Aleve: 5 Important Things Doctors Wish You Knew

Aleve (naproxen) is a popular over-the-counter nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce inflammation and lower fever. While millions rely on Aleve every year, doctors often see preventable problems from misuse. Here are five key points clinicians wish every Aleve user understood.

1. How Aleve Works – The Basics

Aleve blocks cyclooxygenase (COX) enzymes to reduce prostaglandin production, which eases pain and inflammation. Understanding this mechanism helps you:

• Recognize why it’s effective for conditions like back pain, headaches, arthritis and menstrual cramps
• Appreciate that prostaglandins also protect your stomach lining, support kidney blood flow and maintain clotting balance
• Realize that reducing prostaglandins in one place (joints) can cause side effects elsewhere (stomach, kidneys, heart)

2. Use the Right Dose and Duration

Aleve’s benefits and risks both increase with dose and length of use. Follow these guidelines:

• Typical adult dose: 220 mg (one tablet) every 8–12 hours as needed
• Maximum: 660 mg (three tablets) in 24 hours unless your doctor advises otherwise
• Short-term use (up to 10 days for pain, 3 days for fever) is safest for most people
• If pain or fever persists beyond recommended days, check in with a healthcare professional

Over-dosing or prolonged use raises your chance of serious complications. Always read and follow the label, and keep track of timing.

3. Watch Out for Gastrointestinal (GI) Risks

NSAIDs can damage the stomach and intestines by blocking protective prostaglandins. Doctors commonly see:

• Small ulcers or erosions that may bleed without warning
• Symptoms that can be subtle: mild abdominal discomfort, indigestion, or heartburn
• Severe cases presenting as black or bloody stools, vomiting blood or sudden, sharp stomach pain

Who’s at higher GI risk?

• Age 60 or older
• History of ulcers or GI bleeding
• Concurrent use of blood thinners (like warfarin) or corticosteroids
• Heavy alcohol use or smoking

To protect your GI tract:

• Take Aleve with food, milk or an antacid
• Avoid alcohol while on Aleve
• Consider adding a doctor-prescribed acid blocker (like an H2-blocker or proton-pump inhibitor) if you’re at high risk
• Stop Aleve immediately and “symptom check for” early signs of bleeding before it becomes serious

Learn more with a free, online symptom check for early warning signs.

4. Be Aware of Kidney, Heart and Liver Effects

NSAIDs can affect multiple organ systems. Although serious side effects are uncommon at recommended doses, they can be life-threatening.

Kidney Risks

Prostaglandins maintain blood flow to the kidneys. Blocking them may cause:

• Reduced kidney function, especially in dehydration or low blood pressure
• Acute kidney injury presenting as decreased urine output or swelling
• Worsening of chronic kidney disease

Stay hydrated, monitor blood pressure and talk to your doctor if you have kidney concerns.

Heart and Blood Pressure

Aleve may raise blood pressure and reduce the effectiveness of some antihypertensives. It can also slightly increase the risk of heart attack or stroke when used long-term or at high doses.

• Those with existing heart disease, high blood pressure or heart failure should use Aleve cautiously
• Always discuss NSAID use with your cardiologist or primary care physician

Liver Concerns

Although NSAID-induced liver injury is rare, it can happen. The DILIN Prospective Study (Chalasani et al., 2015) found that drug-induced liver injury can range from mild enzyme elevations to acute liver failure.

Signs to watch for:

• Yellowing of skin or eyes (jaundice)
• Unusual fatigue, nausea or abdominal pain
• Dark urine or pale stools

If you notice these symptoms, stop Aleve and get medical attention right away. A healthcare provider may use simple noninvasive indices (like the AST-to-platelet ratio index from Wai et al., 2003) or liver scoring systems (such as the Child-Pugh score from Pugh et al., 1973) to assess liver health and guide treatment.

5. Check for Interactions and Special Conditions

Aleve can interact with many common medications and may be risky in certain medical conditions.

Common Drug Interactions

• Anticoagulants (blood thinners): higher bleeding risk
• Certain antidepressants (SSRIs): additive GI bleeding risk
• Lithium or methotrexate: potential for increased blood levels and toxicity
• ACE inhibitors or diuretics: reduced effect on blood pressure, higher kidney risk

Always review all prescription and over-the-counter drugs, plus supplements, with your healthcare provider or pharmacist.

Special Populations

• Pregnancy: Avoid NSAIDs in the third trimester; discuss use in earlier pregnancy with your obstetrician
• Breastfeeding: Low levels pass into breast milk, but discuss with your pediatrician
• Children: Use only products specifically labeled for pediatric dosing
• Older adults: Increased sensitivity to side effects; start at the lowest effective dose

When to Seek Medical Advice

Aleve is safe for most people when used properly, but you should seek prompt medical attention if you experience:

• Severe stomach pain, persistent vomiting or bloody stools
• Sudden swelling of hands, ankles or feet
• Signs of an allergic reaction (rash, itching, swelling of face or throat)
• Chest pain, shortness of breath or sudden weakness (possible heart attack or stroke)
• Yellowing of skin or eyes, dark urine or upper-right abdominal pain

If in doubt, consider doing a free, online “symptom check for” any concerning signs, then contact your doctor.

Speak to a Doctor About Anything Serious

This information is meant to help you use Aleve wisely. It doesn’t replace professional medical advice. Always read the label, talk with your doctor or pharmacist about personal risks, and seek immediate care for anything life-threatening or serious.