Naproxen interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Naproxen is a generic nonsteroidal anti-inflammatory (NSAID) approved by the United States Food and Drug Administration (FDA) to treat pain and inflammation in the body. Some brand names are Aleve, EC-Naprosyn, Flanax Pain Reliever, Midol Extended Relief, Naprelan, Naprosyn, and Anaprox. Naproxen interacts with aspirin and other NSAIDs. 

Naproxen is a popular option for medical conditions such as osteoarthritis, tendonitis, gout, bursitis, swelling, or fever. If you are already taking medication for these conditions, you should inform your healthcare professional, as they may interact with naproxen. You should also avoid certain blood pressure medications, antacids, or drinking alcohol while on naproxen. Being aware of what interacts with naproxen is important as it may affect its effectiveness or increase negative side effects.

Naproxen drug interactions

Many medications may contain ingredients that interact with naproxen. Even over-the-counter (OTC) medications that many assume are safe can cause adverse reactions. It is important to know what medications to avoid or at least be cautious of while taking naproxen.

Nonsteroidal anti-inflammatory drugs

Naproxen should not be taken with other NSAIDs. Since naproxen is an NSAID, taking two of the same medications places you at increased risk for side effects. The most important side effect that is concerning while taking multiple NSAIDs is spontaneous gastrointestinal distress. This may be fatal with no warning signs. Stomach ulcers or bleeds increase with NSAID use. 

Checking the active ingredients in all drugs is important because there are some medications that have a combination formula (i.e., cold medications, sleep medications, antacids, pain medication for menstrual cramps). If naproxen is not helping with your pain, your healthcare provider may recommend Tylenol in between doses. When another NSAID is recommended, you will have to wait at least 8 hours before trying the new NSAID. If you notice dark, bloody stools, bloody vomit, fatigue, inability to urinate, or abdominal cramps, contact your doctor immediately. 

Example of NSAIDs:

• Celecoxib
• Diclofenac
• Etodolac
• Ibuprofen
• Indomethacin
• Ketoprofen
• Meloxicam
• Nabumetone 

Salicylates

Low-dose aspirin is a popular choice for the prevention of cardiovascular complications. Although aspirin is a salicylate and not an NSAID, it should still be closely monitored with naproxen. Both naproxen and aspirin have antiplatelet effects that help to reduce blood clots in the body. The combination of both medications may cause aspirin to lose its effectiveness- reducing your protection from developing heart attacks or strokes. Naproxen is usually safe when used occasionally, but if this medication is needed on a regular basis, you will need to discuss this further with your healthcare provider.

Example of salicylates:

• Aspirin
• Alka-Seltzer
• Bismuth-subsalicylate

Disease-modifying anti-rheumatic drugs (DMARDs)

Use of naproxen occasionally is common for chronic inflammatory conditions such as rheumatoid arthritis, psoriasis, and Crohn’s disease. However, if any of these types of conditions are also being managed with DMARDs (i.e., methotrexate), it is recommended that use of an additional NSAID be closely monitored. Naproxen can increase methotrexate levels in the body, which increases the chance of negative side effects. Too much methotrexate can also be fatal. Typically if low doses of naproxen and methotrexate are being used, the risk of adverse effects lowers. If you plan to use naproxen with DMARDs, discuss this with your doctor, as they may want to closely monitor your blood levels while taking both medications.

Examples of DMARDs:

• Leflunomide
• Methotrexate
• Rituximab 
• Tocilizumab

Blood thinners

Many people use blood thinners—anticoagulants—for the treatment or prevention of blood clots. If you are on a blood thinner, you may have to reconsider your pain medication options if naproxen is your treatment of choice. The use of both is not recommended due to the antiplatelet properties mentioned previously. The use of both medications can cause the blood to become too thin and can increase your chances of excessive bleeding. Other pain relievers may be suggested if you are on a blood thinner so discuss this with your healthcare provider first before starting any new medications, especially naproxen.

Examples of blood thinners:

• Eliquis (apixaban) 
• Plavix (clopidogrel)
• Lovenox (enoxaparin)
• Xarelto (rivaroxaban)
• Brilinta (ticagrelor)
• Coumadin, Jantoven (warfarin)

Antihypertensive medications

Antihypertensive medications to control blood pressure are not recommended while taking naproxen. It decreases the effectiveness of your blood pressure medications. Naproxen can increase blood pressure, the opposite of what the antihypertensive medication is trying to achieve. This makes it more difficult to keep blood pressure regulated. The addition of naproxen also puts more stress on the kidneys along with your blood pressure medication. Using both medications can cause kidney problems, especially in those who take more than one antihypertensive drug. 

