Tapering off Naproxen

[Briefencounter]

I wrote some time ago about my rheumatologist changing Meloxicam for Naproxen when I had hip/groin pain at the beginning of April . I experienced sudden groin pain and saw a rheumatologist ( not my usual one ) who ordered an X-ray. The X-ray showed healing pelvic fractures which may/may not have been due to a fall last May .

The rheumatologist prescribed Naproxen 500mg twice a day for 4 weeks ( and cancelled the Meloxicam ) .Naproxen has worked very well so I asked for a repeat prescription .

The rheumatologist phoned today and said that he wouldn’t want me to stay on this medication for too long and suggested that I started tapering the Naproxen . This is where my problem starts . I THINK he said start by taking it every other day for a while , then every three days for a while , then every four days etc . Unfortunately, I didn’t quite catch how long between each taper - he may have said a week . Unfortunately, there are builders here at the moment and the rheumatologist spoke quietly . I asked him to repeat what he said but he couldn’t hear me either . So I thanked him for his call .

I thought I might be able to find a tapering schedule on line , but I can’t . I asked if he wanted me to return to Meloxicam after I’d finished with Naproxen but he said that was up to my GP .

I know that we are discouraged from asking medical questions on this site but I wondered if anyone else has weaned off Naproxen and could help . The rheumatologist will be writing to my doctor with his decision and I will receive a copy but that normally takes two weeks .

[sylvi]

If it is like steroids then it would be a week i believe, but i would ring back and aske them. RIng fron some where quiet darling.xxxx

[Briefencounter in reply to sylvi]

Thanks Sylvi - I intend to ring back today to clarify the taper . Unfortunately, the rheumatologist rang me so unless I had put him on hold and staggered down to the bottom of the garden , wasting his time , there was no getting away from the demolition .

[Nessa28]

I just stopped taking mine . I only take them when it’s really awful as it’s the only anti inflammatory that doesn’t raise my blood pressure . I’ve been taking it for about 15 years and in 2017 once the Humera was doing it’s thing . I stopped all meds except the occasional painkillers. Roll on 2022 and I’ve had so many procedures for OA that I have to take the Naproxen , but I literally only take for a few days at a time . Mainly because the acid reflux I have now is horrendous . Don’t worry if you want to taper get someone to break the tablets in half and reduce over a month the dose , but I literally just stopped taking them and the Gabapentin with no Ill effects . Hope you feel better soon ❤️‍🩹

[Briefencounter in reply to Nessa28]

Thank you for your suggestions, Nessa . I'm really disappointed to have to stop Naproxen as it has really helped with the pain . On the other hand I've been very concerned about the frequent referrals to heart attacks and strokes , even if only taken for a short time . My rheumatologist said he didn't want me to stay on Naproxen for much longer . Interesting that it might be possible to take it again for a few days . I am taking a PPI for all the medications I'm taking . And I keep an eye on my blood pressure. Take care . 🙂

[Farahal in reply to Nessa28]

I take naproxen regularily 500mg twice a day. My reflux is controlled and my stomach protected by being prescribed Lanzoprazole. Have you not been offered this type of drug to help the reflux.

[Briefencounter in reply to Farahal]

Yes - I've been taking Lanzoprazole for years , to protect my stomach from all the other medications that I take for RA . I think my age , 80 , has a lot to do with the rheumatologist's decision to stop Naproxen after 4 weeks . Eg . affects on kidneys , heart etc . It's a shame , because Naproxen has been excellent for not only the pain in my hip but RA pain as well . Thanks for answering my query .

[Runrig01]

There is no need to actually taper off of Naproxen. I suggest he’s doing it to prevent a sudden surge in pain from stopping. You could just stop and use it as required for pain going forward, obviously still limiting to twice a day maximum. Might be worth seeing if gp will restart meloxicam in place of it.

[Briefencounter in reply to Runrig01]

Thanks for that Maureen . I guess it is the recurrence of pain that he was concerned about . He did mention that I could go back for a while if the pain increased. I'm sorry that I can't continue with Naproxen as it was excellent for pain relief - although the possibility of sudden heart attack or stroke mentioned in the literature was really concerning . I guess at 80 I have to be more careful - although in my RA journey I have been able to cope with most medications . Keep well .

