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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.

Main differences between naproxen vs. ibuprofen
Drug class NSAID NSAID
Brand/generic status Brand and generic Brand and generic
What is the brand name? Aleve, Anaprox DS, Naprosyn Motrin, Advil
What form(s) does the drug come in? Tablets, caplets, softgels Tablets, caplets, softgels, liquid forms
What is the standard dosage? Adults OTC: 220 mg every 8 to 12 hours

Adults Rx: 250-500 mg every 12 hours

*Take with food

Adults OTC: 200 mg every 4 to 6 hours (maximum 1200 mg per day)

Adults Rx: 400-800 mg 3 to 4 times daily (maximum 3200 mg per day – consult Dr)

*Take with food

How long is the typical treatment? Varies by indication Varies by indication
Who typically uses the medication? Adults, children 2 years and older Adults, children 6 months and older

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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.

Rheumatoid arthritis
Yes Yes
Acute gout
Yes Off-label
Ankylosing spondylitis
Polyarticular juvenile idiopathic arthritis
Yes Off-label
Mild to moderate pain Yes Yes
Primary dysmenorrhea Yes Yes

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.

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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.

Typically covered by insurance? Yes – prescription-strength only Yes – prescription-strength only
Typically covered by Medicare Part D? Yes – prescription-strength only Yes – prescription-strength only
Standard dosage #60, 500 mg tablets #30, 800 mg tablets
Typical Medicare copay Part D $0-20 $0-22
SingleCare cost $9-$20 $5-$8

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.

Side Effect Applicable? Frequency Applicable? Frequency
Heartburn Yes 3-9% Yes 1-16%
Nausea Yes 3-9% Yes 1-16%
Abdominal pain Yes 3-9% Yes 1-16%
Constipation Yes 3-9% Yes 1-16%
Diarrhea Yes <3% Yes 1-16%
Headache Yes 3-9% Yes 1-3%
Dizziness Yes 3-9% Yes 3-9%
Drowsiness Yes 3-9% No
Pruritus (itching) Yes 3-9% Yes 3-9%
Tinnitus (ringing in the ears) Yes 3-9% Yes 1-3%
Edema (swelling) Yes 3-9% Yes 1-3%
Dyspnea (shortness of breath) Yes 3-9% No

Source: DailyMed (naproxen), DailyMed (ibuprofen)

Drug interactions of naproxen vs.


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.

Coumadin (warfarin) Anticoagulant/blood thinner Yes Yes
Other NSAIDs
NSAIDs Yes Yes
Zestril (lisinopril)
Vasotec (enalapril)
ACE inhibitors Yes Yes
Cozaar (losartan)
Avapro (irbesartan)
Benicar (olmesartan)
Diovan (valsartan)
ARB (angiotensin receptor blockers) Yes Yes
Toprol XL (metoprolol)
Tenormin (atenolol)
Beta blockers Yes Yes
Lasix (furosemide)
Diuretics Yes Yes
Lexapro (escitalopram)
Celexa (citalopram)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
SSRI (selective serotonin reuptake inhibitors) Yes Yes
Elavil (amitriptyline)
Pamelor (nortriptyline)
Tricyclic antidepressants Yes Yes
Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
SNRI (serotonin and norepinephrine reuptake inhibitors) Yes Yes
Lanoxin (digoxin) Cardiac glycoside Yes Yes
Lithium Antimanic agent Yes Yes
Methotrexate Antimetabolite Yes Yes
Cyclosporine Immunosuppressant Yes Yes
Antacids Antacids Yes Yes
Carafate (sucralfate) Protectant Yes No
Questran (cholestyramine) Bile acid sequestrant Yes Yes

Warnings of naproxen vs.


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.

Top 9 Things You Must Know About Naproxen

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 15, 2020.

