Naproxen and ibuprofen are both nonsteroidal anti-inflammatory drugs (NSAIDs). They reduce pain, stiffness, swelling, and fever connected with inflammation. Naproxen (Aleve) and ibuprofen (Advil) are available at higher strengths as prescriptions and lower strengths when purchased over the counter. In this article, we provide an overview of the similarities and differences between naproxen and ibuprofen, including:

• How they work
• Their uses
• How to take them
• Side effects
• Interactions
• Costs
• Use in pregnancy and breastfeeding

How do they work?

Naproxen and ibuprofen reduce inflammation by preventing an enzyme from making prostaglandins. Prostaglandins are a critical factor for inflammation. Inflammation is the body's natural response to injury or infection. Doctors link chronic inflammation with various health conditions, including inflammatory bowel disease (IBD) and some forms of arthritis.

Heat, redness, pain, and swelling are signs of inflammation. People may experience pain relief that can occur shortly after taking an NSAID, but it can take weeks for the inflammation to go away. When prostaglandins reach the brain, they can cause fever that naproxen and ibuprofen can also treat.By blocking the enzyme that produces prostaglandins, NSAIDs can impair platelet activity, hindering blood clots from forming.

Differences in use

Naproxen and ibuprofen can have different uses, some of which overlap. Experts approve naproxen for the following:

• Ankylosing spondylitis
• Bursitis
• Gout attacks
• Osteoarthritis
• Body aches, minor muscle aches, and pains in bones and joints
• Menstrual cramps and other menstrual pain
• Rheumatoid arthritis
• Tendonitis

People take ibuprofen for the following:

• Fever
• Headache
• Migraine
• Osteoarthritis
• Pain
• Menstrual cramps
• Rheumatoid arthritis

The American College of Rheumatology recommend NSAIDs for the initial management of osteoarthritis of the hands, hips, and knees but do not list one NSAID as more effective than another. However, some people should not take ibuprofen, such as those who are taking aspirin for heart protection.

Although approving them for rheumatoid arthritis use, the American College of Rheumatology's 2015 recommendations do not list NSAIDs as a long-term treatment option because of their side effects. People may use NSAIDs for a short period early in rheumatoid arthritis, while other medications take effect. People can take an NSAID to treat menstrual cramps, which can be effective in reducing pain, but researchers do not know whether one NSAID is better than another.

How to take naproxen and ibuprofen

Naproxen is available in two forms: Naproxen and naproxen sodium. The body absorbs naproxen sodium better than naproxen.

Indications

For pain, menstrual pain, bursitis, and tendonitis

Naproxen: no dosing information provided

Naproxen sodium: 550 mg every 12 hours or 275 mg every 6–8 hours

For ankylosing spondylitis, osteoarthritis, rheumatoid arthritis

Naproxen: 250–500 mg twice daily

Naproxen sodium: 275–550 mg twice daily

Acute gout

Naproxen: 750 mg followed by 250 mg every 8 hours until the attack has subsided

Naproxen sodium: 825 mg followed by 275 mg every 8 hours

Indications for ibuprofen

Mild-to-moderate pain

400 mg every 4–6 hours

Osteoarthritis, rheumatoid arthritis

400 mg, 600 mg, or 800 mg 3–4 times daily

Menstrual pain

400 mg every 4 hours, as needed

Minor side effects

The most common side effects of naproxen and ibuprofen are:

• Heartburn
• Constipation
• Abdominal pain
• Nausea
• Headache
• Dizziness
• Drowsiness
• Itching
• Rash
• Difficulty breathing
• Fluid retention
• Ringing in ears or tinnitus
• Skin discoloration

Serious side effects

Although available over the counter, naproxen and ibuprofen may not be safe for people with the following conditions:

• Heart disease
• Peptic ulcers
• Stroke

In 2015, the Food and Drug Administration (FDA) strengthened an existing warning about non-aspirin NSAIDs increasing the risk of heart attack or stroke. People who take prescription naproxen or ibuprofen may have increased risks for:

• Stroke
• Heart attack
• Hemorrhagic death
• Gastrointestinal inflammation, bleeds, and ulcers

The risk of cardiovascular events, clots, heart attack, and stroke may be higher in people with a history of cardiovascular disease or risk factors for cardiovascular disease. If taking NSAIDs within 2 weeks after heart surgery, people may be at an increased risk for heart attack and stroke.

People who take naproxen or ibuprofen may have a greater risk of developing high blood pressure, heart failure, and water retention. Older adults are more vulnerable to these severe side effects. People who take over-the-counter naproxen and ibuprofen at the labeled dose for 7–10 days may not have an increased risk of adverse effects. To minimize the risk for these adverse effects, people should take naproxen or ibuprofen at the lowest dose for the shortest length of time.

Drug interactions

Both ibuprofen and naproxen may interact with several other drugs:

• Ibuprofen may interact with aspirin, making the aspirin less effective in protecting the heart and preventing strokes
• Ibuprofen may interact with antidepressants and blood thinners and so increase the risk of bleeding
• Ibuprofen may slow the elimination of lithium or methotrexate, which could result in dangerous levels of these drugs
• Naproxen interacts with alcohol, antidepressants, steroids, and blood thinners, so raising the risk of gastrointestinal bleeding and ulcers
• People should avoid taking naproxen and ibuprofen together. Also, they should avoid taking more than one NSAID at a time because this may increase the risk of side effects

Before starting naproxen or ibuprofen, a person must have their medication list checked by a doctor or pharmacist to identify any potential interactions.

Cost

People can find these drugs at drug stores, supermarkets, and online markets:

• Shop for naproxen
• Shop for naproxen sodium
• Shop for ibuprofen

The costs vary between brands. Cost estimates for prescription strengths include the following:

• 60 tablets of naproxen 250 mg are $25.50
• 60 tablets of naproxen 500 mg are $35.67
• 30 tablets of ibuprofen 400 mg are $11.83
• 30 tablets of ibuprofen 800 mg are $13.89

Pregnancy and breastfeeding

People in the third trimester of pregnancy should avoid taking naproxen, as it may lead to heart development problems in the fetus. Doctors do not recommend naproxen or ibuprofen for people who are breastfeeding because the nursing baby may develop side effects.

Summary

Naproxen and ibuprofen are prescription and nonprescription NSAIDs that people can use to treat pain they experience with a wide variety of inflammatory conditions. The main differences between the two NSAIDs are their uses, frequency of doses, doses, and drug interactions.

Despite their availability, these drugs may not be safe for everyone because of existing health conditions and potential interactions with other medications. People with gastrointestinal, cardiac, or kidney disease should talk to their doctor before starting an NSAID. A doctor or pharmacist will check for drug interactions before having someone start an NSAID. People who are in their third trimester or breastfeeding should not take an NSAID.

Typically, when people use them at the correct dose and for the right time, naproxen and ibuprofen are safe and effective drugs for the treatment of inflammatory pain.