prior to scheduled right knee surgery?

From the Guidelines

I strongly recommend discontinuing ibuprofen 400 mg and starting naproxen 500 mg twice daily for this 45-year-old male prison inmate with right knee pain, as naproxen may provide longer-lasting pain relief with its twice-daily dosing compared to ibuprofen's shorter duration of action. This medication change is appropriate as both are NSAIDs, and according to the most recent guideline 1, a combination of paracetamol and a non-steroidal anti-inflammatory drug or a cyclo-oxygenase-2-selective inhibitor is recommended for postoperative pain management. The patient has already been provided supportive measures including a cane and knee brace, and surgery for the right knee has been scheduled. Naproxen works by inhibiting prostaglandin synthesis through COX enzyme inhibition, reducing inflammation and pain.

The patient should take naproxen with food to minimize gastrointestinal side effects, stay adequately hydrated, and report any unusual bleeding, stomach pain, or allergic reactions. It is also important to note that opioids should be reserved as rescue analgesics in the postoperative period, as recommended by the guideline 1. This medication change should help manage his knee pain more effectively until his scheduled surgery. Additionally, the guideline recommends pre-operative exercise and education, which may also be beneficial for the patient's overall recovery and pain management.

Key points to consider when prescribing naproxen include:

• Taking the medication with food to minimize gastrointestinal side effects
• Staying adequately hydrated
• Reporting any unusual bleeding, stomach pain, or allergic reactions
• Reserving opioids for rescue analgesics in the postoperative period
• Considering pre-operative exercise and education for overall recovery and pain management, as recommended by the guideline 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Carefully consider the potential benefits and risks of naproxen and other treatment options before deciding to use naproxen tablets. The recommended dose is 250 mg, 375 mg, or 500 mg twice daily Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals

The patient is being switched from ibuprofen 400 mg to naproxen 500 mg BID. The recommended dose of naproxen for conditions like osteoarthritis is 250 mg, 375 mg, or 500 mg twice daily. Since the patient is scheduled for surgery on the right knee, it is essential to consider the potential benefits and risks of naproxen.

• The decision to start naproxen 500 mg BID seems reasonable based on the provided dosage information.
• However, it is crucial to monitor the patient's response to the new medication and adjust the dose as needed to minimize potential adverse effects 2.

From the Research

Patient's Request for Medication Change

• The patient is requesting a change in medication from ibuprofen 400 mg to naproxen 500 mg for right knee pain.
• The patient has been issued a cane and a knee brace for support in previous encounters.
• The patient is scheduled for surgery on the right knee.

Efficacy of Naproxen for Postoperative Pain

• A study published in 2004 3 found that naproxen sodium 550 mg (equivalent to 500 mg of naproxen) is an effective dose for treating postoperative pain.
• The study also found that naproxen 400 mg and naproxen sodium 440 mg are effective analgesics for the treatment of acute postoperative pain in adults.
• Another study published in 2015 4 found that naproxen 500/550 mg has a long duration of action (eight hours or greater) and is effective for postoperative pain relief.

Comparison of Naproxen and Ibuprofen

• A study published in 1984 5 found that naproxen was superior to ibuprofen in relieving resting pain, movement pain, night pain, and interference with daily activities in patients with osteoarthritis.
• The study also found that patients who received ibuprofen first showed significant improvement after crossover to naproxen, while patients who received naproxen first did not show significant further improvement after crossover to ibuprofen.

Use of NSAIDs for Postoperative Pain

• A review published in 2021 6 found that NSAIDs, including ibuprofen and naproxen, provide highly effective analgesia for postoperative pain, particularly when combined with acetaminophen.
• The review also found that multimodal analgesia (combining NSAIDs and acetaminophen) is more effective and safer than opioid-based regimens for postoperative pain control.

Decision to Change Medication

• Based on the evidence, changing the patient's medication from ibuprofen 400 mg to naproxen 500 mg may be a reasonable decision, considering the patient's scheduled surgery and the need for effective postoperative pain relief.
• The patient's request for a medication change should be considered in the context of their individual needs and medical history, and the decision to change medication should be made in consultation with the patient and other healthcare professionals, as necessary.