Ibuprofen (Advil, Motrin) vs. Naproxen (Aleve) for Pain

• Ibuprofen (Advil, Motrin) and naproxen (Aleve) are both over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) used for the management of mild to moderate pain, fever, and inflammation.
• Common side effects of ibuprofen and naproxen that are similar include:
  • Rash
  • Ringing in the ears (tinnitus)
  • Headaches
  • Dizziness
  • Drowsiness
  • Abdominal pain
  • Nausea
  • Diarrhea
  • Constipation
  • Heartburn
• Serious side effects of ibuprofen and naproxen that are similar include:
  • Fluid retention (edema)
  • Blood clots
  • Heart attacks
  • High blood pressure (hypertension)
  • Heart failure
• Both ibuprofen and naproxen both may interact with lithium, blood pressure medications, methotrexate (Trexall, Rheumatrex), aminoglycosides, anticoagulants, cyclosporine, furosemide, and thiazide diuretics.
• Taking ibuprofen, naproxen, or other NSAIDs and consuming more than three alcoholic beverages per day may increase the risk of developing stomach ulcers.
• Taking naproxen or ibuprofen with selective serotonin reuptake inhibitors (SSRIs) may increase the likelihood of gastrointestinal (GI) bleeding.
• Brand names of Naproxen include Anaprox, Naprelan, Naprosyn, and Aleve. Brand names of ibuprofen include Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, and PediaCare Fever.

Ibuprofen and naproxen belong to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Other members of this class include indomethacin (Indocin), nabumetone (Relafen), and several others.

• These drugs are used for the management of mild to moderate pain, fever, and inflammation.
• They work by reducing the levels of prostaglandins, chemicals that are responsible for pain, fever, and inflammation.
• Naproxen and ibuprofen block the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. Therefore, inflammation, pain, and fever are reduced.

Is ibuprofen an anti-inflammatory? What is it used for?

Ibuprofen is used for the treatment of mild to moderate pain, inflammation, and fever caused by many and diverse diseases. It is used for treating: 

• menstrual cramps (dysmenorrhea),
• osteoarthritis,
• rheumatoid arthritis, and
• juvenile idiopathic arthritis.

What is naproxen used for?

Naproxen is used for the treatment of:

• mild to moderate pain,
• inflammation, and
• fever.

Ibuprofen side effects

The most common side effects from ibuprofen are:

• rash,
• ringing in the ears,
• headaches,
• dizziness,
• drowsiness,
• abdominal pain,
• nausea,
• diarrhea,
• constipation, and
• heartburn.

NSAIDs reduce the ability of blood to clot and therefore increase bleeding after an injury.

Ibuprofen may cause ulceration of the stomach or intestine, and the ulcers may bleed. Sometimes, ulceration can occur without abdominal pain; and due to bleeding, the only signs or symptoms of an ulcer may be black, tarry stools, weakness, and dizziness upon standing (orthostatic hypotension).

Sometimes, ulceration can occur without abdominal pain, due to the bleeding, and the only signs or symptoms of an ulcer are:

• black, tarry stools,
• weakness, and
• dizziness upon standing (orthostatic hypotension)

NSAIDs reduce the flow of blood to the kidneys and impair function of the kidneys. The impairment is most likely to occur in patients who already have impaired function of the kidney or congestive heart failure, and use of NSAIDs in these patients should be cautious.

People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen.

Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs.

Other serious side effects associated with NSAIDs are:

• fluid retention (edema),
• blood clots,
• heart attacks,
• hypertension (high blood pressure), and
• heart failure.

NSAIDs (except low- dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions in people with or without heart disease or risk factors for heart disease. The increased risk of heart attack or stroke may occur as early as the first week of use and the risk may increase with longer use and is higher in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

Naproxen side effects

The most common side effects from naproxen are:

• rash,
• ringing in the ears,
• headaches,
• dizziness,
• drowsiness, abdominal pain, nausea,
• diarrhea,
• constipation,
• heartburn,
• fluid retention, and
• shortness of breath.

Other important side effects include:

• fluid retention,
• blood clots,
• heart attacks,
• hypertension, and
• heart failure.

Ibuprofen dosage instructions

• For minor aches, mild to moderate pain, menstrual cramps, and fever, the usual adult dose is 200 or 400 mg every 4 to 6 hours.
• Arthritis is treated with 300 to 800 mg 3 or 4 times daily.
• When under the care of a physician, the maximum dose of ibuprofen is 3.2 g daily. Otherwise, the maximum dose is 1.2 g daily.
• Individuals should not use ibuprofen for more than 10 days for the treatment of pain or more than 3 days for the treatment of a fever unless directed by a physician.
• Children 6 months to 12 years of age usually are given 5-10 mg/kg of ibuprofen every 6-8 hours for the treatment of fever and pain. The maximum dose is 40 mg/kg daily.
• Juvenile arthritis is treated with 20 to 40 mg/kg/day in 3-4 divided doses.
• Ibuprofen should be taken with meals to prevent stomach upset.

Naproxen dosage instructions

• Naproxen should be given with food to reduce upset stomach.
• 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.
• The usual dose for EC-Naprosyn is 375-500 mg twice daily.
• The dose for rheumatoid arthritis, osteoarthritis, or ankylosing spondylitis is 500 to 1000 mg every 12 hours.
• Menstrual cramps are treated with 250 mg every 6 to 8 hours after an initial dose of 500 mg.

Ibuprofen drug and alcohol interactions

• Ibuprofen is associated with several suspected or probable interactions that can affect the action of other drugs.
• Ibuprofen 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.
• Ibuprofen may reduce the blood pressure-lowering effects of drugs that are given to reduce blood pressure. This may occur because prostaglandins play a role in the regulation of blood pressure.
• When ibuprofen 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 their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
• Ibuprofen increases the negative effect of cyclosporine on kidney function.
• Individuals taking oral blood thinners or anticoagulants, for example, warfarin (Coumadin), should avoid ibuprofen because ibuprofen also thins the blood, and excessive blood thinning may lead to bleeding.
• If aspirin is taken with ibuprofen there may be an increased risk for developing an ulcer.
• Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking ibuprofen or other NSAIDs.
• Combining SSRIs or selective serotonin reuptake inhibitors (for example, fluoxetine [Prozac], citalopram [Celexa], paroxetine [Paxil, Paxil CR, Pexeva) with NSAIDs may increase the likelihood of upper gastrointestinal bleeding.

Naproxen drug and alcohol interactions

• 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 three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking naproxen or other NSAIDs.

Ibuprofen safety

• There are no adequate studies of ibuprofen in pregnant women. Therefore, ibuprofen is not recommended during pregnancy. Ibuprofen should be avoided in late pregnancy due to the risk of premature closure of the ductus arteriosus in the fetal heart.
• Ibuprofen is excreted in breast milk but the American Academy of Pediatrics states that ibuprofen is compatible with breastfeeding.

Naproxen safety

• NSAIDs may cause a fetal 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.