Generic Name: naproxen (na PROX en)
Common Proprietary Names: Aleve, EC-Naprosyn, Flanax Pain Reliever, Midol Extended Relief, Naprelan, Naprosyn, Anaprox-DS, Naproxen Sodium, Aleve Caplet, Aleve Gelcap, Aleve Easy Open Arthritis

How often do you need pain relief? If you suffer from low back pain, an aching knee, strained muscles, arthritis, throbbing headaches, tooth pain or any other myriad of painful conditions, you are not alone. It is estimated that chronic pain (pain lasting over 3 months) affects more than 100 million Americans. In fact, pain affects more Americans than diabetes, heart disease and cancer combined.

Medications in the class of drugs known as NSAIDs (nonsteroidal anti-inflammatory drugs) are the workhorse of pain and fever relief for millions of people. Not surprisingly, NSAIDs are one of the most commonly used class of drugs in the world.

Available in various formulations with or without a prescription, NSAIDs work to relieve inflammation and pain by inhibiting cyclooxygenase and reducing prostaglandin production – in other words, blocking the mechanism of pain. However, this pain relief does not come without important warnings for effective and safe use of naproxen products.

1. Naproxen and naproxen sodium are available in many forms

You can take naproxen orally by tablet or as a liquid suspension, in an extended-release formulation, surrounded by an enteric coating, combined with a proton pump inhibitor to help protect your stomach, with a decongestant to relieve sinus pressure, or even combined with an antimigraine drug like sumatriptan. You can get it with a prescription, or without.

Naproxen comes in two forms – either as the base naproxen or as the salt form naproxen sodium. Both the base and salt forms work the same way to relieve pain. There is one difference — naproxen base on a milligram-per-milligram basis is slightly stronger than naproxen sodium. Here’s how it works out — 220, 275, or 550 mg of naproxen sodium equals 200, 250, and 500 mg of naproxen, respectively. However, you don’t need to worry about any conversion as these slight differences are already taken into account when doses are determined.

2. Familiar naproxen products:

Over-the-counter (OTC) naproxen sodium:

Prescription-only names of naproxen sodium include:

Prescription-only names of naproxen base include:

Other combos:

  • Vimovo (esomeprazole and naproxen): helps protect against ulcers
  • Treximet (naproxen sodium and sumatriptan): for acute migraine headache


Save money: naproxen comes in generic options

Naproxen and its salt formulation have been around for a long time. In fact, the FDA approved the first formulations of naproxen sodium in 1980. That’s good news, because formulations of many naproxen and naproxen sodium drugs are now available generically, saving you dollars at the pharmacy.

For example, you can easily use the generic OTC naproxen to get the same pain relief as you would from the more expensive prescription brands. Just be sure to ask your doctor what the equivalent OTC dose would be based on your indication. The OTC products come in a lower strength than many prescription options, so you may need to take a higher OTC dose.

Naproxen is available over-the-counter for relief of menstrual cramps, but generics work just as well and save you money, too. For menstrual cramps, it may be less expensive to use the generic or store brand naproxen sodium than the branded products like Midol Extended Relief or Pamprin All Day, so it’s worth a comparison. Be sure to check the package size, too, to be sure you are getting a good deal.

4. Naproxen has many uses in many different age groups

Naproxen and its sodium salt are used for many different types of pain, and it is an excellent fever reducer, too. Below are just some of the common uses for naproxen:

Children can use naproxen, too. The OTC products are only labeled for children 12 years and older, but some prescription formulations can be used in children as young as 2 years of age for:

You must check with your doctor to use any form of naproxen in children under 12 years of age.

Naproxen should be used cautiously and at the lowest possible dose (if at all) in the elderly, especially those at risk for, or with a history of stomach or intestinal ulcers or bleeding.

5. Is naproxen safe for the heart?

You may have heard that naproxen is safer for the heart compared to other NSAIDs like ibuprofen, diclofenac, meloxicam, or celecoxib; however, this is a controversial topic. The FDA has determined that the available studies are not robust enough and were not designed to determine if one NSAID was safer than any other with respect to heart safety (cardiovascular thrombotic events). In addition, when determining the safety of a drug for a patient, risk factors such as other medical conditions, other medications and drug interactions, doses needed, and duration of treatment need to be taken into consideration. The FDA has stated that “based on available data, it is unclear whether the risk for cardiovascular thrombotic events is similar for all non-aspirin NSAIDs.”

