naproxen / esomeprazole DR
Vimovo (naproxen / esomeprazole) is a combination medication for people age 12 years and older who have arthritis. It contains naproxen, a nonsteroidal anti-inflammatory drug (NSAID) that relieves arthritis symptoms like joint pain and swelling. This combination medication also contains the proton pump inhibitor (PPI) esomeprazole to protect against damage to the stomach from naproxen. Vimovo (naproxen / esomeprazole) is a tablet that's taken by mouth twice a day. Side effects can include inflammation of the stomach lining and diarrhea.
What is Vimovo (naproxen / esomeprazole)?
What is Vimovo (naproxen / esomeprazole) used for?
Treatment of different kinds of arthritis while lowering the risk for stomach ulcers
Osteoarthritis (OA) in adults
Rheumatoid arthritis (RA) in adults
Ankylosing spondylitis (AS) in adults
Arthritis in children 12 years and older (juvenile idiopathic arthritis, JIA)
How Vimovo (naproxen / esomeprazole) works
Vimovo (naproxen / esomeprazole) is a combination of two medications.
Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). This pain reliever works by blocking cyclooxygenase (COX), a protein that makes chemicals that cause pain and swelling in the body. By blocking COX, naproxen helps relieve symptoms of arthritis.
Esomeprazole is a proton pump inhibitor (PPI). It blocks your body from making stomach acid. Less stomach acid means less irritation to the gut. This protects you from some side effects of naproxen, such as gut irritation, gut damage, and ulcers in the gut.
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What are the side effects of Vimovo (naproxen / esomeprazole)?
Common Side Effects
- Inflammation of the stomach lining, leading to symptoms like stomach pain, nausea, and loss of appetite (gastritis, 17%)
- Diarrhea (6%)
Other Side Effects
- Passing gas
- Headache
- Changes in taste
- Upper respiratory tract infection
- Urinary tract infection (UTI)
Serious Side Effects
- Heart attack: chest pain, arm pain, shortness of breath, cold sweat
- Stroke: sudden weakness on one side of the body; confusion; severe headache; trouble seeing, walking, or speaking
- Serious bleeding, including stomach bleeding: bleeding or bruising that doesn't stop or go away; blood or coffee ground-like bits in your vomit; bright red, black, or tarry stool
- Liver damage: yellowing of your skin and whites of your eyes (jaundice), pain in the upper right stomach, itching, nausea, tiredness
- Kidney damage: change in how often you urinate, blood in your urine, fever, weakness, nausea, loss of appetite.
- Severe allergic reaction or skin reaction: rash; hives; blisters; peeling; trouble breathing; swelling of the face, tongue, or lips
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Bleeding—bloody or black, tar-like stools, vomiting blood or brown material that looks like coffee grounds, red or dark brown urine, small red or purple spots on skin, unusual bruising or bleeding
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Heart failure—shortness of breath, swelling of the ankles, feet, or hands, sudden weight gain, unusual weakness or fatigue
- Increase in blood pressure
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Low magnesium level—muscle pain or cramps, unusual weakness or fatigue, fast or irregular heartbeat, tremors
- Low vitamin B12 level—pain, tingling, or numbness in the hands or feet, muscle weakness, dizziness, confusion, trouble concentrating
- Rash, fever, and swollen lymph nodes
- Rash on the cheeks or arms that gets worse in the sun
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
- Round red or dark patches on the skin that may itch, burn, and blister
- Severe diarrhea, fever
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Headache
- Loss of appetite
- Nausea
- Upset stomach
Pros and cons of Vimovo (naproxen / esomeprazole)
Pros
Works well to relieve pain and swelling from arthritis
Helps protect against stomach irritation and ulcers from naproxen without needing to take another pill
Cons
Must take twice a day, each time at least 30 minutes before a meal
Has many serious risks from both naproxen and esomeprazole ingredients
Less flexible for dose adjustments since it's a fixed combination of two ingredients
Pharmacist tips for Vimovo (naproxen / esomeprazole)
It's recommended to take the lowest dose of Vimovo (naproxen / esomeprazole) possible for the shortest period of time to relieve your arthritis symptoms. This helps lower your risk of the side effects and many safety warnings that come with the medication.
Take Vimovo (naproxen / esomeprazole) twice a day, each time at least 30 minutes before eating. If you take it with food, the esomeprazole might not get absorbed as fast and as well into the body. This can make it work less well to protect your stomach from harm caused by the naproxen.
