Naproxen vs. ibuprofen: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Naproxen and ibuprofen are NSAIDs (nonsteroidal anti-inflammatory drugs) used to treat pain and inflammation from various conditions. NSAIDs work by blocking a chemical called prostaglandin. Prostaglandin causes pain and inflammation. By blocking prostaglandin, NSAIDs help to treat pain and inflammation. Both naproxen and ibuprofen are known as NSAIDs and have a lot of similarities, but they do have some differences.

What are the main differences between naproxen vs. ibuprofen?

Naproxen, or naproxen sodium, is known by the brand name, Naprosyn, as well as over-the-counter as Aleve. It is also available in generic form alone (by prescription, and OTC in a lower dose) and in combination with other medications. Ibuprofen is known by the brand names Motrin and Advil, and it is also available in generic form alone and in combination with other medications. Dosing varies by indication, and the OTC dose is lower than the prescription dose. Also, ibuprofen is shorter-acting and is dosed more frequently than naproxen, which is longer acting and can be dosed less frequently.

Because both drugs are available in a variety of combinations, such as many various cough and cold medications as well as sleep formulations, when picking an OTC product, it is a good idea to consult your pharmacist to ensure you are selecting the correct product for your symptoms. Also, many of the combination products that contain naproxen or ibuprofen may contain a product that may not be compatible with your medical condition(s) or other medication(s) you may be taking. When choosing a medicine for children, always consult your pediatrician or pharmacist for appropriate dosing based on the child’s age and weight.

Conditions treated by naproxen and ibuprofen

Naproxen and ibuprofen are two popular medications used to treat pain and inflammation. Both drugs are indicated to relieve signs and symptoms of rheumatoid arthritis, osteoarthritis, mild to moderate pain, and primary dysmenorrhea (menstrual cramps). Naproxen is also indicated for the relief of symptoms of tendonitis, bursitis, acute gout, ankylosing spondylitis, and Polyarticular juvenile idiopathic arthritis.

Is naproxen or ibuprofen more effective?

Two randomized, double-blind, placebo-controlled studies comparing naproxen to ibuprofen for osteoarthritis of the knee, looked at both drugs for one week, at OTC (lower) doses, and found that both drugs were effective at lowering pain. Naproxen was found to be slightly more effective, and more effective at reducing night pain. Both drugs were well-tolerated.

Another small study comparing naproxen to ibuprofen found both drugs to be helpful in reducing stiffness, resting pain, movement pain, night pain, interference of the disease with daily activities, and overall disease severity. Naproxen was found to be more effective in this study. Many patients experienced side effects, mostly mild GI issues; however, one patient taking naproxen did have a GI bleed.

In a 20-year review of NSAIDs, the authors recognized the difficulty in choosing an NSAID and stated that “Frequently, the choice of analgesic is based on personal experience rather than evidence.” They go on to say that most studies are for acute, rather than chronic conditions, and that these studies cannot effectively determine which NSAID is best. The authors emphasize the importance of using the lowest dose of NSAID for the shortest duration of time. They do recommend that when Tylenol (acetaminophen) is not sufficient, it is best to start with a low dose of ibuprofen (along with medication to protect the stomach for those at high risk of GI effects).

Because the evidence is rather inconclusive, the most effective medication should be determined by your doctor, who will take into account your medical condition and history, and other medications you are taking.

Coverage and cost comparison of naproxen vs. ibuprofen

Naproxen and ibuprofen are reasonably priced, in both the OTC and Rx version. Both drugs are typically covered by insurance and Medicare Part D in the prescription-strength form. A typical prescription for naproxen would be for 60, 500 mg tablets and cost about $30-$40 without insurance. A typical prescription for ibuprofen would be for 30, 800 mg tablets and cost about $18 without insurance. Insurance and Medicare Part D copays will vary based on the plan. You can save money using a SingleCare coupon on naproxen and ibuprofen.

Side effects of naproxen vs. ibuprofen

Because naproxen and ibuprofen are both NSAIDs, side effects are similar for both medications. The most common side effects are gastrointestinal (GI) which include heartburn, abdominal pain, constipation, and/or diarrhea. Some patients also experience nausea, dizziness or headaches.

Consult a healthcare professional for a complete list of side effects.

Source: DailyMed (naproxen), DailyMed (ibuprofen)

Drug interactions of naproxen vs. ibuprofen

Naproxen or ibuprofen should not be taken with an anticoagulant such as Coumadin (warfarin), as this could increase the risk of bleeding. Taking naproxen or ibuprofen with other NSAIDs, such as aspirin, can also increase the risk of bleeding as well as GI side effects. Naproxen or ibuprofen can interact with many blood pressure medications, including ACE inhibitors, angiotensin receptor blockers, beta blockers, and diuretics. Both drugs also interact with several classes of antidepressants, possibly causing bleeding (potentially life-threatening), as well as low sodium. Consult your healthcare professional for a full list of drug interactions.