Since 2005, labeling laws have required a boxed warning on all NSAIDs alerting of increased cardiovascular risks, like heart attack and stroke. That warning was a result of the withdrawal of the NSAID Vioxx (rofecoxib) from the market in 2004 because of a notable increased risk of heart attack among Vioxx users. Celebrex (celecoxib), another COX-2 selective NSAID, is still on the U.S. market.

The heart warning on all NSAID labels state that this class may cause an increased risk of serious and sometimes fatal heart and blood vessel problems (eg, a heart attack, stroke). The risk may be greater if you already have heart problems or if you take NSAIDs for a long period of time. However, a 2017 study found the heart risk was increased with high doses in the first month of use. Additionally, the label warns that NSAIDs should not be used (they are contraindicated) right before or after coronary artery bypass graft (CABG) surgery.

6. Can NSAIDs hurt my stomach?

Boxed warnings on naproxen labels also alert patients to important side effect risks for stomach and intestine bleeding. NSAIDs may cause an increased risk of serious and sometimes fatal stomach ulcers and bleeding. Elderly patients (those over 65 years of age) may be at a greater risk, and this effect can occur without any warning signs. NSAIDs may worsen intestinal diverticulitis. Patients with a history of diverticulitis should speak with their doctor about the safety of using of NSAIDs.

You should avoid using aspirin and other anticoagulants with NSAIDs, for example:

Check with your doctor before you combine these medications with NSAIDs, as you may increase your risk for serious bleeding.

7. Be sure: check your naproxen drug interactions

Be sure to alert your pharmacist and physician of all of the medications you take, so that they can screen for clinically significant drug interactions with naproxen, even if you buy it over-the-counter.

Over 400 drugs are known to interact with naproxen. Naproxen also has several food and alcohol interactions you should take note of and discuss with your pharmacist. You can also review significant disease interactions that may be affected by the use of naproxen, like high blood pressure.

Always check drug interactions with all of your prescription, over-the-counter, and vitamin or herbal products, too.

8. Avoid all NSAIDs late in pregnancy

It is important that you ask your doctor for advice before taking any drug in pregnancy.

For mild pain and headaches in pregnant women, most physicians usually recommend acetaminophen (Tylenol).

Naproxen (and all other NSAIDs) should be avoided in late pregnancy (usually during the third trimester) because it may cause premature closure of the ductus arteriosus, which can lead to right heart failure and death of the fetus.

What is premature closure of the ductus arteriosus?

Before birth, the baby is supplied with nutrients and oxygen from the mother through a blood vessel called the ductus arteriosus. This blood vessel needs to stay open before birth, but closes right after birth when the baby starts breathing on its own. If the vessel closes before birth when the baby is still in the womb it is called “premature closure of the ductus arteriosus.”

Taking naproxen or other NSAIDs in the third trimester (typically from week 28 to birth) may cause harm and require that the baby needs to be delivered early. Tell your doctor immediately if you have taken any NSAID in the third trimester of pregnancy, especially if you have used it for more than one dose or have used high doses.

9. Join the naproxen support group

Support groups on Drugs.com may be helpful for patients who use medications for pain relief, have multiple conditions, and who are searching for the latest news. In fact, pain is one of the top medical condition support groups on Drugs.com. Joining one or more support groups is a great way to discover others with similar conditions or using related medications, and to share your own experience.

There are over 400 user reviews for naproxen from people who use this drug for arthritis, back pain, headache and other various conditions (some of which may be off-label use, meaning the drug is not approved by the FDA for that particular use). Here you can ask a question, share an experience, browse through the latest blog posts and questions, and see other ratings from patients who are using naproxen.

