Can I take naproxen (nonsteroidal anti-inflammatory drug (NSAID)) with a history of seizure disorder?

Naproxen Use in Patients with Seizure Disorders

Naproxen should be used with caution in patients with a history of seizure disorders, but it is not absolutely contraindicated and can be considered when the benefits outweigh the risks.

Relationship Between NSAIDs and Seizures

The evidence regarding naproxen and seizure risk shows:

• Guidelines indicate that NSAIDs, including naproxen, can potentially increase the risk of abnormal bleeding when used concomitantly with SSRIs in patients with seizure disorders 1.

• While there is no direct contraindication for naproxen in seizure disorders in the available guidelines, caution is warranted as NSAIDs may affect seizure threshold in some patients.

• Case reports have documented seizures in the context of massive naproxen overdose 2, but this differs significantly from therapeutic use.

Decision-Making Algorithm for Naproxen Use in Seizure Disorders

1. Assess seizure control:

   • Well-controlled seizures (no episodes in past 6 months): Lower risk
   • Poorly controlled seizures: Higher risk, consider alternative analgesics

2. Consider medication interactions:

   • Check for potential interactions with anti-epileptic medications
   • Be particularly cautious if patient is on SSRIs, as the combination with NSAIDs may increase bleeding risk 1

3. Evaluate alternative options:

   • For mild pain: Acetaminophen is generally safer in seizure disorders
   • For moderate-severe pain: If naproxen is needed, use the lowest effective dose for the shortest duration

4. Monitor for warning signs:

   • Educate patients about potential warning signs of lowered seizure threshold
   • Advise discontinuation if new neurological symptoms develop

Special Considerations

• Medication interactions: Unlike some medications such as bupropion which is explicitly contraindicated in seizure disorders 3, naproxen does not have a specific contraindication but requires careful consideration.

• Hydration status: Maintain adequate hydration as dehydration can lower seizure threshold and NSAIDs can affect kidney function.

• Dosing: Start with the lowest effective dose and avoid prolonged use when possible.

• Alternative analgesics: In patients with poorly controlled epilepsy, acetaminophen may be a safer first-line option for pain management.

Monitoring Recommendations

• If naproxen is prescribed to a patient with seizure disorder:
  • Monitor for changes in seizure frequency or pattern
  • Ensure regular follow-up, especially during the initial treatment period
  • Discontinue if seizure control worsens

Conclusion

While naproxen is not absolutely contraindicated in patients with seizure disorders, it should be used cautiously with appropriate monitoring. The decision to use naproxen should balance pain management needs against the potential small increased risk of seizures, particularly in patients with poorly controlled epilepsy.