Can naproxen (nonsteroidal anti-inflammatory drug, NSAID) be prescribed to a 13-year-old patient?

Naproxen Use in a 13-Year-Old Patient

Naproxen can be prescribed to a 13-year-old patient, but should be used with caution, at appropriate weight-based dosing, and with careful monitoring for adverse effects.

Safety and Efficacy in Adolescents

Naproxen has been studied in pediatric patients and has established pharmacokinetic profiles in children:

• Pharmacokinetic studies show that plasma naproxen levels in pediatric patients aged 5-16 years with arthritis are similar to those in adults when appropriate weight-based dosing is used 1
• Research has demonstrated that naproxen peak blood levels and half-life in children are not significantly different from adults, supporting twice-daily dosing regimens 2
• A 6-month study of naproxen in JIA patients aged 12-16 years showed the medication was generally well-tolerated with mostly mild to moderate adverse events 3

Dosing Considerations

When prescribing naproxen to a 13-year-old:

• Weight-based dosing is essential for pediatric patients
• For juvenile idiopathic arthritis, the typical dose is 5-7 mg/kg twice daily
• The maximum daily dose should not exceed 1000 mg
• The FDA-approved naproxen formulation indicates that "the terminal half-life appears to be similar in pediatric and adult patients" 1

Potential Adverse Effects and Monitoring

Naproxen, like all NSAIDs, carries risks that require careful monitoring:

1. Gastrointestinal effects:

   • Upper GI symptoms including upset, constipation, and potential ulceration 4
   • Consider gastroprotection with a PPI for extended use

2. Cardiovascular and renal considerations:

   • Monitor blood pressure as NSAIDs can cause mean increases of approximately 5 mm Hg 4
   • Assess renal function before and during treatment
   • Avoid in patients with significant renal impairment

3. Other potential adverse effects:

   • Dizziness, rash, pruritus 4
   • Potential for asthma exacerbation in susceptible individuals 4

Contraindications

Naproxen should be avoided in adolescents with:

• History of aspirin/NSAID-induced asthma
• Significant renal impairment
• Bleeding disorders or concurrent anticoagulant therapy
• Active gastrointestinal bleeding or ulceration
• Severe hepatic disease

Clinical Recommendations

For safe use of naproxen in a 13-year-old:

1. Start with the lowest effective dose based on weight and titrate as needed

2. Limit treatment duration to the shortest period necessary

3. Administer with food to minimize gastrointestinal irritation

4. Monitor for adverse effects regularly, including:

   • GI symptoms
   • Changes in renal function
   • Blood pressure changes
   • Signs of allergic reactions

5. Educate the patient and parents about potential side effects and when to seek medical attention

Special Considerations

• NSAIDs should be discontinued immediately if the patient develops signs of hepatotoxicity, although this is rare 4
• For chronic conditions requiring long-term treatment, consider periodic laboratory monitoring including renal function, complete blood count, and liver enzymes
• Naproxen has been successfully used as an antipyretic in pediatric patients with minimal side effects 5

Remember that while naproxen can be prescribed to a 13-year-old, the benefit-risk assessment should favor clear clinical benefit over potential risks, and appropriate monitoring should be implemented.