Ricky Martino Makalah Kimia Naproxen

MAKALAH OBAT YANG MENGANDUNG ASAM KARBOKSILAT
“NAPROXEN”
DOSEN PENGAMPUH : EDY FACHRIAL,S.Si.,M.Si
OLEH : RICKY MARTINO

NIM : 213307030060
UNIVERSITAS PRIMA INDONESIA

FARMASI KLINIS
TAHUN AJARAN 2021/2022
PEMBAHASAN
Naproxen adalah obat antiinflamasi nonsteroid (NSAID) yang dianjurkan untuk digunakan pada
rematik yang menyakitkan dan inflamasi dan kondisi nonrematik tertentu. Ini dapat diberikan
secara oral atau rektal menggunakan rejimen sekali atau dua kali sehari yang nyaman. Penyesuaian
dosis biasanya tidak diperlukan pada orang tua atau mereka dengan gangguan ginjal atau hati
ringan meskipun mungkin bijaksana untuk memulai pengobatan dengan dosis rendah dan titrasi
ke atas pada kelompok pasien tersebut.
Banyak uji klinis telah mengkonfirmasi bahwa kemanjuran analgesik dan anti-inflamasi naproxen
setara dengan banyak NSAID yang lebih baru dan mapan yang telah dibandingkan. Obat ini efektif
dalam banyak penyakit rematik seperti rheumatoid arthritis, osteoarthritis, ankylosing spondylitis
dan rematik nonarticular, pada cedera traumatis akut, dan dalam pengobatan dan profilaksis
terhadap nyeri akut seperti migrain, sakit kepala tegang, nyeri pasca operasi, nyeri dan nyeri
pascapersalinan. terkait dengan berbagai prosedur ginekologi. Naproxen juga efektif dalam
mengobati rasa sakit dan gejala terkait dismenorea primer atau sekunder, dan mengurangi
kehilangan darah yang berlebihan pada pasien dengan menoragia. Profil efek samping naproxen
telah diketahui dengan baik, terutama dibandingkan dengan banyak NSAID yang lebih baru, dan
obat ini dapat ditoleransi dengan baik.
Dengan demikian, kemanjuran dan tolerabilitas naproxen telah ditetapkan dengan jelas selama
bertahun-tahun penggunaan klinis, dan karena itu dapat dianggap sebagai pengobatan lini pertama
untuk penyakit rematik dan berbagai keadaan nyeri.
Sifat Farmakodinamik
Naproxen memiliki sifat farmakodinamik yang khas dari obat antiinflamasi kelas nonsteroid.
Dalam penelitian pada hewan, obat ini menunjukkan efek antiinflamasi, analgesik, dan antipiretik
terkait dosis: berdasarkan berat-untuk-berat, obat ini lebih poten daripada aspirin dan fenilbutazon,
dan sama dengan atau kurang poten daripada indometasin. Efek anti-inflamasinya masih tampak
jelas pada hewan yang mengalami adrenalektomi, yang menunjukkan mekanisme aksi nonsteroid.
Efek anti-inflamasi naproxen, dan sebagian besar efek farmakologis lainnya, umumnya dianggap
terkait dengan penghambatan siklooksigenase dan akibatnya penurunan konsentrasi prostaglandin
dalam berbagai cairan dan jaringan, termasuk mukosa lambung, cairan sinovial, urin. dan darah.
Secara umum dengan NSAID lainnya naproxen dapat menyebabkan perdarahan mikro
gastrointestinal dan lesi gastrointestinal yang terbukti secara endoskopi: umumnya menghasilkan
efek yang lebih sedikit daripada aspirin dan indometasin tetapi lebih dari diflunisal, etodolak,
nabumeton dan sulindac. Dalam praktek klinis, bagaimanapun, sementara tolerabilitas
gastrointestinal naproxen lebih baik daripada aspirin dan indometasin, tidak ada bukti definitif
yang menunjukkan perbedaan yang signifikan dalam tolerabilitas (keluhan kecil, perdarahan atau
ulserasi) antara naproxen dan NSAID lainnya.