Remember, the information is NOT intended to endorse naproxen or recommend drug therapy. While these reviews might be helpful to you, they are NOT a substitute for the expertise, skill, knowledge and judgement of your healthcare provider.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Uses, side effects, dosage, warnings, and interactions

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People usually use the drug naproxen to relieve pain and swelling, but it can also help treat fever.

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). Naproxen is available by prescription, or people can purchase lower-strengths forms over the counter.

In this article, we provide an overview of naproxen, including how it works, its uses, and the potential side effects, warnings, and interactions.

Share on PinterestA person can take naproxen for rheumatoid arthritis, osteoarthritis, and dental pain.

Naproxen is a pain medication that relieves inflammation and joint stiffness. Other NSAIDs in the same medication class include acetylsalicylic acid, diclofenac, ibuprofen, and meloxicam.

Naproxen works by blocking the enzyme that produces prostaglandins. Prostaglandins play an essential role in inflammation. The body produces them at the site of injured tissue, and they cause redness, heat, swelling, and pain.

Naproxen is available as naproxen or naproxen sodium. The major difference between naproxen and naproxen sodium is that naproxen sodium is more rapidly absorbed.

The body reaches peak levels of naproxen in 2–4 hours and naproxen sodium in 1–2 hours, meaning that it absorbs naproxen sodium faster than regular naproxen.

People use naproxen for the following conditions:

In the United States, over-the-counter (OTC) naproxen is called Aleve. Prescription naproxen is known as Naprosyn and Anaprox.

Naproxen is available for purchase in drug stores, or people can choose between brands online.

There are various types and strengths of naproxen. Regular naproxen tablets contain 250 milligrams (mg), 375 mg, or 500 mg of naproxen.

Fast-absorbing naproxen sodium is available in 220 mg OTC capsules and tablets, and 275 mg and 550 mg tablets by prescription. Low-dose naproxen is available in tablet or capsule form.

Children and people who have difficulty swallowing tablets can use naproxen suspension. Naproxen suspension contains 25 mg of the drug per milliliter (ml).

The following table lists the inactive ingredients in regular naproxen, naproxen sodium, and naproxen suspension. People who have allergies or intolerances to any inactive ingredients should avoid using naproxen.

Naproxen Naproxen sodium Naproxen suspension
  • microcrystalline cellulose
  • croscarmellose sodium
  • povidone
  • magnesium stearate
  • iron oxide
  • microcrystalline cellulose
  • croscarmellose sodium
  • povidone
  • magnesium stearate
  • colloidal silicon dioxide
  • talc
  • methylparaben
  • fumaric acid
  • magnesium aluminum silicate
  • sodium chloride
  • sorbitol solution 70%
  • sucrose
  • flavor
  • FD&C Yellow No. 6

Naproxen is also available in enteric-coated tablets. These tablets release naproxen in the intestine rather than in the stomach. This formulation helps prevent gastrointestinal side effects that manufacturers have sometimes associated with naproxen. Similarly to regular naproxen, enteric-coated tablets come in tablets of 250 mg, 375 mg, and 500 mg.

Share on Pinterest A person should take naproxen at the lowest effective dose for the shortest duration.

Naproxen is available as tablets, liquid capsules, and in a liquid form.

The dose of naproxen that a person requires depends on why they are using the medication. A general rule is to use the lowest effective dose for the shortest possible duration. This dosing helps prevent side effects from occurring.

Doctors advise people to take naproxen and other NSAIDs with food to prevent gastrointestinal side effects.

Mild to moderate pain

For fever and mild to moderate pain, adults between 12 and 65 years old can take one 220 mg tablet of naproxen every 12 hours. Children under 12 years old should not take naproxen unless their doctor recommends it.

Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis

People can manage the symptoms of osteoarthritis, which is commonly known as arthritis, rheumatoid arthritis, and ankylosing spondylitis with a dose of 220 mg to 550 mg of naproxen every 12 hours. Naproxen does not cure these conditions but offers relief from pain and inflammation.

Acute gout attacks

People with experience acute gout attacks may take 825 mg for one dose, followed by 275 mg every 8 hours.

