Napaxin Plus Tablet (Delayed Release) 375 mg + 20 mg

Napaxin Plus Tablet (Delayed Release) is a combination medication containing Naproxen Sodium (375mg) and Esomeprazole Magnesium (20mg). Manufactured by Pharmik Laboratories Ltd, this delayed-release tablet offers dual action for pain management and gastric protection. Priced at ৳13.00 per unit, it’s available in strips of 10 tablets (৳130.00) and packs of 3×10 (৳390.00).

Primarily prescribed for osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, Napaxin Plus reduces inflammation while preventing NSAID-induced ulcers. Its unique formulation releases esomeprazole first to neutralize stomach acid before naproxen is absorbed in the intestines. This mechanism helps minimize gastrointestinal risks associated with long-term NSAID use.

The recommended dosage for adults is one tablet twice daily (375/20mg or 500/20mg). For pediatric patients (12+ years), dosage depends on weight:

• >50kg: 375/20mg or 500/20mg twice daily
• 30-50kg: 375/20mg twice daily

Key precautions include avoiding concurrent use with warfarin (↑ bleeding risk) and monitoring drug interactions with ACE inhibitors. Common side effects (>5% users) include dyspepsia, gastritis, and abdominal pain. Pregnant women should avoid it in third trimester due to potential fetal complications.

Store below 30°C in dry conditions. For complete Naproxen+Esomeprazole information, consult healthcare providers regarding individualized treatment plans and potential alternative therapies.

Adults: 375/20 mg or 500/20 mg tablet twice daily. Adolescents (12+ years, >50 kg): Same dose. For 30-50 kg adolescents: 375/20 mg twice daily. Adjust dose in renal/hepatic impairment. Administer with/without food. Treatment duration varies based on clinical response.

Immediate release esomeprazole has been included in the tablet formulation to decrease the incidence of gastrointestinal side effects from Naproxen. Naproxen and Esomeprazole tablet has been shown to significantly decrease the occurrence of gastric ulcers and NSAID associated upper gastrointestinal adverse events compared to Naproxen alone. Naproxen: Clinical trial and epidemiological data suggest that use of coxibs and some NSAIDs (particularly at high doses and in long-term treatment) may be associated with a small increased risk of arterial thrombotic events (for example myocardial infarction or stroke). Although data suggest that the use of Naproxen (1000 mg daily) may be associated with a lower risk, some risk cannot be excluded. Oedema, hypertension and cardiac failure have been reported in association with NSAID treatment. The most commonly observed adverse events are gastrointestinal in nature. Peptic ulcers, perforation or GI bleeding, sometimes fatal, particularly in older people, may occur. Nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, abdominal pain, melaena, haematemesis, ulcerative stomatitis, exacerbation of colitis and Crohn’s disease have been reported following administration. Less frequently, gastritis has been observed.

Pregnancy Category C. Avoid in third trimester (risk of premature ductus arteriosus closure). Contraindicated in lactation – naproxen excreted in breast milk.

Assess CV risk in smokers/diabetics/cardiac patients. Monitor renal/hepatic function during prolonged use. Discontinue if GI bleeding occurs. Avoid alcohol to prevent gastric irritation.

Geriatric: Increased free naproxen levels – use lowest effective dose. Renal: Contraindicated if CrCl <30 mL/min. Hepatic: Avoid in Child-Pugh C. Pediatrics: Limited safety data <12 years.

Symptoms: Related to Naproxen overdose- Significant Naproxen overdosage may be characterized by lethargy, dizziness, drowsiness, epigastric pain, abdominal discomfort, heartburn, indigestion, nausea, transient alterations in liver function, hypoprothrombinemia, renal dysfunction, metabolic acidosis, apnea, disorientation or vomiting. Gastrointestinal bleeding can occur. Hypertension, acute renal failure, respiratory depression, and coma may occur, but are rare. Anaphylactoid reactions have been reported with therapeutic ingestion of NSAIDs, and may occur following an overdose. It is not known what dose of the drug would be life-threatening.

Related to esomeprazole overdose- The symptoms described in connection with deliberate esomeprazole overdose (limited experience of doses in excess of 240 mg/day) are transient. Single doses of 80 mg esomeprazole were uneventful.

Management: Related to Naproxen- Patients should be managed by symptomatic and supportive care following a NSAID overdose, particularly with respect to GI effects and renal damage. There are no specific antidotes. Hemodialysis does not decrease the plasma concentration of Naproxen because of the high degree of its protein binding. Emesis and/or activated charcoal (60 to 100 g in adults, 1 to 2 g/kg in children) and/or osmotic cathartic may be indicated in patients seen within 4 hours of ingestion with symptoms or following a large overdose. Forced diuresis, alkalinization of urine or hemoperfusion may not be useful due to high protein binding.

Related to Esomeprazole- No specific antidote is known. Esomeprazole is extensively plasma protein bound and is therefore not readily dialyzable. As in any case of overdose, treatment should be symptomatic and general supportive measures should be utilised.