Naproxen, seperti NSAID lainnya, merupakan inhibitor poten dari fase sekunder agregasi platelet.
Namun, pada dosis terapeutik biasa, efeknya kecil pada waktu perdarahan pada manusia. Secara
umum, naproxen tidak menghasilkan efek ginjal yang merugikan pada pasien dengan fungsi ginjal
normal meskipun beberapa perubahan dilaporkan pada beberapa pasien dengan gangguan ginjal
atau gagal jantung yang sudah ada sebelumnya. Naproxen tidak memberikan efek urikosurik.
Pada hewan normal naproxen tidak mempengaruhi metabolisme kolagen tetapi dapat
menghambat erosi tulang rawan dan tulang pada hewan dengan arthritis yang diinduksi adjuvant.
Tidak ada bukti definitif pada manusia dengan penyakit rematik bahwa naproxen atau NSAID
lainnya dapat menghambat perkembangan tulang rawan atau kerusakan tulang. Seperti yang
terjadi dengan NSAID lainnya, naproxen mempengaruhi fungsi leukosit mengurangi kemotaksis,
dan lisosom dan protease netral, dan aktivitas kolagenase pada hewan.
Sifat Farmakokinetik
Naproxen tersedia dalam 2 bentuk: asam bebas atau garam natrium. Naproxen dan naproxen
sodium secara farmakologis dan terapeutik setara pada dosis yang sebanding (naproxen 500mg
sama dengan naproxen sodium 550mg). Satu-satunya perbedaan antara kedua bentuk tersebut
adalah kecepatan absorpsinya: natrium naproxen larut lebih cepat dalam jus lambung dan
akibatnya menghasilkan konsentrasi plasma yang lebih awal dan lebih tinggi. Konsentrasi plasma
puncak dicapai dalam waktu sekitar 1 jam dengan naproxen sodium dan 2 jam dengan naproxen.
Ada kemungkinan bahwa ini dapat memberikan onset kerja yang lebih cepat dengan garam
natrium setelah dosis awal; ini akan menjadi relevansi dalam pengobatan keadaan nyeri akut.
Terlepas dari perbedaan ini, farmakokinetik fase pasca-penyerapan garam natrium dan asam
induknya adalah identik.
Naproxen benar-benar diserap setelah pemberian oral dan rektal. Pemberian makanan secara
bersamaan dapat menunda penyerapan naproxen yang diberikan secara oral tetapi tidak
mengurangi tingkatnya. Penyerapan lebih lambat setelah rektal dibandingkan dengan pemberian
oral, menyebabkan penundaan dan konsentrasi plasma puncak yang lebih rendah. Konsentrasi
plasma meningkat secara proporsional dengan dosis setelah pemberian oral dosis tunggal hingga
500mg, tetapi setelah itu peningkatannya kurang dari linier. Hal ini terkait dengan peningkatan
klirens yang disebabkan oleh ikatan protein jenuh. Naproxen sangat terikat protein (> 99,5%):
fraksi bebas, bagaimanapun, meningkat secara signifikan pada konsentrasi plasma yang lebih
tinggi. Volume distribusi naproxen kecil, sekitar 10% dari berat badan. Obat mudah mencapai
cairan sinovial dan membran sinovial. Naproxen melintasi penghalang plasenta, dan transfer
minimal terjadi ke ASI (sekitar 1% dari sampel plasma ibu). Sekitar 95% dari dosis radiolabel
naproxen ditemukan dalam urin dan 3% atau kurang dalam tinja. 70% obat diekskresikan sebagai
naproxen yang tidak berubah dan sisanya dimetabolisme menjadi metabolit 6-demetil yang tidak
aktif, mungkin melalui oksidasi mikrosomal hati. Senyawa induk dan metabolitnya diekskresikan
secara bebas atau sebagai konjugat glukuronida atau sulfat. Waktu paruh eliminasi adalah sekitar
12 hingga 15 jam.
