From the Guidelines
Patients with constipation taking Naproxen and Aluminum Hydroxide should consider alternative antacids or stool softeners to manage their constipation symptoms.
Recommendations for Managing Constipation
- The American Gastroenterological Association (AGA) recommends a rational and judicious diagnostic approach to constipation, as well as more efficacious therapies to improve symptoms 1.
- For patients taking NSAIDs like Naproxen, which can exacerbate constipation, and antacids like Aluminum Hydroxide, which can also contribute to constipation, alternative management strategies should be considered.
- The AGA suggests assessing colonic transit at a later stage, only for patients who do not have a defecatory disorder or patients with a defecatory disorder that has not responded to pelvic floor retraining 1.
- Therapeutic recommendations have been updated to include newer agents, and patients may benefit from trying alternative laxatives or stool softeners to manage their constipation symptoms.
- It is essential to weigh the benefits and risks of different management strategies, considering the strength of recommendation and quality of evidence, as outlined by the AGA using the GRADE system 1.
From the FDA Drug Label
Concomitant administration of some antacids (magnesium oxide or aluminum hydroxide) and sucralfate can delay the absorption of naproxen.
- Key Considerations:
- Aluminum Hydroxide can delay the absorption of Naproxen
- No specific recommendations are provided for managing constipation in patients taking Naproxen and Aluminum Hydroxide
- Clinical Decision: Naproxen and Aluminum Hydroxide can be used together, but the absorption of Naproxen may be delayed. For constipation, the patient should be advised to consult their physician for appropriate management, as the label does not provide specific recommendations for this condition 2
From the Research
Recommendations for Patients with Constipation Taking Naproxen and Aluminum Hydroxide
- For patients taking Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), and experiencing constipation, it is essential to consider the gastrointestinal (GI) and cardiovascular (CV) risks associated with NSAID treatment 3, 4.
- Aluminum Hydroxide, an antacid, can cause constipation as a side effect, which may exacerbate existing constipation in patients 5, 6.
- To manage constipation in patients taking Naproxen and Aluminum Hydroxide, the following options can be considered:
- Reducing the dose of Aluminum Hydroxide to minimize its constipating effect 5.
- Switching to a different antacid that is less likely to cause constipation.
- Considering alternative treatments for constipation, such as fiber supplements or laxatives.
- It is crucial to weigh the benefits and risks of continuing Naproxen treatment against the potential harm caused by constipation and other GI complications 3, 4.
- Patients with high CV risk and low/moderate GI risk may be suitable candidates for Naproxen treatment, but careful monitoring and consideration of gastroprotective therapy (e.g., proton pump inhibitors) may be necessary 3, 4.
- The use of low-dose antacids, such as Aluminum Hydroxide, may not be effective in preventing NSAID-induced gastropathy and may even exacerbate constipation 7.