<p><strong>Elderly patients</strong>: Studies indicate that although the total plasma concentration of naproxen is unchanged, the unbound plasma fraction of naproxen is increased in the elderly. Use caution when high doses are required &amp; some adjustment of dosage may be required in elderly patients. As with other drugs used in the elderly use the lowest effective dose.<br />
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<strong>Patients with Moderate to Severe Renal impairment</strong>: Naproxen-containing&nbsp;products are not recommended for use in patients with moderate to severe or severe renal impairment (creatinine clearance &lt;30 ml/min).<br />
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<strong>Hepatic insufficiency</strong>: Monitor patients with mild to moderate hepatic impairment closely &amp; consider a possible dose reduction based on the Naproxen component of this tablet. This is not recommended in patients with severe hepatic impairment because Esomeprazole dosage should not exceed 20 mg daily in these patients.</p>