Profil farmakokinetik naproxen umumnya tidak terpengaruh sampai batas yang signifikan secara
klinis berdasarkan usia atau adanya penyakit. Namun, konsentrasi plasma bebas naproxen dapat
meningkat pada pasien lanjut usia dengan rheumatoid arthritis dan pada pasien dengan gangguan
hati, karena penurunan kadar albumin plasma. Insufisiensi ginjal memiliki sedikit efek pada
farmakokinetik naproxen sampai parah. Ketika klirens kreatinin kurang dari 10 ml/menit terjadi
penurunan yang signifikan pada konsentrasi naproxen plasma tetapi peningkatan konsentrasi
metabolit. Naproxen tidak dihilangkan dengan hemodialisis. Oleh karena itu, pengurangan dosis
tidak diperlukan pada pasien dengan gangguan ginjal ringan sampai sedang dan suplementasi dosis
setelah hemodialisis juga tidak diperlukan.
Penggunaan terapeutik
Naproxen, biasanya 500 sampai 1000 mg/hari sekali atau dua kali sehari, diberikan secara oral
atau rektal, telah dipelajari dengan baik dalam uji klinis terkontrol pada pasien dengan rheumatoid
arthritis, osteoarthritis dan ankylosing spondylitis. Obat ini menunjukkan kemanjuran analgesik
dan anti-inflamasi yang serupa dengan dosis terapi biasa dari NSAID lain yang umum digunakan
(misalnya aspirin, diklofenak, ibuprofen, indometasin, ketoprofen, piroksikam), dan NSAID lain
yang lebih jarang digunakan atau lebih baru. Seperti yang diharapkan dalam sejumlah besar
perbandingan, perbedaan yang signifikan secara statistik ditemukan untuk beberapa parameter
penilaian tetapi perbedaan ini tidak signifikan secara klinis dan biasanya terkait dengan
perbandingan dosis terapeutik yang tidak setara. Dengan titrasi dosis yang tepat, respons klinis
terhadap NSAID umumnya tampak setara (walaupun pasien individu mungkin secara tidak dapat
dijelaskan merespons atau mentoleransi satu NSAID dan bukan yang lain). Kemanjuran terapeutik
naproxen dipertahankan selama pengobatan jangka panjang hingga beberapa tahun dan dikaitkan
dengan efek hemat steroid pada pasien dengan rheumatoid arthritis.
Beberapa penelitian telah menunjukkan bahwa naproxen efektif dalam pengobatan gout akut dan
arthritis juvenil tetapi penelitian lebih lanjut diperlukan untuk memungkinkan kesimpulan yang
pasti mengenai kemanjuran dan tolerabilitas dibandingkan dengan agen lain yang umum
digunakan. Naproxen hingga 1000 mg/hari telah terbukti menjadi agen analgesik dan anti-
inflamasi yang efektif untuk pengobatan kondisi rematik nonartikular akut atau kronis dan cedera
jaringan lunak. Kemanjurannya dalam kondisi ini sebanding dengan agen lain yang umum
digunakan. Naproxen adalah analgesik yang berguna dalam berbagai keadaan nyeri akut, seperti
migrain, sakit kepala tegang, nyeri pasca operasi, nyeri pascapersalinan, dan nyeri yang terkait
dengan berbagai prosedur ginekologi. Dalam pengobatan migrain akut naproxen sebanding
dengan ergotamine. Di negara nyeri akut lainnya naproxen setidaknya sama efektifnya dengan
beberapa analgesik 'murni' yang lebih umum digunakan atau kombinasinya [mis. parasetamol
(asetaminofen), kodein, dekstropropoksifen]. Naproxen juga telah berhasil digunakan dalam
profilaksis migrain, mengurangi keparahan dan frekuensi serangan migrain pada tingkat yang
sama seperti pizotifen dan propranolol.
