Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NSAID and PPI combination launched

A combination of naproxen and esomeprazole (Vimovo®) has been launched with a license for use in symptomatic treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. The product license specifically aims the product at people who are at risk of developing a non-steroidal anti-inflammatory (NSAID) related gastric or duodenal ulcer when treatment with lower doses of naproxen or other NSAIDs has been insufficient. The Summary of Product Characteristics (SPC) is available now.

The product contains 500mg of naproxen (NSAID) and 20mg of esomeprazole, a proton pump inhibitor (PPI), in each tablet with a recommended daily dose of one tablet twice daily. The esomeprazole ingredient envelopes an enteric coated core containing the naproxen and the former is released first with the naproxen made available in the small intestine. Due to the modified release characteristics of this product it would be unsuitable for treating acute pain where a rapid onset is desired.

This product will cost £14.95 for 60 tablets. Comparative costs to enteric coated naproxen and alternative PPIs are listed below based on the January Drug Tariff:

  • Naproxen enteric coated 500mg tablets (56) - £5.17
  • Omeprazole 20mg capsules (28) - £1.68
  • Omeprazole 40mg capsules (7) - £1.85
  • Lansoprazole 30mg capsules (28) - £2.08
  • Esomeprazole 20mg tablets (28) - £18.50
  • Esomeprazole 40mg tablets (28) - £25.19

Action: Naproxen, or an alternative NSAID, could be co-prescribed with an alternative PPI at lower cost. This product may be useful in patients already on a combination of naproxen and esomeprazole in doses equivalent to this product when switching would be less expensive.

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