What are the likely side effects of taking Aleve (naproxen) and prednisone 30mg daily for 5 days in a 55-year-old female weighing 100lbs?

Side Effects of Naproxen and Prednisone in a 55-Year-Old Female Weighing 100 lbs

The concurrent use of Aleve (naproxen) and prednisone 30 mg daily for 5 days in a 55-year-old female weighing 100 lbs significantly increases the risk of gastrointestinal complications, particularly gastric ulceration and bleeding, which should be monitored closely.

Primary Concerns with This Combination

Gastrointestinal Risks

• The combination of NSAIDs like naproxen with prednisone substantially increases the risk of gastrointestinal ulceration, bleeding, and perforation 1
• Higher doses of naproxen (this patient is likely receiving a standard dose that may be relatively high for her low body weight) are associated with more frequent and severe gastrointestinal reactions 1
• The short duration (5 days) somewhat mitigates but does not eliminate these risks 2

Cardiovascular and Fluid Retention Concerns

• Both medications can cause fluid retention, edema, and hypertension 1, 2
• The patient's low body weight (100 lbs) may increase sensitivity to these effects, particularly with the relatively high prednisone dose of 30 mg daily 2
• Monitoring for increased blood pressure is warranted, especially if the patient has pre-existing hypertension 1, 2

Specific Side Effects by System

Metabolic and Endocrine Effects

• Short-term prednisone use (30 mg daily for 5 days) commonly causes:
  • Reversible abnormalities in glucose metabolism 2
  • Increased appetite 2
  • Mood alterations including emotional instability, anxiety, or insomnia 2
  • Weight gain due to fluid retention and increased appetite 2

Neurological Effects

• The combination may cause:
  • Headaches (3-9% with naproxen) 1
  • Dizziness and lightheadedness 1
  • Cognitive effects including difficulty concentrating 1
  • Mood disturbances including depression or emotional lability 2, 1

Other Common Side Effects

• Dermatologic: Increased bruising, skin thinning (even with short-term prednisone), rash, pruritus 1, 3
• Sensory: Tinnitus and visual disturbances from naproxen 1
• Musculoskeletal: Risk of steroid-induced osteoporosis is minimal with short-term use but may be a concern if the patient has pre-existing osteopenia 2

Special Considerations for This Patient

Weight-Based Concerns

• At 100 lbs (approximately 45 kg), this patient is receiving a relatively high dose of prednisone (30 mg daily) 2
• Guidelines typically recommend weight-based dosing for prednisone (0.5-1 mg/kg/day), which would suggest a lower dose for this patient 2
• The standard naproxen dose may also be relatively high for her weight, increasing risk of side effects 1

Age-Related Concerns

• At 55 years old, this patient may have increased sensitivity to both medications 2
• Postmenopausal women are at higher risk for steroid-induced bone loss 2
• Risk of cardiovascular events with NSAIDs increases with age 1

Monitoring Recommendations

• Monitor for signs of GI distress including epigastric pain, nausea, or black/tarry stools 1
• Watch for signs of fluid retention including weight gain, edema, or increased blood pressure 1, 2
• Be alert for mood changes, sleep disturbances, or cognitive effects 2, 1
• Consider prophylactic antacid or proton pump inhibitor during treatment to reduce GI risks 2

Mitigation Strategies

• Consider a lower dose of prednisone if clinically appropriate based on her low body weight 2
• Take naproxen with food to reduce GI irritation 1
• Avoid other medications that increase bleeding risk (e.g., anticoagulants) during this treatment period 1
• Ensure adequate hydration to support renal function 1
• Consider calcium and vitamin D supplementation even for short-term prednisone use 2

While this combination can be effective for treating inflammatory conditions, the patient should be closely monitored for side effects, particularly gastrointestinal complications, given her low body weight and the relatively high dose of prednisone.