Warnings of naproxen vs. ibuprofen

Because both naproxen and ibuprofen are NSAIDs, they have the same warnings:

• There is a boxed warning (the strongest warning as required by the FDA):
  • Cardiovascular thrombotic events, such as heart attack or stroke, which could be fatal, may occur. The risk can occur early in treatment and increase with longer use.
  • The use of naproxen or ibuprofen is contraindicated in the setting of CABG surgery.
  • There is an increased risk of GI bleeding, ulceration, or perforation of the stomach or intestines, which could potentially be fatal. This could occur at any time and without warning. Patients that are elderly or who have a history of peptic ulcer disease and/or GI bleeding are at higher risk. Because of these risks, patients should use the lowest dose for the shortest time possible.
• NSAIDs should not be used in patients with a prior history of allergic reactions, such as asthma, rash, or anaphylaxis, due to the risk of severe, potentially fatal anaphylactic reaction in these patients.
• Patients should not be treated with NSAIDs after a heart attack.
• There is a small risk of toxicity to the liver; patients should be aware of signs such as nausea, fatigue, lethargy, diarrhea, itching, jaundice, right upper quadrant tenderness, and flu-like symptoms, and seek emergency treatment if symptoms occur.
• Hypertension (high blood pressure) may occur or worsen.
• NSAIDs should not be used in patients with heart failure.
• Long-term use may cause kidney injury. Patients should be monitored for kidney function and should not use NSAIDs if there is impaired kidney function.
• Patients with asthma, nasal polyps, and aspirin sensitivity (aspirin-sensitive asthma) should avoid NSAIDs.
• Serious skin reaction, which may include exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN)m which can be fatal and occur without warning. Patients should stop the NSAID and seek treatment if there is a sign of skin reaction.
• Anemia has occurred in patients treated with NSAIDs; patients should be monitored if signs or symptoms of anemia occur.
• NSAIDs, by reducing inflammation and fever, may make it more difficult to diagnose infections.
• Patients on long-term NSAIDs should periodically be monitored with a CBC and chem profile.
• NSAIDs should not be used in pregnant women starting at 30 weeks gestation (third trimester) because they may cause premature closure of the fetal ductus arteriosus. Throughout the first and second trimester, consult your healthcare provider. NSAIDs may also interfere with ovulation; consult your healthcare provider if you are trying to conceive.

Frequently asked questions about naproxen vs. ibuprofen

What is naproxen?

Naproxen is an NSAID (nonsteroidal anti-inflammatory drug) used to treat pain and inflammation. It is available in both brand and generic, and prescription as well as OTC.

What is ibuprofen?

Ibuprofen is also an NSAID that treats mild to moderate pain and inflammation. It is available in both brand and generic with a prescription or as an OTC.

Are naproxen and ibuprofen the same?

Both drugs are NSAIDs approved by the FDA. Because they are both NSAIDs, naproxen and ibuprofen have many similarities but they also have some differences. See above for details. Other NSAIDs include Celebrex (celecoxib, a COX-2 inhibitor), Mobic (meloxicam), aspirin, and Relafen (nabumetone). Tylenol (acetaminophen) is not an NSAID but is often found near NSAIDs on the shelf. Tylenol is helpful for fever and pain but does not treat inflammation.

Is naproxen vs. ibuprofen better?

As discussed above, naproxen and ibuprofen are similar and can both be effective in reducing pain and inflammation. They have similar side effects and risks. Often, it is a matter of personal preference as to which one would be a better medication for you. Consult your healthcare provider for guidance.

Can I use naproxen vs. ibuprofen while pregnant?

Naproxen, ibuprofen, or any NSAID should not be used in the third trimester of pregnancy because they can cause premature closure of the fetal ductus arteriosus. Because there is not enough information about NSAID use in women during the other stages of pregnancy, consult your OB/GYN. If you currently use naproxen or ibuprofen and find out that you are pregnant, consult your doctor for guidance.

Can I use naproxen vs. ibuprofen with alcohol?

No. Taking naproxen or ibuprofen and drinking alcohol can significantly increase the risk for gastritis (inflammation of the protective stomach lining) and gastrointestinal bleeding.

What happens if you take naproxen and ibuprofen together?

Do not take naproxen and ibuprofen together. Check your labels; better yet, ask your pharmacist, especially with combination products, to ensure that you are only taking one NSAID at a time. Taking both can increase the risk of side effects as well as stomach bleeding and ulcers.

Is naproxen a muscle relaxer or pain killer?

Naproxen is not technically a muscle relaxer; it is a pain medication and also helps with inflammation. Some popular muscle relaxers include Flexeril (cyclobenzaprine) or Skelaxin (metaxalone). It can be confusing because although naproxen is technically not a muscle relaxer, it can help mild to moderate muscle pain, so sometimes people think of it as a muscle relaxer.