This question concerns general information on CNS side effects of naproxen (e.g. meningitis and hea

Fråga: This question concerns general information on CNS side effects of naproxen (e.g. meningitis and headache) and overdose with emphasis on symptoms.

Sammanfattning: Meningitis associated with naproxen has been reported in the medical literature. Symptoms presented were headache, fever, shaking chills, nuchal rigidity, nausea and vomiting and weight loss. Headache is a common side effect of naproxen. Symptom described with overdoses are hypoprothrombinemia, nausea, epigastric pain, indigestion and epileptic fit.

Svar: Aseptic meningitis associated with naproxen has been reported in the medical literature (1). Symptoms presented were headache, fever, shaking chills, nuchal rigidity, nausea and vomiting and weight loss. A review of 17 published cases of meningitis associated with other NSAID is also given in this paper. It is considered a rare adverse reaction, ocurring primarily in patients with systemic lupus erythematosus or mixed connective tissue disease.

According to reference (2) naproxen frequently causes headache, particularly in the start of treatment due probably to salt and water retention and redistribution of intracranial fluid. Other CNS side-effects described in the literature are drowsiness, dizziness, sweating, fatigue, depression and ototoxicity (3).

A pharmacokinetic study of naproxen overdoses with 1,2,3 and 4 grams reported only one case of epigastric pain after 3 grams of naproxen (4). Sixteen subjects participated in this study. With higher overdoses of naproxen the following symptoms have been described: hypoprothrombinemia with 10 grams (5), transient nausea and indigestion with 25 grams (6) and epileptic fit with 35 grams (7). Further references to poisoning with other non-steroidal antiinflammatory drugs are (7-8). 1 Sylvia LM, Forlenza SW, Brocavich JM: Aseptic meningitis associated with naproxen. Drug Intell Clin Pharm 1988; 22: 399-401 (bifogas) 2 Davies, Textbook of adverse drug reactions. 1986, pp 496 3 Goodman and Gilman, The pharmacological basis of therapeutics. 1985; 7th ed: 702 4 Runkel R, Chaplin MD, Sevelius H, Ortega E, Segre E: Pharmacokinetics of naproxen overdoses. Clin Pharmacol Ther 1976; 20: 269-277 5 Waugh PK, Keatinge DW: Hypoprothrombinemia in naproxen overdose. Drug Intell Clin Pharm 1983; 17: 549-550 6 Fredell EW, Strano LJ: Naproxen overdose. JAMA 1977; 238: 939 7 Court H, Volans GN: Poisoning after overdose with non-steroidal antiinflammatory drugs. Adv Drug React Ac Pois Rev 1984; 3: 1-21 8 Vale JA, Meredith TJ: Acute poisoning due to non-steroidal anti-inflammatory drugs. Clinical features and management. Med Toxicol 1986; 1: 12-31