[Runrig01 in reply to Briefencounter]

I had a severe stroke at 52, due to an adrenal crisis, and was diagnosed with adrenal insufficiency after the stroke. It meant I was no longer allowed any NSAIDS, which I miss so much. However the risks are just too high now. Take care, Naproxen is a lot harder on the body than many other nsaids, particularly the Cox inhibitors, might be worth looking at them

[Briefencounter in reply to Runrig01]

Gosh - really sorry to hear about your stroke - that must have been terrifying . I hope you’re fully recovered now . I keep reading that Naproxen can cause heart/stroke problems which can creep up unawares . You have to wonder why we’re put on these drugs , although I guess the incidence is fairly low , but nevertheless still a big concern .

I contacted the rheumatology helpline because I wasn’t too sure about how to follow the instructions that the consultant had given me , verbally , about tapering . So they’re going to get a nurse , who knows the way he works , to give me a call and talk me through it . Several people have told me it’s not necessary for naproxen but I guess he has his own ideas . I shall be interested to hear what they are .

It’s a pity because this NSAID was much more effective than the Meloxicam I’ve been on for years - and no one was concerned about . I’ve also read conflicting articles on whether Naproxen is “harder” or “softer” on the body - each putting forward their own reasons . So what is the poor patient to do 🥺😩🤨 ?

[Runrig01 in reply to Briefencounter]

My stroke has been b on Ames on the fact my body stopped producing cortisol. There’s only 2 hormones we can’t live without insulin and cortisol. I knew something wasn’t right the 48hrs leading up to the stroke, and asked my gp if I could increase my prednisolone from 4 to 5mg. He declined insisting I waited till I seen the endocrinologist 3 weeks later. Sadly 48hrs later I was unconscious and fighting for my life. They wanted to fly me to kings cross for surgery, but they had no beds, so I was thrombolysed. I’ve recovered well physically with just minimal weakness in my left hand & foot. My memory has been badly affected and I rely on alarms and reminders on my phone. The endocrinologist said had I increased my pred I would have probably averted a stroke, which is frustrating. If it happened again I’d follow my gut. It’s good that a nurse is going to phone & talk you through his plan. It is frustrating when you have conflicting opinions from medics. I was told I had pulmonary fibrosis probably caused by my methotrexate and told to stop. When I seen the respiratory specialist she said recent evidence actually shows it slows down pulmonary fibrosis appearing, and insisted I restart it. I had 7 months being told my life expectancy was 2-5yrs, which at 55 was a shock. Then 7 months later she phoned to say the Brompton had studied my scans and my lung damage was caused by aspirating acid, so although it looks like PF it’s not. Best Xmas present I had last year 🤪, I had only just started to accept the prognosis.

I hope they find an alternative to control your pains, wishing you well. Take care & stay safe 🤗

[Briefencounter in reply to Runrig01]

You really have been "through the wars" , Maureen . What scary incidents you've braved your way through. Especially, frightening as you're a medical professional and understood what was happening and what could happen . It's good to hear that you've made a remarkable recovery, albeit with some peripheral problems .

After I'd had a rheumatology meeting at the beginning of April , where I'd had an xray of my hip , I received an unexpected call from the rheumatologist to say that they'd found evidence of healing pelvic fractures , and had I had a recent fall ? I reminded him of the fact that I'd had a fall the previous May , ended up in A &E , had an xray which I was told was fine but that I had "deep tissue injury" . This took months to heal .

Apparently, they had an MDT meeting and wondered if I'd fallen again . He was a bit coy about whether the healing fractures were from the May 2021 fall ( and had been missed ) especially as I assured him I hadn't had a recent fall . So I guess things like this happen - reading an xray is probably just as much an art as science .

Anyway, generally speaking I'm pleased with the care I get from my GP , my RA team and the care I've received from the RNHRD .I feel that I'm included in my care , get my questions answered and my opinions considered ( when they're sensible 🙂) - which I guess is all that can be hoped for in the present climate.

Incidentally was your lung damage caused by GERD ?

So glad you had such an amazing Christmas present last year , after that prognosis . ❤️

[Runrig01 in reply to Briefencounter]

Not sure if I mentioned I was a trauma nurse. It would be quite easy to gauge if your fracture was recent or not. I suspect they know the answer, it’s highly likely it occured in May 2021. In fairness sometimes X-rays can miss new fractures, and especially with pelvic fractures they can move when you start weight bearing on them. I hope they don’t cause to much pain now 🤗.I’ve taken a proton pump inhibitor for 10yrs, which kept gerd symptoms at bay. My breathlessness and heart burn appeared at the same time. My ribs are fused due to my AS, so I have no chest expansion. This has made my diaphragm weak, and resulted in a hiatus hernia, which has resulted in the acid reflux and aspiration. We are trying stronger PPI but if that doesn’t resolve the damage occurring, she says I may need surgery on the hernia.

