Can you take naproxen (Nonsteroidal Anti-Inflammatory Drug) as needed (PRN) with asthma?

Naproxen Use in Patients with Asthma

Naproxen should not be administered to patients with asthma who have aspirin/NSAID-induced asthma due to the risk of severe bronchospasm, which can be fatal. 1

Contraindications and Risks

• Naproxen is specifically contraindicated in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs 1
• Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in patients with aspirin-sensitive asthma 1
• Cross-reactivity, including bronchospasm, between aspirin and other NSAIDs (including naproxen) has been documented in aspirin-sensitive patients 1

Patient Assessment Before Considering Naproxen

Before considering naproxen use in a patient with asthma, evaluate for:

• History of aspirin or NSAID sensitivity 1
• Presence of high-risk features for NSAID intolerance:
  • Severe asthma
  • Nasal polyps
  • Chronic rhinosinusitis 2

Decision Algorithm for Naproxen Use in Asthma

1. Absolute contraindication:

   • Known history of aspirin/NSAID-induced asthma exacerbation
   • Do NOT administer naproxen under any circumstances 1

2. High-risk patients (severe asthma, nasal polyps, chronic rhinosinusitis):

   • Formal aspirin/NSAID provocation testing recommended before therapeutic use
   • Use only under close medical supervision if testing is negative 2

3. Patients with asthma who regularly use NSAIDs without problems:

   • Can continue use but should be warned that intolerance can develop later in life
   • Monitor for any new respiratory symptoms after NSAID use 2

4. Patients with asthma without high-risk features who have never used NSAIDs:

   • Should be treated as potentially intolerant
   • First use should be under medical supervision 2

Alternative Pain Management Options

For patients with asthma who cannot take naproxen:

• Acetaminophen (paracetamol) at low to moderate doses (<1000mg) is generally better tolerated, though cross-reactivity with aspirin occurs in approximately 20-30% of aspirin-sensitive asthmatics 3, 4
• Selective COX-2 inhibitors (such as celecoxib) are well tolerated by almost all aspirin-sensitive asthmatic patients 3

Monitoring and Precautions

• If naproxen is deemed safe to use in a non-sensitive asthmatic patient:
  • Monitor for signs of bronchospasm, especially with first dose
  • Instruct patient to discontinue immediately if respiratory symptoms worsen
  • Have rescue medications readily available 1
• Patients should be educated about the warning signs of respiratory deterioration and instructed to seek immediate medical attention if these occur 1

Important Caveats

• NSAID intolerance can develop at any time, even in patients who have previously tolerated these medications 2
• The risk of severe reactions is higher in patients with more severe or poorly controlled asthma 2
• Even in patients without a history of sensitivity, the first dose of any NSAID should be taken with caution 2