Juvenile rheumatoid arthritis

Doctors can prescribe naproxen to manage the pain and inflammation caused by juvenile rheumatoid arthritis. People can administer the liquid suspension of naproxen to children 2 years old and older. The recommended dose is 10 mg per kilogram (kg), or mg/kg divided into two doses 12 hours apart.


Using naproxen to relieve pain from headaches and migraine headaches is controversial.

People can try taking 550 mg of naproxen sodium every 12 hours and may increase it to 825 mg if needed. The daily dose should not exceed 1,375 mg.

Naproxen sodium is degraded more slowly than regular naproxen and other NSAIDs. This means that naproxen sodium should remain active for longer than other anti-inflammatory drugs.

However, after 2 hours, headache pain relief is lower with naproxen sodium than with other NSAIDs.

Although naproxen can be used to reduce the pain of headaches and migraine headaches, other NSAIDs may provide better relief.

Maximum recommended daily dose

People should only use OTC naproxen for a short-term period of between 3–5 days for pain and no more than 3 days for fever. If they need ongoing treatment, people should consult their doctor first.

For children between 2–12 years old, the maximum daily dose by weight is 20 mg/kg. They should not be taking more than 1,000 mg in 24 hours.

When OTC medications, children 12 years and older should not take more than 660 mg in 24 hours.

Studies have not shown any benefit in using daily doses higher than 1,000 mg, but some sources suggest a maximum of 1,650 mg per day for up to 6 months for arthritis.

The frequency and severity of side effects that naproxen causes depend on several factors.

Considerations include the dose and duration of treatment, other medical diagnoses a person may have, and individual risk factors.

The following sections discuss the common and serious side effects of naproxen.

Common side effects

The following table from the naproxen monograph lists the most common side effects grouped by body system. The side effects in this table occur in approximately 3 to 9 percent of people.

Body system Side effect
Gastrointestinal tract Heartburn, constipation, abdominal pain, nausea
Central nervous system Headache, dizziness, drowsiness, depression, fatigue
Skin Itchy skin, ecchymoses, skin eruptions
Cardiovascular system Dyspnea, peripheral edema
Senses Ringing in the ear

Serious side effects

Although people can buy low-dose naproxen without a prescription, it is not safe for everyone.

People with serious heart conditions, such as heart disease, cerebrovascular disease, and congestive heart failure, may experience severe side effects from taking naproxen.

Severe side effects of naproxen include:

People with high blood pressure should only take naproxen cautiously.

Naproxen can cause sodium retention in the kidneys, which can result in increased blood pressure. A person with high blood pressure should consult their doctor before taking naproxen.

Gastrointestinal side effects of taking naproxen can be severe. Bleeding in the stomach, the formation of ulcers, and stomach or intestinal blockages can occur when taking naproxen. Most often, older adults are the most vulnerable age group for gastrointestinal side effects.

People who have a history of ulcers or gastrointestinal bleeding have a 10-fold higher risk for developing a bleed when taking naproxen. For these individuals, even short-term treatment can be risky.

Naproxen may interact with several prescription and nonprescription drugs. Drinking alcohol and taking naproxen may increase the risk of gastrointestinal side effects.

Selective serotonin reuptake inhibitors

People taking the antidepressant class of selective serotonin reuptake inhibitors (SSRIs) have an increased risk of gastrointestinal bleeding and ulcers when taking naproxen. SSRIs include:

  • citalopram
  • escitalopram
  • fluoxetine
  • fluvoxamine
  • paroxetine
  • sertraline
  • vortioxetine

Oral steroids

Oral steroids, such as prednisone and antiplatelet drugs, may also increase stomach and intestinal bleeding and ulceration if people combine them with naproxen.

Blood thinners

Naproxen blocks the aggregation of platelets, which is an essential step in blood clotting. Blocking the aggregation of platelets can increase the time it takes for bleeding to stop.

People must talk to a doctor before combining naproxen with blood thinners, such as antiplatelet and anticoagulant medications.

Women should avoid taking naproxen in the third trimester of pregnancy.