I’m glad you have a good team around you. My rheumatologist is as useful as a chocolate teapot, and refuses to examine any joints except my spine, unless I’ve seen my gp first. My gp is infuriated by this as she sees examining joints as his job, as do I. He refused to investigate my breathing issues, and my respiratory specialist was astounded that had been left to my gp, who is marvellous thankfully. The Xmas present was the change in prognosis, worth more than any gift 🤗

[Hidden]

Naproxen is really bad for you (rotting internal organs) if taken long term. I felt tons better when I came off it, as I used to get ‘toxicity’ all the time. I take Amitriptyline 20mg now (7pm). No more day to day pain, sleep really well.. would recommend.

[Briefencounter in reply to Hidden]

I'm sorry to hear that you had problems with Naproxen ( rotting guts sound horrible) . Naproxen really appeared to suit me but I guess long term it's not so good .

[Hidden in reply to Briefencounter]

I was on it for 6-8 years 😳. Worrying 🥺. Glad it has helped with short term relief for you..

[oldtimer2]

It isn't necessary to have a strict regime of tapering down naproxen like there is with steroids. The suggestion is prevent you having a resurge in pain. This is the official advice from the NHS page:Your dose of naproxen depends on the reason why you're taking it, your age, how well your liver and kidneys work, and how well it helps your symptoms.

Usually, the dose to treat:

joint conditions is 500mg to 1,000mg a day in 1 or 2 doses

muscle and bone disorders and painful periods is 500mg at first, then 250mg every 6 to 8 hours as needed

attacks of gout is 750mg, then 250mg every 8 hours until the attack has passed

Doses are usually lower for older people and people with heart, liver or kidney problems.

I think it is only available on prescription. It might be possible to talk to your GP and ask for a one-off prescription for the 250mg strength to help you tail off?

[Briefencounter in reply to oldtimer2]

Thanks for that , old-timer. I'm 80 so I guess it's not good to continue with the 2 x 500 pills I was taking . I have 2 monthly blood tests and one of my LFTs was up a bit this time so I guess it is time to stop . Having said that , though , my LFTs do jump around . I noticed my CRP was almost normal so the Naproxen was obviously doing some good .

[Briefencounter]

Thanks Thinksunshine , great name ! I use codeine and paracetemol at the moment , as well as Naproxen. When I start tapering Naproxen I will just rely on those two . I was only prescribed Naproxen for groin/hip pain ( which is now resolving ) but it has helped a lot with the aches and pains of RA so I'll be sorry to give it up . I was on Meloxicam before but it was as effective as Naproxen- although of course my body had probably got used to it .

[Ailsa-NRAS Partner NRAS]

Hello Briefencounter

We actively discourage anyone giving 'advice' on medications as we are not qualified rheumatologists and we all come with our own unique bodies and circumstances. Recounting experience of taking a medication may be helpful but we all react differently to medications and experience side effects differently so nothing can be 'assumed' about one person's experience in regard to applying it to someone else. There is a great deal of evidence about the negative side effects of all anti-inflammatories taken over the long-term which is why rheumatologists prescribe them with care and with PPI protection and for short periods only. Can I please encourage you to connect with your GP or rheumatology nurse advice line for any queries related to taking/tapering medications. Good luck.

Ailsa, NRAS's National Patient Champion

[Briefencounter in reply to Ailsa-NRAS]

Thanks for your reply , Ailsa - NRAS . Not sure why it has appeared now , 2 years after my replies to old-timer and Thinksunshine . I haven't taken Naproxen for the last couple of years , although grateful for the relief offered at the time . Best wishes , Briefencounter .

[Ailsa-NRAS Partner NRAS in reply to Briefencounter]

hi there

How strange! It appeared in my inbox as if it were a new string. I will investigate with HealthUnlocked - thanks for flagging

[Briefencounter in reply to Ailsa-NRAS]

Thanks 😊! Was it my mention of relying on codeine and paracetemol for pain relief , that you felt was me giving "advice" ? I was under the impression that their use was fairly standard practice given by doctors . Apologies if I overstepped the mark . 😔

[Jackie1947]

I'm trying to recall but I think I just stopped them. I was on them for quite a while then many years ago my rhuematologist wanted me off them. She said I was a higher risk of a stroke or heart attack on them and having RA the risk was already there. TBH I didn't miss them as I increased the paracetamol to 8 per day.