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

Naproxen is an NSAID used for pain relief and more.
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Investing the time it takes to learn the basics of taking Aleve or naproxen may help you avoid side effects and complications.

Aleve (active ingredient naproxen) is a non-steroidal anti-inflammatory (NSAID) medication used for pain relief, fever reduction, and for reducing inflammation. Because of its anti-inflammatory action, naproxen —whether prescribed or purchased over the counter—may be helpful as part of your treatment for either back pain or an arthritis related spine condition; this includes both ankylosing spondylitis (a form of inflammatory arthritis) and osteoarthritis.

Naproxen can be purchased over-the-counter at your local drug store as the brand Aleve, or as a generic. But based on the symptoms you present, your doctor may determine that a higher dose may be in order. In that case, she may give you a prescription.

How Often Can You Take Naproxen?

If you're taking over-the-counter naproxen for pain, the directions on the packaging will recommend one pill every eight to 12 hours as long as you have symptoms. The label will also tell you it’s okay to take two pills within the first hour, but that it’s not wise to take more than two in any eight to 12 hour time period, nor three in any 24 hour period.

Drugs.com recommends taking 440 mg by mouth the first hour as needed, and then 220 mg by mouth every eight to 12 hours, again, as needed. They also say that the maximum dosage should be no more than 440 mg in any eight to 12 hour period, or 660 in any 24 hour period.

Things change if your doctor is prescribing naproxen for neck or back pain. In that case, Drugs.com says the recommended first naproxen dose can be between 500 and 1000 mg, depending on if the tablet is the immediate release or the controlled release type. 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 of the immediate release tablet orally every six to eight hours, or 550 orally every 12 hours as needed for symptom abatement. But keep in mind that the max dosage for an immediate release tablet that is taken on the first day is 1375 mg. On following days, it’s 1100 mg.

For controlled tablets on the first day (after the initial dose), you can increase up to 1500mg. But on following days, the recommendation is to bring the dose down to 1000mg or below.

Note that one dose of Aleve contains 200mg naproxen and 20mg sodium.

Naproxen Dosage Information for Arthritis Related Spine Conditions

For osteo and/or inflammatory arthritis, the recommended naproxen doses are lower.

When it comes to immediate release tablets, Drugs.com says to take between 250 and 500mg by mouth twice per day. Then, starting on day two, you can increase the dose to 1500mg orally.  There is a warning for some patients—this dosage amount may only be safe for up to six months.

Are you taking (or considering taking) naproxen for ankylosing spondylitis? If so, the recommended dosage of 750mg to 1000mg by mouth once a day, or 375 to 500mg by mouth twice per day.

And for osteoarthritis, the recommendation is between 750mg to 1000mg orally once a day.

Forgetting to Take Naproxen

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 Naproxen

Safely store your naproxen 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, naproxen should be kept at room temperature. Discard it if it is outdated, or you don’t need it anymore.

You can ask your pharmacist the best way to do that. Keep naproxen out of the reach of children.

Naproxen's Mechanism of Action

All medicines in the NSAID class, including naproxen, work largely by inhibiting the formation of chemicals in the body known as prostaglandins. This is the main way the drug delivers relief. (In case you’re interested, prostaglandins are substances that are responsible for, among other things, producing inflammation and the pain that results from it.)

Naproxen Safety Considerations

Most people—including many licensed health professionals—are under the impression that taking naproxen is generally safe.

Whether you realize it or not, though, the active ingredient in naproxen is not appropriate for everyone. Naproxen has been associated with serious, and even fatal, GI tract, kidney, and cardiovascular complications. (We’ll talk more in-depth about that below.)

Because the side effects associated with this pain drug are frequently quite serious in nature, it’s best to take only the amount necessary, for the shortest time period necessary.

Your doctor is the best person to help you determine how much to take and how often (as with any drug). If she is not available to speak with you, follow the instructions on the package very carefully, and/or ask your pharmacist. But don't take more or less than the amount recommended, and stick with the recommended frequency.

Potential Serious Side Effects

As a highly effective pain reliever and anti-inflammatory, naproxen may also pose a very strong risk to your health.

First, there’s the potential for an allergic reaction. This may show up as hives, facial swelling, asthma, skin rash, blisters, or shock. If even one of these symptoms occur, stop taking naproxen and seek emergency medical attention.

Next is the well-known and very serious side effect of stomach bleeding. It's important to remain observant—if you experience signs or symptoms of bleeding, seek immediate medical attention. Doing so may save your life.

And third is the well-established cardiovascular risk profile of taking any NSAID. According to Gregory Curfman, MD, Editor in Chief, Harvard Health Publications, we’ve witnessed, over the last 12 years or so, emerging evidence that taking NSAIDs does pose a risk to your cardiovascular system. The health risks to which he refers include heart attack, heart failure and stroke; a related risk elevated blood pressure.

Based on research findings, the FDA, in 2015, required manufacturers to strengthen their warnings about these CV health risks on NSAID packages and labeling. The labeling now must inform you that your risk for heart attack and stroke may increase, even if you only use NSAIDs for a few weeks, and that higher doses taken for longer periods of time may become problematic.

