Napro-A Plus 375 Tablet (Delayed Release)

Indication
It is indicated for the relief of signs and symptoms of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis and to decrease the risk of developing gastric ulcers in patients at risk of developing NSAID-associated gastric ulcers.

Pharmacology
It is a preparation of Naproxen and Esomeprazole. Naproxen is a NSAID with analgesic and antipyretic activities. It inhibits prostaglandin synthesis. Esomeprazole is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the H+/K+ ATPase in the gastric parietal cell. By acting specifically on the proton pump. Esomeprazole blocks the final step in acid production, thus reducing gastric acidity.

Dosage
The recommended dose is one tablet twice daily. Do not split, chew, crush or dissolve the tablet. This tablet is to be taken at least 30 minutes before meals.

Interaction
ACE Inhibitors, diuretics and beta-blockers: may reduce the antihypertensive effect.Cyclosporin: increases the risk of nephrotoxicity.Lithium: increases plasma level of lithium.Methotrexate: may increase the serum levels of methotrexate.Warfarin: may increase the risk of bleeding complications.Digoxin: may increase the digoxin toxicity.Clopidogrel: may decrease the exposure to the active metabolite of clopidogrel.

Contradiction
It is contraindicated in patients with known hypersensitivity to any components of this products. It is also contraindicated in patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs and for the treatment of per-operative pain in the setting of coronary artery bypass graft (CABG) surgery.

Side Effect
The most common side effects are gastritis, erosive gastritis, dyspepsia, diarrhea, gastric ulcer, upper abdominal pain and nausea etc.

Pregnancy
The use of this tablet should be avoided in pregnancy and lactation unless the potential benefits to the other outweigh the possible risks to the fetus.

Precaution
Caution should be exercised in following conditions: Fatal cardiovascular thrombotic events like myocardial infarction, stroke, hypertension, congestive heart failure and edema. Serious GI adverse events. Hypomagnesaemia. Renal or hepatic insufficiency.

Overdose

Storage
Keep in a dry place away from light and heat. Keep out of the reach of children.