Swallow the whole tablet of Vimovo (naproxen / esomeprazole) with water. Don't cut, chew, crush, or dissolve it. The way the tablet works is to release the naproxen for arthritis slowly over several hours. But when the coating gets damaged, too much naproxen can get released too fast. This can raise your risk for side effects.
Avoid drinking alcohol while you're taking Vimovo (naproxen / esomeprazole). It can raise your risk of stomach issues.
Regularly check your blood pressure at home. Vimovo (naproxen / esomeprazole) can raise your blood pressure. Let your care team know if your blood pressure is consistently higher than normal.
Be careful of accidental injuries. You might bleed or bruise more easily after an injury while you're taking Vimovo (naproxen / esomeprazole). Your risk for bleeding is higher if you have any bleeding problems. Also keep in mind that some other medications, like blood thinners and antidepressants, can also raise your risk for bleeding. Get medical help right away if any bleeds don't stop.
Tell your care team if you feel tired, lightheaded, or short of breath often. These can be signs of anemia, which is a possible side effect of Vimovo (naproxen / esomeprazole). You might need to get a blood test done to check for anemia.
Call your prescriber if you have stomach pain, cramps, or heartburn that doesn't go away while you're taking Vimovo (naproxen / esomeprazole). You might need a check-up to see whether these symptoms are related to a more serious stomach problem.
Tell your prescriber and pharmacist about all prescription medications, over-the-counter products, and herbal supplements you take or plan to take. Your care team can check for harmful drug interactions that can happen with Vimovo (naproxen / esomeprazole). These interactions can block some medications from working well or put you at risk for side effects. Your medications might need dose adjustments or you might need to stop certain medications to lower your risk for harm.
Frequently asked questions about Vimovo (naproxen / esomeprazole)
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What are the risks and warnings for Vimovo (naproxen / esomeprazole)?
Vimovo (naproxen / esomeprazole) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Heart attack or stroke
Risk factors: Recent heart attack or stroke | Heart condition | High blood pressure | High cholesterol | Recent heart surgery | Taking a high dose of Vimovo (naproxen / esomeprazole) | Taking Vimovo (naproxen / esomeprazole) for a long time
Vimovo (naproxen / esomeprazole) contains an NSAID, which can raise your risk of having a heart attack or stroke. These events can be life-threatening.
The risk for heart attack or stroke can appear as early as the first few weeks of taking Vimovo (naproxen / esomeprazole). You're also at higher risk if you take higher doses of the medication. Studies also suggest that the risk of having a heart attack or stroke is higher if you take Vimovo (naproxen / esomeprazole) within the first 2 weeks after heart bypass surgery or after a recent heart attack.
To minimize your risk, you'll be prescribed the lowest dose of Vimovo (naproxen / esomeprazole) that relieves your arthritis symptoms for the shortest time possible. Don't take this medication right before or after heart bypass surgery or if you've had a recent heart attack.
Call 911 and get medical help right away if you have signs of a heart attack (chest or arm pain, cold sweat, shortness of breath) or stroke (facial drooping, weakness on one side of the body, severe headaches, or sudden changes in your speech or vision).
Stomach bleeding and ulcers
Risk factors: History of stomach ulcers or stomach bleeding | Bleeding problems | Advanced liver problems | Taking Vimovo (naproxen / esomeprazole) for a long time | Taking other medications that can raise the risk of bleeding | Taking more than one NSAID medication | Taking low-dose aspiring | Smoking | Drinking alcohol | Age 65 years or older | Poor health
The naproxen component of Vimovo can cause dangerous bleeding, ulcers, and tearing in the stomach, intestines, or esophagus (the tube connecting your mouth to your stomach). The other component of Vimovo, esomeprazole, is meant to help lower the risk for this damage to the digestive tract. But it's still important to be aware that it can happen at any time without warning symptoms even while you're taking this medication.
Stop taking Vimovo (naproxen / esomeprazole) and go to the emergency room right away if you have any signs of serious stomach bleeding. This includes bloody vomit; vomit that looks like coffee ground-like bits; or bright red, black, or tarry stool.
Liver damage
Some people who take NSAIDs like the naproxen component in Vimovo had elevated liver enzyme levels on their blood test results. This can be a sign of liver damage. Although rare, liver damage could be severe.
