Can naproxen (Pronaxen) 500 mg x2 be given to a patient with coagulant factor VIII deficiency?

Fråga: Can naproxen (Pronaxen) 500 mg x2 be given to a patient with coagulant factor VIII deficiency?

Sammanfattning: There is no documentation concerning naproxen treatment in haemophiliac patients. However, several studies have shown that ibuprofen can be used safely in most haemophiliac patients under supervised conditions. It has been suggested that haemostatic parameters including bleeding time and platelet aggregation be checked.

Svar: Naproxen treatment in the haemophilias has not been documented according to a Medline search (Med75-90). However, the use of other NSAIDs in haemophilia has been studied (1-6).

NSAIDs are theoretically contraindicated in the haemophilias because of the possibility of NSAIDs producing erosions and ulceration of the upper gastrointestinal tract and reducing platelet reactivity by interfering with prostaglandin pathways. But they might be useful with certain indications. The beneficial effects of ibuprofen in the treatment of chronic arthritic pain (1) and haemophiliac arthropathy (2,4,5) have been reported. Concerning the safety of NSAIDs in haemophilias, it has been concluded in most of the studies that ibuprofen can be used safely by haemophiliac subjects (1,2,4,6).

Three randomised double-blind placebo-controlled studies (2,4,6) including 12-15 haemophiliac patients in each study have demonstrated that ibuprofen 600-1600 mg/day for up to four months did not significantly change the bleeding times or platelet function. In another double-blind placebo-controlled study in eight haemophiliac patients, ibuprofen 1600 mg/day for six weeks did not affect bleeding times or platelet aggregation in seven patients. However, in one subject bleeding time became markedly prolonged from 4 to 15 minutes after one weeks´ treatment with ibuprofen (5). 1 Steven MM, SMall M, Pinkerton L, Madhok R, Sturrock RD, Forbes CD: Non-steroidal anti-inflammatory drugs in haemophilic arthritis. A clinical and laboratory study. Haemostasis 1985: 15: 204-209 2 Inwood MJ, Killackey B, Startup SJ: The use and safety of ibuprofen in the hemophiliac. Blood 1983; 61: 709-711 3 Eyster ME, Gordon RA, Ballard JO: The bleeding time is longer than normal in hemophilia. Blood 1981; 58: 719-723 4 Hasiba U, Scranton PE, Lewis JH, Spero JA: Efficacy and safety of ibuprofen for hemophilic arthropathy. Arch Intern Med 1980; 140: 1583-1585 5 Thomas P, Hepburn B, Kim HC, Saidi P: Nonsteroidal anti-inflammatory drugs in the treatment of hemophilic arthropathy. Am J Hematol 1982; 12: 131-137 6 McIntyre BA, Philip RB, Inwood MJ: Effect of ibuprofen on platelet function in normal subjects and hemophiliac patients. Clin Pharmacol Ther 1978; 24: 616-621 7 Ragni MV, Miller BJ, Whalen R, Ptachcinski R: Bleeding tendency, platelet function, and pharmacokinetics of ibuprofen and zidovudine in HIV(+) hemophilic men. Am J Hematol 1992; 40: 176-182