Aspirin vs. Aleve (naproxen): What's the difference?

What is aspirin? What is Aleve (naproxen)?

Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat fever, pain, and inflammation in the body. It also prevents blood clots (antithrombotic). Other NSAIDs include ibuprofen (Motrin), indomethacin (Indocin), and nabumetone (Relafen). NSAIDs work by reducing the levels of prostaglandins, chemicals released when there is inflammation that cause pain and fever. NSAIDs block the enzyme that makes prostaglandins (cyclooxygenase), causing lower concentrations of prostaglandins, that results in a reduction of inflammation, pain, and fever. Inhibition of prostaglandins also reduces the function of platelets and the blood’s clotting ability. Because aspirin inhibits the function of platelets for prolonged periods of time, it is used to reduce the risk of another stroke or heart attack in people who have already had a stroke or heart attack.

Naproxen is used for the treatment of mild to moderate pain, inflammation, and fever. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs work by reducing the levels of prostaglandins, chemicals responsible for pain, fever, and inflammation. Naproxen blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. As a consequence, inflammation, pain and fever are reduced.

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What are the side effects of aspirin and Aleve?

Aspirin

Most patients benefit from aspirin and other NSAIDs with few side effects. However, serious side effects can occur and generally tend to be dose-related. Therefore, it is advisable to use the lowest effective dose to minimize side effects.

The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears.

Gastrointestinal side effects are

  • ulcerations,
  • abdominal burning,
  • pain,
  • cramping,
  • nausea,
  • gastritis, and
  • even serious gastrointestinal bleeding and
  • liver toxicity.

Sometimes, ulceration and bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.

Ringing in the ears

  • Should ringing in the ears occur, the daily dose should be reduced.

Other side effects include:

Other side effects and adverse reactions

  • Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.
  • Aspirin may exacerbate asthma.
  • Aspirin can raise the blood uric acid level and is avoided in patients with hyperuricemia and gout.
  • Children and teenagers should avoid aspirin for symptoms of the flu or chickenpox because of the associated risk of Reye's Syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
  • Aspirin can increase the effect of medicines used to treat diabetes mellitus, resulting in abnormally low blood sugars if blood sugar levels are not monitored.
  • NSAIDs should be discontinued prior to elective surgery because of a mild tendency to interfere with blood clotting. Aspirin, because of its prolonged effect on platelets, is best discontinued at least ten to fourteen days in advance of the procedure.

Aleve

The most common side effects from naproxen are:

Other important side effects include:

What is the dosage of aspirin vs. aleve?

Aspirin

Aspirin should be taken with food. Doses range from 50 mg to 6000 mg daily depending on the use.

  • Usual doses for mild to moderate pain are 350 or 650 mg every 4 hours or 500 mg every 6 hours.
  • Doses for rheumatoid arthritis include 500 mg every 4-6 hours; 650 mg every 4 hours; 1000 mg every 4-6 hours; 1950 mg twice daily.
  • Heart attacks are prevented with 75, 81, 162 or 325 mg daily.
  • 160 to 325 mg of non-enteric coated aspirin should be chewed immediately when experiencing symptoms of a heart attack.
  • The dose for preventing another stroke is 75 to 100 mg daily.

Aleve

The usual adult dose for pain is 250 every 6 to 8 hours or 500 mg twice daily using regular naproxen tablets. The usual dose for Naprelan controlled release tablets is 750 to 1000 mg given once daily. For EC-Naprosyn, the usual dose is 375-500 mg twice daily.

Naproxen should be given with food to reduce upset stomach. The dose for rheumatoid arthritis, osteoarthritis, or ankylosing spondylitis is 500 to 1000 mg every 12 hours. Dysmenorrhea is treated with 250 mg every 6 to 8 hours after an initial dose of 500 mg.

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What drugs interact with aspirin and Aleve?

Aspirin

  • Aspirin is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common of the suspected interactions.
  • NSAIDs may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
  • Aspirin may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation of blood pressure.
  • When aspirin is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
  • Individuals taking oral blood thinners or anticoagulants, for example, warfarin, (Coumadin) should avoid aspirin because aspirin also thins the blood, and excessive blood thinning may lead to serious bleeding.

Aleve

Naproxen is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common suspected interactions.

  • Naproxen may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
  • Naproxen may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins play a role in the regulation of blood pressure.
  • When naproxen is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycosides (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because the elimination from the body of these drugs is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
  • Individuals taking anticoagulants, for example, warfarin, (Coumadin), should avoid naproxen because naproxen also thins the blood, and excessive blood thinning may lead to bleeding.
  • Naproxen increases the negative effect of cyclosporine on kidney function and reduces the effect of furosemide (Lasix) and thiazide diuretics because of prostaglandin inhibition.
  • Naproxen should be avoided by patients with a history of asthma attacks, hives or other allergic reactions to aspirin or other NSAIDs. If aspirin is taken with naproxen there may be an increased risk for developing an ulcer.
  • Persons who have more than 3 alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking naproxen or other NSAIDs.

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Are aspirin and Aleve safe to use while pregnant or breastfeeding?

Aspirin

Aspirin is generally avoided during pregnancy because it may adversely affect the fetus. However, low aspirin doses have been safely used for the prevention of complications of pregnancy.

Aspirin is excreted into breast milk and may cause adverse effects in the infant.

Aleve

NSAIDs may cause a fatal birth defect called ductus arteriosus (early closure of two major blood vessels of the heart and lung) in the third trimester of pregnancy. Therefore, NSAIDs should be avoided during this last part of pregnancy.

A small amount of naproxen is excreted in breast milk. Because the concentration in breast milk is low, breastfeeding while taking naproxen probably is not harmful to the infant.

Summary

Aspirin and Aleve (naproxen) are nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat fever, pain, and inflammation in the body. Aspirin is also used to prevent blood clots (it is antithrombotic). Brand names for aspirin include Bayer Aspirin, Ecotrin, and many others. Both aspirin and Aleve are available over-the-counter (OTC) and as generics.

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Medically Reviewed on 1/25/2019
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