When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to naproxen, esomeprazole, or to similar medicines. Do not use this medicine right before or right after you have heart bypass surgery.

How to Use This Medicine:
Delayed Release Tablet

• Your doctor will tell you how much medicine to use. Do not use more than directed.
• Take this medicine at least 30 minutes before a meal.
• Swallow the tablet whole with water. Do not break, crush, chew, or dissolve it.
• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.
• Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.
• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use any other NSAID medicine unless your doctor tells you to. Some examples of other NSAIDs are aspirin, celecoxib, diclofenac, diflunisal, ibuprofen, or salsalate.
• Some foods and medicines can affect how naproxen/esomeprazole works. Tell your doctor if you are using any of the following:
  
  • Cholestyramine, cilostazol, clopidogrel, cyclosporine, diazepam, digoxin, erlotinib, ketoconazole, lithium, methotrexate, mycophenolate mofetil, pemetrexed, probenecid, rifampin, St John's wort, tacrolimus, or voriconazole
  • Blood pressure medicines
  • Blood thinner (including dicumarol, heparin, warfarin)
  • Diuretic (water pill)
  • Iron supplements
  • SSRI medicine to treat depression
  • Medicine to treat HIV infection (including atazanavir, nelfinavir, saquinavir, ritonavir)
  • Steroids (including dexamethasone, hydrocortisone, methylprednisolone, prednisolone, prednisone)

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding. Do not use this medicine during the later part of pregnancy, unless your doctor says it is okay.
• Tell your doctor if you have kidney disease, liver disease, asthma, bleeding problems, Crohn disease, ulcers or other stomach problems, osteoporosis, heart failure, high blood pressure, any heart or blood vessel problems, or a recent heart attack. Tell your doctor if you drink alcohol.
• This medicine may cause the following problems:
  
  • Increased risk of blood clots, heart attack, stroke, or heart failure
  • Stomach ulcers or bleeding
  • Kidney or liver problems
  • Low vitamin B12 or magnesium levels
  • Increased risk of broken bones in the hip, wrist, or spine
• This medicine can cause diarrhea. Call your doctor if the diarrhea becomes severe, does not stop, or is bloody. Do not take any medicine to stop diarrhea until you have talked to your doctor. Diarrhea can occur 2 months or more after you stop taking this medicine.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• This medicine may cause a delay in ovulation for women and may affect their ability to have children. If you plan to have children, talk with your doctor before using this medicine.
• This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.
• Your doctor will do lab tests at regular visits to check on the effects of this medicine. Keep all appointments.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, or red skin rash
• Bloody, black, or tarry stools
• Change in how much or how often you urinate, bloody or cloudy urine
• Chest pain that may spread, trouble breathing, nausea, unusual sweating, fainting
• Dark urine or pale stools, nausea, vomiting, loss of appetite, stomach pain, yellow skin or eyes
• Numbness or weakness in your arm or leg, or on one side of your body
• Seizures, tremors, uneven heartbeat, muscle spasms or cramps
• Severe diarrhea, stomach cramps, fever
• Stomach pain, nausea, vomiting, weight loss
• Sudden or severe headache, problems with vision, speech, or walking
• Unexplained weight gain, swelling in your hands, ankles, or feet
• Unusual bleeding, bruising, or weakness
• Vomiting of blood or material that looks like coffee grounds

If you notice these less serious side effects, talk with your doctor:

• Mild diarrhea, stomach upset

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088