Is naproxen (nonsteroidal anti-inflammatory drug (NSAID)) effective for post-viral cough?

Naproxen for Post-Viral Cough

Naproxen can be effectively administered to help decrease cough associated with the common cold and post-viral infections, with substantial benefit supported by evidence-based clinical practice guidelines. 1

Efficacy of Naproxen for Post-Viral Cough

• Naproxen, a non-steroidal anti-inflammatory drug (NSAID), has demonstrated efficacy in reducing cough in patients with viral upper respiratory tract infections 1
• In a randomized, double-blind, placebo-controlled trial of experimentally induced rhinovirus common cold, naproxen decreased cough as well as other symptoms like headache, malaise, and myalgia 1
• The mechanism appears to be related to naproxen's anti-inflammatory properties, supporting the contribution of inflammation to the pathogenesis of cough in the common cold 1
• The American College of Chest Physicians gives a grade A recommendation (level of evidence: fair; benefit: substantial) for naproxen in treating acute cough associated with the common cold 1

Treatment Algorithm for Post-Viral Cough

First-Line Options:

• First-generation antihistamine/decongestant (A/D) preparation (brompheniramine and sustained-release pseudoephedrine) OR naproxen should be used as first-line therapy 1
• Naproxen can be administered alongside A/D preparations for enhanced symptom relief 1

Second-Line Options:

• For persistent post-viral cough (lasting 3-8 weeks), consider inhaled ipratropium bromide, which has shown efficacy in controlled trials 1, 2
• Inhaled corticosteroids may be considered when cough persists despite ipratropium use 1

For Severe Cases:

• For severe paroxysms of post-infectious cough, consider oral prednisone (30-40 mg daily) for a short, finite period 1

Important Clinical Considerations

• Post-viral cough is typically self-limited but can persist for up to 8 weeks 1, 3
• If cough persists beyond 8 weeks, it should be reclassified as chronic cough and evaluated for other causes 1, 4
• Approximately 25% of patients with common colds continue to have symptoms of cough, post-nasal drip, and throat clearing at day 14 1
• Newer generation non-sedating antihistamines are ineffective for reducing cough in the common cold and should not be used 1

Common Pitfalls to Avoid

• Inappropriate use of antibiotics for post-viral cough, as there is no evidence that bacterial infection plays a role unless there is confirmed bacterial sinusitis 1
• Failing to recognize when post-infectious cough has persisted beyond 8 weeks, which requires reclassification as chronic cough 3, 4
• Overlooking underlying conditions that may contribute to persistent cough (asthma, upper airway cough syndrome, gastroesophageal reflux disease) 1
• Diagnosis of bacterial sinusitis should not be made during the first week of symptoms, as sinus imaging abnormalities are common in viral infections 1

Dosing and Safety

• Standard anti-inflammatory dosing of naproxen is effective for symptom relief in viral respiratory infections 5, 6
• Naproxen has a well-established safety profile compared to many newer NSAIDs 6
• The convenient once or twice daily dosing regimen of naproxen improves patient adherence 6
• Caution should be used in elderly patients and those with renal or hepatic impairment, starting at lower doses 6