Naproxen adalah agen yang dipelajari dengan baik dalam pengobatan dismenorea primer dan
sekunder, mengurangi rasa sakit dan gejala terkait. Ini mengurangi gejala setidaknya serta NSAID
lain yang telah dibandingkan. Selain itu, naproxen mengurangi kehilangan darah dan anemia
akibat menoragia.
Naproxen tampaknya menjadi agen yang sangat efektif dalam mengendalikan demam neoplastik
dan telah digunakan untuk membedakan antara demam terkait neoplasma dan infeksi terkait pada
pasien kanker dengan demam yang tidak diketahui asalnya. Ini mungkin juga efektif sebagai agen
antipiretik umum meskipun studi lebih lanjut diperlukan untuk membandingkan kemanjurannya
relatif terhadap pengobatan standar lainnya.
Dampak buruk
Profil tolerabilitas naproxen sudah mapan, karena pengalaman luas telah diperoleh dengan obat
selama bertahun-tahun. Obat ini umumnya ditoleransi dengan baik. Sama dengan NSAID lain,
efek samping yang paling sering termasuk gangguan gastrointestinal ringan dan efek SSP, diikuti
oleh reaksi kulit ringan sesekali. Peningkatan usia tampaknya tidak terkait dengan peningkatan
efek yang tidak diinginkan dan hanya ada sedikit bukti yang menunjukkan bahwa sifat, tingkat
keparahan atau frekuensi efek samping berbeda dengan naproxen dibandingkan dengan NSAID
lainnya. Meskipun beberapa klaim peningkatan tolerabilitas dengan beberapa NSAID yang lebih
baru, tidak ada temuan yang pasti untuk menunjukkan hal ini. Aspirin dan indometasin dapat
menghasilkan frekuensi gejala gastrointestinal dan efek SSP yang lebih tinggi dibandingkan
dengan naproxen.
Seperti obat apa pun yang telah digunakan secara luas dalam praktik klinis, sejumlah efek samping
serius yang jarang terjadi telah dikaitkan dengan naproxen, yang juga telah dikaitkan dengan
NSAID lainnya. Mereka termasuk: perdarahan gastrointestinal atau ulserasi, pseudoporfiria dan
reaksi kulit parah lainnya; gagal ginjal akut termasuk nekrosis papiler, nefritis interstisial dan
hiperkalemia; hepatitis; infiltrat paru dengan eosinofilia; agranulositosis; anemia aplastik;
anemia hemolitik; neuropati perifer; meningitis aseptik; dan kekeruhan kornea. Pasien yang
menunjukkan hipersensitivitas aspirin dapat menunjukkan reaktivitas silang dengan naproxen.
Dosis dan Administrasi
Jadwal dosis berikut mengacu pada naproxen yang diberikan sebagai asam bebas. Jika naproxen
sodium digunakan, dosisnya dinaikkan 10% untuk mencapai bioekivalensi (naproxen 500mg =
naproxen sodium 550mg).
Dosis pemeliharaan naproxen dewasa yang biasa pada pasien dengan penyakit rematik kronis atau
nyeri kronis adalah 375 hingga 1000 mg/hari setelah makan dan sekali atau dua kali sehari. Ini
dapat ditingkatkan menjadi 1500 mg/hari dalam dosis terbagi hingga 2 minggu untuk mengobati
eksaserbasi akut penyakit. Untuk anak-anak dengan arthritis remaja dosis yang dianjurkan adalah
10 mg/kg dalam 2 dosis terbagi; formulasi suspensi tersedia untuk membantu pemberian. Pada
pasien dengan kondisi akut seperti tendinitis, bursitis, dismenorea dan nyeri ringan hingga sedang,
dosis awal 500mg harus diberikan dan diikuti oleh 250mg setiap 6 hingga 8 jam sesuai kebutuhan
(hingga maksimum 1250 mg/hari).
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