Medications used for water retention (diuretics) to manage blood pressure is also an example of blood pressure medication that should be avoided as fluid retention is increased. Speak with your doctor if you are in pain. They may recommend an alternative such as Tylenol instead of naproxen.

Examples of antihypertensives:

• Amlodipine
• Clonidine
• Furosemide
• Guanfacine
• Hydralazine
• Hydrochlorothiazide
• Lisinopril
• Losartan
• Propranolol
• Ramipril 
• Valsartan

Psychiatric drugs

Not all drugs for mental illness interact with naproxen. Antidepressants in the selective serotonin reuptake inhibitors (SSRIs) category should be closely monitored in conjunction with naproxen. These types of antidepressants are known to cause abdominal discomfort (nausea, vomiting, diarrhea). When naproxen is taken with an SSRI, this increases the chances of serious GI problems (stomach ulcers and GI bleeds). Lithium is a mental health drug used for bipolar disorder. It should also be avoided with naproxen. The use of both medications increases the amount of lithium in the body, which can be life-threatening. If you are taking medication for your mental health but need pain relief, discuss this with your healthcare provider, as alternatives or medications to protect the stomach may be recommended.

Examples of psychiatric drugs:

• Citalopram
• Escitalopram
• Fluoxetine
• Fluvoxamine
• Lithium
• Sertraline
• Vortioxetine

Naproxen food interactions

There are some food interactions that should be noted while taking naproxen. In general, it is recommended that naproxen be taken with food or milk to coat the stomach and reduce gastrointestinal problems associated with its use. Avoiding foods that are overly processed (especially meat and carbohydrates), meals high in sodium, garlic, red meat, fried foods, and sugary drinks or desserts can reduce stomach irritation while taking naproxen. Oils like soy, peanuts, corn, or vegetable oils can trigger inflammation in the body as they contain omega-6 fatty acids. 

Related: What’s the best diet for inflammation? 

Other naproxen interactions

As with other medications and food, there are other interactions with naproxen that one should be aware of.

Naproxen and alcohol 

Before you grab that glass of wine, remember that naproxen should not be taken with alcohol. Both increase the possibility of GI bleeds and stomach ulcers. When mixed together, the chances are even higher. 

Related: Can you drink on Naproxen?

Naproxen and caffeine 

When combining naproxen with caffeine, it is good to remember that caffeine can increase the effectiveness of NSAIDs like naproxen. This also increases the chances of negative side effects of naproxen if you are drinking that morning cup of coffee or your lunchtime soda.

Related: Is it safe to mix ibuprofen and caffeine?

Naproxen and disease/CBD/illicit drugs/vitamins/herbal supplements/etc.

Do not take naproxen right before or after coronary artery bypass graft surgery, as this can be fatal. People with known heart disease or blood clots should avoid naproxen as it increases the chances of heart attack or stroke. People with a history of asthma, gastrointestinal problems, especially GI bleeds, kidney disease, liver disease, or problems with fluid retention (congestive heart failure) should all avoid naproxen. Taking naproxen during pregnancy is typically not recommended. If needed, it can be discussed with your doctor as long as it is not past the 20-week timeframe. It has been linked to kidney and heart problems in the fetus. Breastfeeding and taking naproxen is also not recommended.

Cannabidiol (CBD) use should be avoided or at least closely monitored while using naproxen. Cannabis can increase the effectiveness of naproxen which increases side effects. Temporarily discontinuing CBD until naproxen is out of your system is the safest option.

Many people use vitamins or supplements and assume they are safe. However, combining vitamins and supplements with certain medications may be harmful. Vitamin C is shown to increase levels of naproxen. As mentioned before, this increases the chances of minor or serious side effects associated with using this NSAID.

How to minimize naproxen interactions

The best way to prevent interactions while taking naproxen is first to know what negative side effects can occur while taking this NSAID. Next, you should know all over-the-counter and prescription medications you typically take. This will allow you to know if you are at risk for interactions with this medication. Once you know the warning signs, monitor your body closely for any changes that may occur once naproxen or any other medication is initiated. If you begin to notice any negative side effects, primarily bloody stools, vomiting, abdominal cramps, chest pain, fatigue, or weakness, contact your healthcare provider right away.

When to talk to a healthcare provider about naproxen interactions

Please discuss any side effects occurring now that you are taking naproxen. This is not the complete list of potential interactions associated with naproxen use. It is better to review every prescription and nonprescription drug, supplement, recreational alcohol, or drug use with your healthcare provider. They can determine if the symptoms are related to any interactions you may not be aware of. Sometimes alternatives for pain can be provided that may respond better with your current prescription drugs. Additionally, your healthcare specialist may recommend medications that can protect the stomach to reduce GI complications. If any medications are recommended to address naproxen use, Singlecare is always here to help with your prescription needs.