NX-Plus
Generic Name
Naproxen 500 mg + Esomeprazole 20 mg
Manufacturer
Beximco Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nx plus 500 mg tablet | ৳ 15.00 | ৳ 150.00 |
Description
Overview of the medicine
NX-Plus 500 mg Tablet is a combination medicine containing Naproxen, a non-steroidal anti-inflammatory drug (NSAID), and Esomeprazole, a proton pump inhibitor (PPI). It is used to relieve pain, inflammation, and stiffness while protecting the stomach from the irritating effects of Naproxen.
Uses & Indications
Dosage
Adults
One tablet once or twice daily, or as directed by the physician. Typically, one tablet (Naproxen 500 mg + Esomeprazole 20 mg) taken once or twice daily.
Elderly
Use with caution and at the lowest effective dose. Monitor renal function.
Renal_impairment
Dose adjustment may be required. Avoid in severe renal impairment.
How to Take
Take orally with a glass of water, preferably before meals or as directed by the physician. Do not crush, chew, or split the tablet.
Mechanism of Action
Naproxen inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to reduced prostaglandin synthesis, which is responsible for pain, inflammation, and fever. Esomeprazole is a PPI that irreversibly blocks the H+/K+-ATPase proton pump in gastric parietal cells, reducing gastric acid secretion and protecting the stomach lining.
Pharmacokinetics
Onset
Naproxen: 1 hour for pain relief. Esomeprazole: 30-60 minutes for acid suppression.
Excretion
Naproxen and its metabolites are primarily excreted in the urine. Esomeprazole metabolites are excreted via urine and feces.
Half life
Naproxen: 12-17 hours. Esomeprazole: 1-1.5 hours (but acid suppression lasts longer).
Absorption
Naproxen is rapidly and completely absorbed from the GI tract. Esomeprazole is acid-labile and absorbed after passing through the stomach.
Metabolism
Naproxen is primarily metabolized in the liver by cytochrome P450 enzymes. Esomeprazole is extensively metabolized in the liver by CYP2C19 and CYP3A4.
Side Effects
Contraindications
- Hypersensitivity to Naproxen, Esomeprazole, or any component of the formulation
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Severe uncontrolled heart failure
- Third trimester of pregnancy
- Active gastrointestinal bleeding or peptic ulcer
Drug Interactions
Digoxin
Increased digoxin levels
Warfarin
Increased risk of bleeding
SSRI/SNRI
Increased risk of GI bleeding
Tacrolimus
Increased nephrotoxicity
Clopidogrel
Increased risk of bleeding
Methotrexate
Increased methotrexate toxicity
Ketoconazole, Itraconazole
Decreased absorption due to esomeprazole's acid-reducing effect
Diuretics, ACE inhibitors, ARBs
Reduced antihypertensive effect and increased risk of renal impairment
Storage
Store in a cool and dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include drowsiness, lethargy, epigastric pain, nausea, vomiting, and GI bleeding for Naproxen. Esomeprazole overdose is generally well-tolerated. Management involves symptomatic and supportive care. Gastric lavage and activated charcoal may be considered if appropriate.
Pregnancy & Lactation
Should be avoided in the third trimester of pregnancy due to potential harm to the fetus. Use during other trimesters only if clearly needed and the potential benefit outweighs the risk. Naproxen is excreted in breast milk; Esomeprazole also likely. Consult a doctor before use during breastfeeding.
Side Effects
Contraindications
- Hypersensitivity to Naproxen, Esomeprazole, or any component of the formulation
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Severe uncontrolled heart failure
- Third trimester of pregnancy
- Active gastrointestinal bleeding or peptic ulcer
Drug Interactions
Digoxin
Increased digoxin levels
Warfarin
Increased risk of bleeding
SSRI/SNRI
Increased risk of GI bleeding
Tacrolimus
Increased nephrotoxicity
Clopidogrel
Increased risk of bleeding
Methotrexate
Increased methotrexate toxicity
Ketoconazole, Itraconazole
Decreased absorption due to esomeprazole's acid-reducing effect
Diuretics, ACE inhibitors, ARBs
Reduced antihypertensive effect and increased risk of renal impairment
Storage
Store in a cool and dry place, below 30°C. Protect from light and moisture. Keep out of reach of children.
Overdose
Symptoms may include drowsiness, lethargy, epigastric pain, nausea, vomiting, and GI bleeding for Naproxen. Esomeprazole overdose is generally well-tolerated. Management involves symptomatic and supportive care. Gastric lavage and activated charcoal may be considered if appropriate.
Pregnancy & Lactation
Should be avoided in the third trimester of pregnancy due to potential harm to the fetus. Use during other trimesters only if clearly needed and the potential benefit outweighs the risk. Naproxen is excreted in breast milk; Esomeprazole also likely. Consult a doctor before use during breastfeeding.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24 months
Availability
Pharmacies, hospitals
Approval Status
Approved by relevant regulatory bodies (e.g., FDA, DGDA)
Patent Status
Off-patent for generics
Clinical Trials
Extensive clinical trials have demonstrated the efficacy and safety of Naproxen in pain and inflammation, and Esomeprazole in acid suppression and gastroprotection. Combination trials confirm the reduced risk of NSAID-induced GI events.
Lab Monitoring
- Complete Blood Count (CBC) for signs of GI bleeding
- Renal function tests (Creatinine, BUN) especially in elderly or patients with renal impairment
- Liver function tests (ALT, AST)
Doctor Notes
- Counsel patients on the black box warnings regarding cardiovascular and gastrointestinal risks.
- Monitor renal function, liver enzymes, and blood pressure periodically during long-term therapy.
- Emphasize the importance of taking the medication as prescribed and not exceeding the recommended dose.
Patient Guidelines
- Take exactly as prescribed by your doctor.
- Report any unusual bleeding, persistent stomach pain, black stools, or severe rash immediately.
- Do not stop taking the medicine without consulting your doctor.
- Avoid concurrent use of other NSAIDs or aspirin unless directed by your physician.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
This medicine may cause dizziness or drowsiness in some individuals. If you experience these symptoms, avoid driving or operating heavy machinery.
Lifestyle Advice
- Avoid excessive alcohol consumption.
- Maintain a healthy diet and stay hydrated.
- Inform your doctor about all other medications and supplements you are taking.
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