A 38-year-old woman with musculoskeletal backache was prescribed naproxen 250 mg 1-2 tablets once o

Fråga: A 38-year-old woman with musculoskeletal backache was prescribed naproxen 250 mg 1-2 tablets once or twice a day since the 15th of August. At the end of October she noticed hair loss. The doctor wants to know the prevalence of this adverse effect and whether it is reversible.

Sammanfattning: Hair loss is a reversible side effect due to treatment with several different NSAID´s. Considering the wide use of naproxen and other NSAID´s, hair loss seems to be a rarely reported side effect. However, in this particular patient an alternative anti-inflammatory drug could be considered eg diflunisal or dextropropoxyphen in combination with paracemol.

Svar: A search in Drugline, Embase, Medline and pharmacological handbooks has been performed. According to one reference hair on the scalp have an anagen phase (growth phase) which lasts about three years and a telogen phase (resting phase) which lasts roughly three months (1). Anagen hair loss is associated only with cytotoxic and radiation treatment and at the time of toxic effect. Telogen hair loss is delayed by three months, during which the telogen hair root is retained in the follicle. As the hair root is not damaged by the process regrowth of hair spontaneously follows. "Toxic events" can occur with eg childbirth, fever and haemorrhage (1).

It is mentioned in (2) that treatment with NSAIDs (ibuprofen and naproxen) can cause a reversible loss of hair. No references are given in this book. Referring to (3), in total five drugs from the NSAID group are described in connection with hair loss. These are as follows: Benoxaprofen, diclofenac, ibuprofen, piroxicam and naproxen. No figures on prevalence are given.

A case report (4) concerns hair loss in a child after starting treatment with naproxen. The child´s hair regrew when naproxen was stopped after two months.

The files of SADRAC (Swedish Adverse Drug Reactions Advisory Committee) contain in total 10 cases of defluvium in connection with treatment of different NSAID´s. Among these six cases were judged as possible and one case as probable on treatment with naproxen. The time range was three weeks to ten months for this side effect. Only four cases contain information of reversible hair loss. Also one case of reversible alopecia during treatment with sulindac was judged as possible.

We recommend this case be reported to the regional centre of adverse drug effects. 1 Barth JH, Dawber RPR: Drug induced hair loss. Br Med J 1989; 298: 675 2 Bork, Cutaneous side effects of drugs. 1988 3 Meyler´s, Side effects of drugs. Ed by MNG Dukes. Elsevier, Amsterdam 4 Barter DAC: Hair loss in a child associated with naproxen. Br Med J 1989; 298: 325