Let your prescriber know if you have liver problems before you start taking Vimovo (naproxen / esomeprazole) to check that it's safe for you to take. People who have severe liver problems should avoid taking this medication.
Watch for symptoms of liver damage, such as yellowing of your skin or whites of your eyes (jaundice), nausea, diarrhea, tiredness, pain in the upper right stomach, and flu-like symptoms. Let your provider know if you notice any of these symptoms while you're taking Vimovo (naproxen / esomeprazole). You might need to stop taking the medication while your care team checks out the problem.
High blood pressure, heart failure, and fluid buildup in the body
Risk factors: History of high blood pressure or heart failure
Taking Vimovo (naproxen / esomeprazole) can lead to new or worsening high blood pressure. The medication can also cause your body to hold onto fluids, which can look like swelling in the feet, ankles, hands, or belly. Fluid buildup in the body can add to the rise in blood pressure. It can also worsen heart failure for people with this heart condition.
Tell your prescriber about your medical history before you start Vimovo (naproxen / esomeprazole), especially if you have high blood pressure or heart failure. Your prescriber can weigh the risks and benefits of treatment. This medication isn't recommended if you have severe heart failure. In addition, Vimovo (naproxen / esomeprazole) can make certain heart medications used for blood pressure, heart failure, and fluid buildup work less well.
It's important to regularly check your blood pressure while you're taking Vimovo (naproxen / esomeprazole). Let your prescriber know if your blood pressure is consistently higher than usual or if your symptoms of heart failure get worse.
Kidney damage
Risk factors: Kidney problems | Liver problems | Heart failure | Dehydration | Age 65 years and older | Taking certain blood pressure medications (e.g., water pills, ACE inhibitors, ARBs) | Taking Vimovo (naproxen / esomeprazole) for a long time
Vimovo (naproxen / esomeprazole) can cause kidney damage that can happen at any time. Discuss with your prescriber about whether this medication is safe for you if you have kidney problems. People at risk for kidney problems who take Vimovo (naproxen / esomeprazole) might need blood tests during treatment so the care team can keep an eye on kidney health.
Stop taking Vimovo (naproxen / esomeprazole) and let your care team know if you have a change in how often you urinate, blood in your urine, fever, weakness, nausea, or a loss of appetite. These can be signs of kidney damage.
Severe allergic reaction or skin reaction
Risk factors: Allergy to naproxen | Asthma related to NSAID use
Vimovo (naproxen / esomeprazole) can cause serious and sometimes life-threatening allergic reactions, such as anaphylaxis or drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. It can also cause severe skin reactions, like Stevens-Johnson syndrome (SJS).
Stop taking Vimovo (naproxen / esomeprazole) and get medical help right away if you notice any unusual and concerning changes to your skin, including rash, hives peeling, or blistering. Look out for any fever or swollen lymph nodes because they can happen with the allergic reaction. Call 911 right away if you have trouble breathing or swelling in the face.
Abnormal nutrient and electrolyte levels
Risk factors: Taking Vimovo (naproxen / esomeprazole) for a long time | Kidney damage | Medical conditions that cause abnormal electrolyte levels | Taking medications that can raise potassium levels | Taking medications that can lower vitamin B12 or magnesium levels
Vimovo (naproxen / esomeprazole) might raise your potassium levels. The risk is higher if you have kidney damage (which could also be caused by the medication). In addition, taking PPIs like the esomeprazole in Vimovo for a long time can rarely cause low magnesium levels and low vitamin B12 levels. Magnesium levels typically drop after taking the medication for at least 3 months, though in most cases after a year of treatment. And vitamin B12 levels usually start to go down after more than 3 years of treatment.
Depending on your risk factors, you might need to get blood work done before you start Vimovo (naproxen / esomeprazole) and periodically during treatment. This helps your prescriber check that your nutrient and electrolyte levels are in a safe range.
Contact your care team if you have any symptoms of abnormal nutrient or electrolyte levels. These can include tiredness, lightheadedness, weakness, muscle cramps, nausea, tinging or numbness, and pale skin. More serious symptoms are trouble breathing and an irregular heartbeat. You might need supplementation as treatment. If supplementation isn't enough, you might need to stop taking Vimovo (naproxen / esomeprazole).
Bone fracture
Risk factors: History of osteoporosis | Taking Vimovo (naproxen / esomeprazole) for a year or longer | Taking high doses of esomeprazole
Some studies suggest that PPIs (like the esomeprazole component of Vimovo) can raise the risk for fractures at the hip, wrist, or spine. These fractures might be related to bone weakening or osteoporosis. They might be more likely to happen if you take Vimovo (naproxen / esomeprazole) for longer than 1 year.
