How Often Can You Take Aleve? Get the Correct Dosage Information

Aleve
Aleve. Mario Tama Collection/Getty Images News

Aleve, aka Naproxen

Aleve (active ingredient naproxen) is a non-steroidal anti-inflammatory (NSAID) medication used for pain relief, fever reduction and for reducing inflammation. In other words, Aleve — whether prescribed or purchased over the counter — may be helpful as part of your treatment for chronic spine conditions that are related to arthritis. This includes both ankylosing spondylitis (which is a form of inflammatory arthritis) and osteoarthritis.

 

And of course, if you injure your neck or back, Aleve may help you reduce the associated pain.

All medicines in the NSAID class, including Aleve and naproxen, work largely by inhibiting the formation of chemicals in the body known as prostaglandins. This is the main way this the drug delivers relief. Prostaglandins are substances that are responsible for, among other things, producing inflammation (and the resultant pain.)

Taking Aleve is not for everyone, and it should be done according to your doctor's instructions. Aleve is associated with a higher risk for certain serious medical conditions including heart attack and stroke. Later in this article, I'll give you the full scoop, including the action the FDA now requires manufacturers of naproxen as a way of informing the public of the potential dangers.

How Often Can You Take Aleve (and Other Questions)

Aleve or naproxen can be purchased over-the-counter at your local drug store, as a brand (Aleve) or as a generic (naproxen.) That said, your doctor may determine that a higher dose may be helpful to you in which case, she may give you a prescription.

Aleve comes in a number of different forms – from tablet, gel caps, liquid to tablet with “benefits,” so to speak. What I mean by “benefits” is that some types of Aleve tablets are enteric coated to help reduce irritation to the stomach that may accompany the taking of this drug. Note that the benefits to your tum will likely be limited; if you’re looking for a way to reduce your risk of ulcers or bleeding in the lining of your stomach (a serious side effect associated with taking any type of NSAID,) enteric coated medication won’t help you.

The positive effect on the GI tract that enteric coating can have is pretty limited. 

Another way to minimize stomach discomfort is to take your Aleve or naproxen on a full stomach. Also crushing or chewing enteric-coated naproxen is not recommended, as it will cancel its stomach protective benefits. 

Aleve tablets may also be the extended release variety, where the active ingredient goes into your bloodstream in increments, rather than all at once. Controlled release tablets are also available. Note that the delayed release tablets are slower-acting forms of naproxen and are used only for treating chronic conditions.  As such they will likely not work fast enough to give you relief from your acute neck or back pain.

If you’re taking Aleve or naproxen for pain but you don’t have an arthritic condition, you’ll likely take it by mouth. Of course, it's a good idea to take your Aleve with a full glass of water and/or with food in your stomach.

Dosage Amounts May Depend on the Reason You're Taking Aleve

If you're taking over-the-counter Aleve or naproxen for pain  (i.e., you have an acute injury or just sitting at the computer is is getting to you, causing aches and pains,) the website Drugs.com recommends taking 440 mg by mouth the first hour as needed, and then 220 mg by mouth every 8 to 12 hours, again, as needed.

They also say that the maximum dosage should be no more than 440 mg in any 8 to 12 hour period, or 660 in any 24 hour period.

But it changes if your doctor is prescribing Aleve or naproxen for neck or back pain. In that case, Drugs.com says the recommended first Aleve or naproxen dose varies from 500 mg to 1000 mg, depending on if you’re taking an immediate release or a controlled release tablet.  They also say that delayed release tablets are not recommended for acute pain.  

After that initial dose (but still on the first day,) the recommendation is to take 275 mg orally every 6 to 8 hours, or 550 orally every 12 hours as needed for the immediate release tablet.

The max you should take on that first day for the immediate release tablet is 1375 mg.  For the following days, it's 1100 mg.  

For controlled tablets on the first day (after the initial dose) Drugs.com says, you can increase up to 1500 mg. But after the first day, it's advisable to bring the max dose back down to 1000 mg.

For arthritis, which includes both osteo and inflammatory forms, the recommended Aleve or naproxen doses are lower.  With immediate release tablets, Drugs.com says to take between 250 and 500 mg by mouth twice per day.  Starting on day 2, you can increase the dose to 1500 mg orally.  They warn that this dose is likely safe only up to 6 months for some patients, though.

As with any drug, your doctor is the best person to help you determine how much to take and how often. If she is not available to speak with you, follow the instructions on the package very carefully, and/or ask your pharmacist. Don't take more or less than the amount recommended, nor more frequently. Because Aleve side effects can be very serious in nature, take as little as necessary for only the shortest time period necessary. If you have stomach, heart or kidney problems, your doctor may suggest you take less than the normal dosage; this may help protect your health.

What to do if You Forget to Take Aleve When You Should

If you miss a dose, take one as soon as you remember. An exception would be when it is almost time for the next dose. In that case, just wait until it is time to take it again. Stay as close to your regular dosing schedule and never double dose this medication.

Storing Aleve

Safely store your Aleve by keeping it tightly closed in the container it came in, away from heat and moisture. This means not keeping it in the bathroom. Also, Aleve should be kept at room temperature. Discard it if it is outdated, or you don’t need it anymore. You can ask you pharmacist the best way to do that. Keep Aleve out of the reach of children.

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Aleve - Side Effects

Pain medication side effects in general can be serious, moderate or minor, rare, or related to overdosing, and side effects from Aleve are no exception.  Aleve's side effects are too numerous to thoroughly list, but we'll go over the most common to help you understand what you may be getting yourself into for taking this medication.  

Most important, don't hesitate to seek medical attention if symptoms come up for you after you take it.

