Ibuprofen and naproxen: uses, side effects and what to know

Ibuprofen and naproxen are nonsteroidal anti-inflammatory drugs (NSAIDs), the same class as aspirin and meloxicam. Ibuprofen is sold as Advil, Motrin IB and generics; naproxen is sold over the counter as Aleve (naproxen sodium) and by prescription as Naprosyn or generic naproxen.

Over the counter and prescription. At the pharmacy you can buy low strengths without a prescription: 200 mg ibuprofen and 220 mg naproxen sodium tablets. Higher strengths need a prescription: per their FDA labels, ibuprofen 400, 600 and 800 mg tablets, and naproxen 250, 375 and 500 mg (or naproxen sodium 275 and 550 mg).

They are not controlled substances. They are not opioids, but that does not make them risk-free: read the warnings below.

According to the over-the-counter Drug Facts label and MedlinePlus, ibuprofen reduces fever and temporarily relieves minor aches and pains such as:

MedlinePlus explains that ibuprofen and naproxen work by stopping the body’s production of a substance that causes pain, fever and inflammation (prostaglandins). Those same substances protect the stomach lining and help keep blood flowing to the kidneys. That is why NSAIDs can irritate the stomach and affect the kidneys, especially at high doses, with long use or when you are dehydrated.

These are the directions on the over-the-counter Drug Facts label for 200 mg ibuprofen. For prescription doses, the doctor decides the dose.

• Do not take more than directed; the smallest effective dose should be used.
• Adults and children 12 years and older: take 1 tablet every 4 to 6 hours while symptoms persist. If pain or fever does not respond to 1 tablet, 2 tablets may be used.
• Do not exceed 6 tablets in 24 hours, unless directed by a doctor.
• Children under 12 years: ask a doctor (children’s products carry their own chart).
• Take with food or milk if stomach upset occurs.

When to stop and ask a doctor. The label says to stop and ask a doctor if pain gets worse or lasts more than 10 days, if fever gets worse or lasts more than 3 days, or if redness or swelling is present in the painful area.

What is naproxen used for? Over the counter, it relieves the same minor aches as ibuprofen (arthritis, muscles, back, menstrual cramps, headache, toothache, the common cold) and reduces fever. By prescription, per its FDA label, it is used for rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, juvenile idiopathic arthritis, tendonitis, bursitis, acute gout, pain and menstrual cramps.

How to take it over the counter. The Drug Facts label for 220 mg naproxen sodium says, for adults and children 12 years and older:

• Do not take more than directed; the smallest effective dose should be used.
• Drink a full glass of water with each dose.
• Take 1 tablet every 8 to 12 hours while symptoms last.
• For the first dose you may take 2 tablets within the first hour.
• Do not exceed 2 tablets in any 8- to 12-hour period, and do not exceed 3 tablets in a 24-hour period.
• Children under 12 years: ask a doctor.

For prescription doses, the doctor decides the dose. The same stop rules apply: pain lasting more than 10 days or fever lasting more than 3 days.

Both are NSAIDs, work the same way and carry the same warnings. The main difference is how long the effect lasts: per their over-the-counter labels, ibuprofen is taken every 4 to 6 hours and naproxen every 8 to 12 hours. So naproxen is taken fewer times a day.

Never combine them. Do not take ibuprofen and naproxen together, or with aspirin, meloxicam or another NSAID: the label warns that taking more than one NSAID raises the risk of stomach bleeding. Check cold and sleep products too, because some contain ibuprofen or naproxen.

Neither is “best” for everyone. If you have a health condition or take other medicines, the doctor helps you choose.

According to MedlinePlus and the labels, the most common side effects of ibuprofen and naproxen involve the stomach and gut:

The prescription labels for ibuprofen and naproxen carry a boxed warning, the FDA’s most serious:

• Heart and brain. NSAIDs raise the risk of heart attack and stroke, which can be fatal. The risk may start early in treatment and rise with longer use. They are not used in the setting of coronary artery bypass graft (CABG) surgery.
• Stomach and intestines. NSAIDs raise the risk of bleeding, ulcers and perforation of the stomach or intestines, which can be fatal and can happen at any time without warning symptoms. Older adults and people who have had ulcers or bleeding are at greater risk.

