Annova Plus 500 mg+20 mg (Tablet (Delayed Release))

Indications

• Osteoarthritis
• Rheumatoid arthritis
• Ankylosing spondylitis
• Decrease risk of developing gastric ulcers

Pharmacology

• Consists of immediate release Esomeprazole Magnesium layer
• Enteric-coated Naproxen core
• Naproxen mechanism of action: inhibit prostaglandin synthesis
• Esomeprazole mechanism of action: proton pump inhibitor

Dosage

• Carefully consider potential benefits & risks before usage
• Use lowest effective dose for shortest duration
• Variants for Adults and Adolescent Patients

Administration

• Do not split, chew, crush or dissolve the tablet
• Take at least 30 minutes before meals

Interaction

• Concomitant use of NSAIDs may reduce antihypertensive effect of certain medications
• Concomitant use with warfarin may increase risk of bleeding complication
• Esomeprazole may interfere with absorption of specific drugs
• Administration with high-fat food may affect absorption of naproxen

Contraindications

• Known hypersensitivity to any tablet component
• History of allergic-type reactions after taking aspirin or other NSAIDs
• Use during peri-operative period in coronary artery bypass graft surgery

Side Effects

• Decrease occurrence of gastric ulcers and NSAID associated adverse events
• Possible arterial thrombotic events with high doses and long-term treatment
• Gastrointestinal adverse events
• Oedema, hypertension, cardiac failure
• Nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, abdominal pain

Pregnancy & Lactation

• Not recommended during first and second trimester of pregnancy
• Contraindicated during third trimester of pregnancy
• Not recommended during breastfeeding
• NSAIDs may impair female fertility

Precautions & Warnings

• Avoid combination with other NSAIDs
• Consider use with low dose acetylsalicylic acid
• Minimize undesirable effects with lowest effective dose
• Risk-factors for NSAID related gastro-intestinal complications
• Increased risk of adverse reactions in older people
• Consideration for combination therapy with protective agents

Use in Special Populations

• Elderly patients: use caution and lowest effective dose
• Patients with Moderate to Severe Renal impairment: not recommended
• Hepatic insufficiency: monitor closely and consider possible dose reduction

Overdose Effects

• Symptoms related to naproxen overdose
• Symptoms related to esomeprazole overdose
• Management: symptomatic and supportive care

Therapeutic Class

• Drugs for Osteoarthritis
• Drugs used for Rheumatoid Arthritis
• Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Storage Conditions

• Store at temperature below 30°C
• Protect from light and moisture
• Keep out of reach of children

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