As an NSAID, Aleve is subject to the strengthened warning requirements on the drug facts label (on the box and in the insert) that the FDA implemented in 2015.  What's this all about?

Basically after reviewing updated research, the FDA determined that NSAIDs increase the chance of a cardiovascular event such as a heart attack or stroke even within only a few weeks of taking, and that this class of medication (except for aspirin) can lead to death from such events.

Not only that, but the longer you take Aleve or other NSAID, the greater is your risk for cardiovascular events.

For this reason, it's important to seek immediate medical attention if, after taking naproxen, you experience circulation or heart symptoms.  These would include chest pain, weakness, shortness of breath, slurred speech or vision or balance problems. Fluid retention is another sign you need immediate medical attention.

The risk of stomach or intestine problems that may be caused by taking Aleve can be serious, and even fatal.

Stomach and GI symptoms that require immediate medical attention include: bleeding in stomach or intestines, black, bloody or tarry stools, or coughing up blood or vomit that looks like coffee grounds.

If you experience nausea, vomiting, loss of appetite, itching, yellowing of your skin or eyes, flu-like symptoms and dark urine, you may have liver damage.

Stop taking the medicine and call your doctor immediately.

Allergy also may occur in some individuals, which would take the form of a rash, wheezing, and/or problems breathing or swallowing. Other symptoms that require immediate medical attention include changes in your vision, signs of infection, unexplained weight gain, or a feeling that the tablet is stuck in your throat.

If the following symptoms persist, you should talk to your doctor about them:

  • constipation, diarrhea or gas
  • sores in the mouth
  • you are very thirsty
  • headache
  • dizzy or lightheaded
  • drowsy
  • sleeping problems
  • burning or tingling in arms or legs
  • you feel like you have a cold
  • ringing in the ears or other hearing problems.

If you are pregnant or you plan to become pregnant, talk to your doctor before taking Aleve. Taken in the last trimester of pregnancy, it can cause birth defects. Naproxen can pass through breast milk to the nursing child and may do harm. It is not recommended to give Aleve to a child under the age of 2 except as directed by your doctor.

When Not to Take Aleve

Having certain health problems means you might not be able to take Aleve, or you may need to consult with your doctor to get the dose adjusted.

If you have a history of heart problems, blood clots, high blood pressure, stroke, kidney problems, blood clots or stomach ulcers, then your risk for a cardiovascular event (discussed above) is higher.

 Check with your doctor to be sure that Aleve is the right pain reliever for you. 

Taking Aleve or any naproxen product just before or after a heart bypass operation is not recommended.

Also, as discussed above, NSAIDs come with the risk for ulcers, bleeding in the stomach lining and other GI tract problems.  These are very serious side effects and may even lead to death. They can occur at any time when taking Aleve, and may show up without previous warning. These and other risks for side effects are amplified for older adults who take Aleve.

Again, the wisest thing to do if you already have stomach problems is to speak with your doctor before taking Aleve or other NSAID.

While we're on the subject, drinking and Aleve don't mix.  Alcohol increases the risk for stomach and GI problems associated with this drug.

Other conditions that may increase your risk for the dangerous side effects of Aleve include liver or kidney disease, asthma, polyps in the nose, bleeding and clotting disorders and being a smoker. If you have any of these conditions, you may not be able to use Aleve, or you may need your dose adjusted. Speak with your physician or pharmacist if you are unsure.

Aleve and other naproxen medications cause the skin to be more sensitive to sunlight, so if you take it, you might want to stay away from the sun, tanning beds or sunlamps. 

Drug Interactions or Overdose

Taking other medications, including other pain drugs or cold and allergy drugs, increases your risk of overdosing by accident. This is because many over-the-counter medicines also contain NSAIDs. So read the label on the box. If you take more than one medication, check the box or insert of each one of them to be sure that you are getting naproxen and any other NSAID only once.

If you think you may have overdosed, call 911 or your local poison control center.

Aleve - Drug Interactions

When taking Aleve or medication with naproxen in it, it is very important to consider the other drugs you may take.  (This includes nutritional supplements, herbs, recreational drugs, coffee and alcohol.)

Because these substances can interact with the Aleve and alter the way it works, your health care provider may wish to change your dosage or suggest a different pain reliever. Also, talk to your doctor if you plan to start or stop taking any of your medications.

The following is an incomplete list of drugs and other substances that may interact with Aleve with negative consequences for you. Consult with your doctor or pharmacist if your other medication(s) is on this list, or if you take other medication or drugs:

  • alcohol
  • alendronate, taken to prevent bone loss
  • other NSAIDs, including aspirin. If you use aspirin long term, your chances of stomach bleeding are increased.
  • other anti-inflammatory drugs (such as ibuprofen or prednisone)
  • entecavir, for hepitits-B infections
  • cidofovir, taken for eye infections in HIV patients
  • entecavir, for hepitits-B infections
  • cyclosporine, given to transplant patients
  • water pills (diuretics)
  • blood pressure medications, such as ACE inhibitors
  • blood thinners such as Coumadin, or other medications treat or prevent blood clots
  • methotrexate, chemotherapy drug
  • pemetrexed, a chemotherapy drug
  • herbal products that contain feverfew, garlic, ginger, or ginkgo biloba
  • lithium medication such as Eskolith Lithobid

 

Source:

FDA Alert for Healthcare Providers: Naproxen. FDA website. Dec 2004.

Hochadel, M., PhD., ed., The AARP Guide to Pills., Gold Standard Publishers. Tampa, Fl 2006.

Naproxen Drugs and Supplements. Medline plus Jan 2006.

Naproxen. Patient Information Sheet. FDA website. Dec 2004.

​Naproxen Side Effects. Drugs.com website.

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