The over-the-counter warnings. The Drug Facts label carries three alerts: the allergy alert (a severe allergic reaction is possible, especially in people allergic to aspirin), the stomach bleeding warning (higher risk if you are 60 or older, have had ulcers, take a blood thinner or a steroid, take another NSAID, have 3 or more alcoholic drinks a day, or use it more or longer than directed) and the heart attack and stroke warning.

Stop use and ask a doctor if you have symptoms of heart problems or stroke: chest pain, trouble breathing, weakness in one part or side of the body, slurred speech or leg swelling. That is what the over-the-counter label says. If symptoms are severe or sudden, call 911.

Other label risks: kidney injury (higher risk if you are dehydrated, have kidney or heart disease, or take diuretics or ACE inhibitor or ARB blood pressure medicines, such as lisinopril or losartan); raised blood pressure, or your high blood pressure pills working less well; worsening heart failure and fluid retention; high potassium; rare liver injury; and serious skin reactions such as Stevens-Johnson syndrome.

Do not take them if you have ever had asthma, hives or another allergic reaction after taking aspirin or another NSAID, or right before or after heart surgery, per the labels.

Low-dose aspirin. If you take aspirin to prevent a heart attack or stroke, the label warns that ibuprofen and naproxen may decrease this benefit of aspirin. Ask the doctor or a pharmacist before using them, and do not stop your aspirin on your own.

Higher bleeding risk with blood thinners such as warfarin, steroids such as prednisone, and SSRI and SNRI antidepressants such as sertraline, duloxetine or venlafaxine.

Other medicines. They can raise lithium levels and methotrexate toxicity, and reduce the effect of diuretics and some blood pressure medicines.

Alcohol. Having 3 or more alcoholic drinks a day while using them raises the risk of stomach bleeding, per the label.

Ask the doctor first if you have high blood pressure, heart disease, kidney disease or cirrhosis, asthma, a past stroke, past ulcers or frequent heartburn, or if you take a diuretic.

Pregnancy. In 2020 the FDA recommended avoiding NSAIDs at 20 weeks of pregnancy or later unless a doctor advises it, because they can cause kidney problems in the unborn baby and low amniotic fluid. From about 30 weeks they can also close a blood vessel next to the baby’s heart (the ductus arteriosus) too early. This does not include low-dose aspirin your doctor has told you to take during pregnancy. If you are or could be pregnant, ask the doctor before taking them.

Breastfeeding. According to LactMed, the National Library of Medicine database, very little ibuprofen passes into breast milk, and it is a preferred choice for pain or inflammation while nursing. Naproxen levels in milk are also low, but it stays in the body longer, and LactMed says other medicines may be preferred while nursing a newborn or premature baby.

Liquid ibuprofen is made for children. Per the label for children’s ibuprofen suspension (100 mg per 5 mL), it is for ages 2 to 11, and you find the dose on the chart in the box, by weight if you know it, otherwise by age. It can be repeated every 6 to 8 hours if needed, no more than 4 times a day, measured only with the cup or syringe that comes with it. Infant drops are for 6 to 23 months; for babies under 6 months, ask a doctor first.

Over-the-counter naproxen has no directions for children under 12: ask a doctor. Read more about fever in children.

Acetaminophen (Tylenol) also relieves pain and fever, but it is not an NSAID: it does not carry the NSAID stomach-bleeding warning, and it is what the CDC recommends when dengue is possible. It has its own risk: the Tylenol Extra Strength label warns that severe liver damage may occur if you take more than 4,000 mg of acetaminophen in 24 hours, with other drugs containing acetaminophen, or with 3 or more alcoholic drinks a day. That figure is the liver-safety limit, not a dose to aim for: the directions on the same label say not to take more than 6 caplets in 24 hours unless directed by a doctor. Check cold products, because many contain acetaminophen. For a fever, the doctor can help you choose.