What is the recommended dose of Vimovo (naproxen and esomeprazole)?

Recommended Dosage of Vimovo (Naproxen and Esomeprazole)

The recommended dose of Vimovo is 500 mg naproxen and 20 mg esomeprazole taken twice daily. 1, 2, 3

Dosing Details

• Vimovo combines enteric-coated naproxen (500 mg) with immediate-release esomeprazole (20 mg) in a fixed-dose combination 2, 4
• The medication should be taken twice daily (BID) for optimal therapeutic effect 3, 5
• Vimovo should be taken 30 minutes before meals for optimal absorption 6
• The esomeprazole component (20 mg) is equivalent to 20 mg of omeprazole once daily according to proton pump inhibitor dose equivalence guidelines 6

Clinical Considerations

Patient Populations

• Vimovo has been studied in various populations:
  • Adults with osteoarthritis and rheumatoid arthritis 3, 5
  • Adolescents aged 12-16 years with juvenile idiopathic arthritis 1
  • Patients aged ≥50 years or those with history of gastrointestinal ulcers 3

Pharmacokinetic Considerations

• The combination shows bioequivalent absorption compared to individual components 2, 4
• The enteric coating on naproxen helps protect the stomach while the immediate-release esomeprazole provides rapid acid suppression 4
• Food may affect the absorption of both components, hence the recommendation to take it 30 minutes before meals 6

Safety Profile

• The fixed-dose combination was developed specifically to reduce the risk of NSAID-associated gastric ulcers 1, 3
• Common adverse events (occurring in ≥5% of patients) include:
  • Dyspepsia
  • Constipation
  • Upper respiratory tract infection
  • Nausea
  • Back pain 3
• Treatment-related adverse events occur in approximately 24-28% of patients 3

Important Considerations and Precautions

• Higher-potency PPIs like esomeprazole (20 mg) are preferred over pantoprazole for combination with NSAIDs 6
• When used with amoxicillin-containing regimens for H. pylori treatment, esomeprazole 20 mg is equivalent to 32 mg of omeprazole 6
• Long-term use of Vimovo has been studied for up to 12 months with no new safety concerns identified 3
• Vimovo has shown comparable upper gastrointestinal tolerability to celecoxib in patients with osteoarthritis 5

Common Pitfalls

• Failure to take the medication 30 minutes before meals may reduce effectiveness 6
• Inadequate dosing frequency (once daily instead of twice daily) may lead to suboptimal pain control and gastroprotection 3, 5
• Not recognizing that the esomeprazole component in Vimovo is immediate-release (unlike some other esomeprazole formulations which are delayed-release) 4
• Assuming that all proton pump inhibitors have equivalent potency when combined with NSAIDs 6