Vimovo (naproxen / esomeprazole) has a set dose of esomeprazole (40 mg per day). Discuss with your prescriber about whether this medication is safe for you if you have or are at risk of osteoporosis. Your prescriber might decide on a different medication that provides a lower dose of a PPI to lessen your risk for fracture.
Lupus
Some people who took PPIs like the esomeprazole in Vimovo developed new or worsening lupus, which is an autoimmune condition. This can happen within days to years of treatment. Symptoms can include rash (e.g., butterfly rash across cheeks and nose), joint pain, tiredness, and on-and-off fever. Stop taking Vimovo (naproxen / esomeprazole) and contact your care team if you notice any symptoms of lupus while you're taking this medication. Most times, symptoms improve within a few months after stopping the medication.
Harm to unborn baby
Risk factors: Currently pregnant
Speak with your prescriber about whether it's safe for you to take Vimovo (naproxen / esomeprazole) if you're pregnant. This medication isn't recommended for people who are 20 weeks pregnant or are at a later stage in pregnancy.
This combination medication contains naproxen, which can cause problems with how the unborn baby's kidneys and heart develop if taken during the second half of pregnancy. Taking naproxen after 20 weeks of pregnancy can also cause complications that affect how other organs develop.
Vimovo (naproxen / esomeprazole) dosage forms
Typical dosing for Vimovo (naproxen / esomeprazole)
People 12 years and older weighing more than 110 lbs: The typical dose is 375 mg/20 mg (naproxen/esomeprazole) by mouth twice a day. If needed, your prescriber can raise the dose to 500 mg/20 mg (naproxen/esomeprazole) twice a day. Take the medication at least 30 minutes before eating.
People 12 years and older weighing between 84 lbs and 110 lbs: The typical dose is 375 mg/20 mg (naproxen/esomeprazole) by mouth twice a day. Take the medication at least 30 minutes before meals.
Children below the age of 12 or weighing less than 84 lbs: Ask your child's pediatrician to see what other options there are.
The two strengths of Vimovo (naproxen / esomeprazole) available both provide a total daily dose of 40 mg of esomeprazole. If this is too much esomeprazole for you, ask your prescriber about other options that might be more appropriate for you.
How much does Vimovo (naproxen / esomeprazole) cost?
Vimovo (naproxen / esomeprazole) contraindications
Allergy to naproxen, aspirin, or other NSAIDs (e.g., ibuprofen)
Allergy to esomeprazole or other PPIs (e.g., omeprazole)
History of asthma after taking aspirin or other NSAIDs
Upcoming or recent heart bypass surgery (coronary artery bypass graft or CABG)
Take medications that contain rilpivirine (e.g., Edurant, Odefsey, Juluca)
What are alternatives to Vimovo (naproxen / esomeprazole)?
Treatment of different kinds of arthritis while lowering the risk for stomach ulcers
Osteoarthritis (OA) in adults
Rheumatoid arthritis (RA) in adults
Ankylosing spondylitis (AS) in adults
Arthritis in children 12 years and older (juvenile idiopathic arthritis, JIA)
Treatment of osteoarthritis (OA) and rheumatoid arthritis (RA) in adults, while lowering the risk of stomach ulcers
Treatment of osteoarthritis (OA) and rheumatoid arthritis (RA) in adults who are at high risk for stomach and intestinal ulcers
Vimovo (naproxen / esomeprazole) images
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References
Best studies we foundDatto, C., et al. (2013). Efficacy and tolerability of naproxen/esomeprazole magnesium tablets compared with non-specific NSAIDs and COX-2 inhibitors: A systematic review and network analyses. Open Access Rheumatology: Research and Reviews.
Holt, R. J., et al. (2015). Onset and durability of pain relief in knee osteoarthritis: Pooled results from two placebo trials of naproxen/esomeprazole combination and celecoxib. The Physician and Sportsmedicine.
Horizon Therapeutics USA, Inc. (2024). Vimovo- naproxen and esomeprazole magnesium tablet, delayed release [package insert]. DailyMed.
National Institute of Diabetes and Digestive and Kidney Diseases. (2019). Symptoms & causes of gastritis & gastropathy.
U.S. Food and Drug Administration. (2022). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid.
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