Hot Flushes After Taking Naproxen
Hot flushes are not a recognized adverse effect of naproxen itself; however, calcium channel blockers (diltiazem and verapamil) commonly cause hot flushes as a side effect, and this symptom should prompt evaluation for other medications or underlying conditions rather than attributing it to naproxen. 1
Evidence from Guidelines
The most comprehensive guideline evidence addressing hot flushes as a medication side effect comes from cardiovascular management literature:
- Calcium channel blockers (diltiazem and verapamil) list hot flushes as one of the most common reported adverse symptoms, along with dizziness, malaise, lethargy, headache, gastrointestinal upset, and edema 1
- In contrast, naproxen and other NSAIDs do not have hot flushes listed among their recognized adverse effect profiles in major clinical guidelines 1
Known Adverse Effects of Naproxen
The established adverse effect profile of naproxen includes:
- Gastrointestinal effects: peptic ulcer disease, bleeding, and perforation (particularly in patients >60 years, with history of peptic ulcer disease, or on concurrent corticosteroids) 1
- Cardiovascular risks: increased risk of myocardial infarction and stroke, though naproxen is considered among the preferred NSAIDs for patients at high cardiac risk 1
- Renal toxicity: acute renal failure, particularly in patients >60 years, with compromised fluid status, or on other nephrotoxic drugs 1, 2
- Hypertension and heart failure exacerbation: NSAIDs should be discontinued if these conditions develop or worsen 1, 3
Clinical Approach to Hot Flushes in a Patient Taking Naproxen
When a patient reports hot flushes after taking naproxen, consider:
- Review all concurrent medications, particularly calcium channel blockers, which are a well-established cause of hot flushes 1
- Evaluate for hormonal causes: menopausal symptoms, androgen deprivation therapy (which causes hot flushes in up to 65% of patients), or selective estrogen receptor modulators like raloxifene 1
- Consider allergic/hypersensitivity reactions: while rare, fixed drug eruptions and hypersensitivity reactions to naproxen have been documented, though these typically present with skin manifestations rather than isolated hot flushes 4
Alternative Explanations
The temporal association between naproxen use and hot flushes is likely coincidental rather than causal, as:
- Hot flushes are not documented in the extensive safety literature on naproxen spanning decades of use 5, 6, 3
- Multiple large-scale meta-analyses examining NSAID adverse effects do not identify hot flushes as an NSAID-related symptom 1, 3, 7
If pain management is needed and the patient wishes to avoid naproxen due to concerns, alternative NSAIDs (ibuprofen) or acetaminophen can be considered, though these carry their own risk profiles 1, 7