From the Guidelines
Naproxen and other NSAIDs are generally not recommended for patients with Crohn's disease due to the potential to worsen symptoms and trigger flare-ups. The use of NSAIDs in patients with Crohn's disease can damage the intestinal lining and increase gut permeability, exacerbating inflammation in the already compromised intestinal tract 1. For pain management in Crohn's disease, acetaminophen (Tylenol) is typically considered a safer alternative. If pain control is inadequate with acetaminophen alone, patients should consult their gastroenterologist about appropriate pain management strategies, which might include short-term, low-dose NSAIDs under close supervision, or other pain management approaches specific to their condition.
Some key points to consider when managing Crohn's disease include:
- Avoiding the use of NSAIDs and IL-17 inhibitors in patients with active inflammatory bowel disease (IBD) 1
- Using monoclonal antibody TNF inhibitor therapies in patients with Crohn's disease, as they are strongly recommended over treatment with other biologic disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase (JAK) inhibitors 1
- Considering the use of acetaminophen as a first-line treatment for pain management in Crohn's disease, due to its safer profile compared to NSAIDs
- Consulting with a gastroenterologist to determine the best course of treatment for each individual patient, taking into account their disease activity, overall health status, and other factors.
It's also important to note that the management of Crohn's disease often requires a multidisciplinary approach, involving collaboration between gastroenterologists, surgeons, and other healthcare professionals 1. By prioritizing the use of safer treatments and carefully considering the individual needs of each patient, healthcare providers can help to minimize the risks associated with NSAID use and optimize outcomes for patients with Crohn's disease.
From the FDA Drug Label
NSAIDs should be given with care to patients with a history of inflammatory bowel disease (ulcerative colitis, Crohn’s disease) as their condition may be exacerbated.
Naproxen is not entirely safe for use in patients with Crohn's disease, as it may exacerbate their condition. Patients with a history of inflammatory bowel disease, including Crohn's disease, should be given naproxen with care. The risk of gastrointestinal adverse events, such as ulceration, bleeding, and perforation, is a concern in these patients. 2
From the Research
Safety of Naproxen in Crohn's Disease
The safety of naproxen, a nonsteroidal anti-inflammatory drug (NSAID), in patients with Crohn's disease is a concern due to the potential for NSAIDs to exacerbate inflammatory bowel disease (IBD) [ 3 ].
Key Findings
- A study published in the Journal of Clinical Gastroenterology found that regular use of NSAIDs (≥5 times/month) was associated with an increased risk of active disease in patients with Crohn's disease [ 3 ].
- The same study found that acetaminophen use was also associated with active disease at follow-up in Crohn's disease patients [ 3 ].
- Another study published in Current Gastroenterology Reports discussed the management of Crohn's disease, but did not specifically address the safety of naproxen in these patients [ 4 ].
- A review of conventional therapies for Crohn's disease published in Gastroenterology Clinics of North America did not mention NSAIDs as a treatment option [ 5 ].
Naproxen Pharmacology and Therapeutic Use
Naproxen is a well-established NSAID used to treat various rheumatic diseases and pain states [ 6 ]. Its efficacy and tolerability have been demonstrated in numerous clinical trials [ 6 ]. However, its safety in patients with Crohn's disease is not well established.
Treatment Options for Crohn's Disease
The primary agents used to treat Crohn's disease include aminosalicylates, corticosteroids, immunomodulators, and biologics [ 5, 7 ]. The choice of treatment depends on the individual patient's needs and the severity of their disease.