Curfman also reports that for patients already diagnosed with heart disease, taking naproxen is likely not a good idea. This may extend, he says, those without known heart disease.

That said, while a 2016 Danish study did find an association between short-term ibuprofen or diclofenac  treatment and early risk for a cardiovascular event, they were not able to identify any association specifically between naproxen and such events. Aspirin is still considered a low risk NSAID.

Symptoms to be on the lookout for that may indicate a cardiovascular event include circulation or sensations related to your heart, such as chest pain, weakness, shortness of breath, slurred speech or vision or balance problems. Fluid retention is another sign you need immediate medical attention.

Other Possible Side Effects

Liver damage is another potential complication of taking naproxen or other NSAID. Symptoms of a liver problem include nausea, vomiting, appetite loss, itching, yellowing of skin and/or eyes, flu-like symptoms and dark urine. If you have any of these, stop taking naproxen and seek immediate medical attention.

And finally, here is a list of other side effects that may be less common or more moderate than those we've talked about above. (Note that the list is not complete, so if you want more information check out Drugs.com.) Speak with your doctor as soon as you can if any of these symptoms apply to you:

Should You Take Naproxen?

It may be obvious now that in light of your overall health picture along with new research on NSAIDs naproxen is not necessarily your best option for pain relief.

Of course, if you already have any of the conditions mentioned earlier (heart disease, stroke, gastrointestinal problems, liver problems) taking naproxen is likely not a good idea at all, as it will raise your risk for associated death. But here are a few other considerations.

Are you pregnant or planning to conceive? If so, you should speak with your doctor before taking naproxen. This drug may cause birth defects when taken in the last trimester of pregnancy. It may also pass through breast milk to the nursing child and do harm.

Along those lines, giving naproxen to a child under the age of 2 is not recommended, except as directed by your doctor.

Obviously if you have a history of heart problems, blood clots, high blood pressure, stroke, kidney problems, blood clots or stomach ulcers, reconsidering naproxen is probably in your best interest. Again, this is because it may further raise your risk for a cardiovascular event, or death. (See below for further specifics.) And taking any naproxen product just before or after a heart bypass operation is not recommended.

As we talked about above, NSAIDs come with the risk for ulcers, bleeding in the stomach lining and other GI tract problems.  These side effects are very serious. Keep in mind that they can occur at anytime, and may show up without previous warning. Senior citizens may be at an even higher risk. So if you already have GI problems, work with your doctor to determine an appropriate pain relief solution.

Also, drinking and naproxen don't mix.  Alcohol consumption in combination with naproxen is another way to increase your risk for stomach and GI problems.

Other conditions that may increase your risk for the dangerous side effects of naproxen include asthma, polyps in the nose, bleeding and clotting disorders, being a smoker, skin that's sensitive to sunlight, and, as already mentioned kidney and liver disease or problems.

Drug Interactions and Overdose

We've already chatted a little about mixing alcohol and naproxen; that's a no-no! But if you take other types of medications, whether they are (also) pain drugs or they are cold/allergy drugs you may end up with an accidental overdose. (Many OTC medications contain NSAIDs, even though that is not the type of active ingredient that's touted in advertisements, or on pharmacy shelves.) For this reason, it's very important to read all medication labels (OTC and prescribed) before mixing them. Be sure you're getting only one dose of an NSAID in the appropriate time periods (as described earlier in this article.) 

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

Believe it or not, mixing nutritional supplements, herbs, recreational drugs, and/or coffee can interact with naproxen and change the way it works in your body. Speak with your health provider about dosage amounts for each and/or alternative pain relieving substances.

And always talk to your doctor if you want or need to stop taking any medication.

Along with the drugs and other things already discussed in this article, below is a list of medications that may interact with naproxen in a negative way. Be sure to consult with your doctor or pharmacist if your other medication(s) or 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 hepatits-B infections
  • cidofovir, taken for eye infections in HIV patients
  • 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

A Word From Verywell

Naproxen may be helpful for your condition, but to make the most of it you need to use it safely. Regardless of whether you obtain your naproxen over the counter or as a prescription from your doctor, make sure to follow the dosage instructions and be aware of the possible side effects and interactions. If you feel that something isn't right, contact your doctor.

Sources:

Curfman, G., M.D., Editor in Chief. FDA strengthens warning that NSAIDs increase heart attack and stroke risk. Harvard health Publications. Harvard Medical School. July 2015. http://www.health.harvard.edu/blog/fda-strengthens-warning-that-nsaids-increase-heart-attack-and-stroke-risk-201507138138

Naproxen. Drugs.com website. Last Updated: April 2017. https://www.drugs.com/naproxen.html

Sondergaard KB, Weeke P, Wissenberg M, et al. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case–time–control study. European Heart Journal – Cardiovascular Pharmacotherapy. Dec 2016. https://academic.oup.com/ehjcvp/article/doi/10.1093/ehjcvp/pvw041/2739709/Non-steroidal-anti-inflammatory-drug-use-is

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