NSAIDs can prevent the body from producing prostaglandin, which may affect pregnancy. Taking naproxen during the third trimester of pregnancy may cause heart malformations in the fetus.

Also, nursing babies may experience serious side effects if the mother is taking naproxen. Doctors do not recommend naproxen for women who are breastfeeding.

If a person has a history of an allergy or intolerance to any NSAID, they should not take naproxen. Cross-allergies and intolerances may occur between NSAIDs.

Aspirin-induced asthma

One type of intolerance to NSAIDs is aspirin-induced asthma. Asthma symptoms and severe allergic reactions may occur when affected individuals take aspirin. These people should avoid naproxen and all other NSAIDs because of the risk of developing severe side effects.


During the first two trimesters of pregnancy, women should use naproxen cautiously. Once the pregnancy enters the third trimester, they must avoid taking naproxen. Naproxen may be present in breast milk, which can cause serious side effects for an infant.

Drug interactions

People should not combine certain antidepressants, high blood pressure, and blood thinners with naproxen.

Medical conditions

Certain diagnoses may increase the likelihood of experiencing side effects, such as heart disease, ulcers, and kidney disease.


Children under 12 years old should avoid using naproxen unless a doctor prescribes the medication.

Naproxen is a prescription and nonprescription NSAID. People can use it to relieve pain that inflammation causes.

Naproxen is not safe for everyone. People taking certain medications should use naproxen cautiously to avoid side effects. People with stomach or intestinal diseases, cardiac disease, or kidney disease should discuss the use of NSAIDs with their doctor.

Naproxen can also be dangerous during pregnancy and breastfeeding.

At the appropriate dose, naproxen is a safe and effective pain reliever.

What’s the Difference Between Tylenol, Advil and Aleve?

Ever wonder which over-the-counter medicine to give a child experiencing muscle aches or pain from a mild injury? Tylenol, Advil and Aleve are common pain relievers on drugstore shelves. While all three medications can help alleviate a child’s discomfort, the active ingredient in each drug is different. In Tylenol, it’s acetaminophen; in Advil and Motrin, it’s ibuprofen; and in Aleve, it is naproxen.

Dr. Shevaun Doyle, a pediatric orthopedic surgeon at HSS, provides some general information and guidelines about acetaminophen, ibuprofen and naproxen:

Acetaminophen (Tylenol)
  • Provides pain relief
  • May be given to infants
  • Available as a pill, chewable tablet and in liquid form
  • May not be used in children with liver abnormalities or medications affecting liver function
  • In children scheduled for surgery, may be used right up until surgery
Ibuprofen (Advil and Motrin)
  • Provides pain relief
  • Works as an anti-inflammatory to reduce swelling
  • Longer-acting than Tylenol
  • Available as a pill, chewable table and in liquid form
  • Needs to be taken with food or milk
  • Should not be taken if a child is vomiting, dehydrated, or not eating much
  • May not be used in children with gastrointestinal or kidney abnormalities or with medications affecting kidney function
  • May not be used 72 hours prior to surgery
  • May not be used in patients under 6 months old
Naproxen (Aleve)
  • Provides pain relief
  • Works as an anti-inflammatory
  • Longer-acting than acetaminophen and ibuprofen
  • Available over the counter in pill form; by prescription in liquid form
  • May not be used in children with gastrointestinal or  kidney abnormalities or with medications affecting kidney function
  • Needs to be taken with food or milk
  • May not be used 72 hours prior to surgery
  • May not be used in patients under 2 years old

Proper Dosage is Key

No matter which medication is used, Dr. Doyle advises parents to pay careful attention to dosing. For the liquid form, parents should use the dropper or dosing cup that comes with the product. Kitchen spoons should never be used, since they’re not uniform in size.

A recent study commissioned by the National Institutes of Health found that many parents had trouble measuring the proper dose and inadvertently gave their children too much medicine. The research supports the use of oral syringes over dosing cups, especially when small amounts of medication are given.

“Some parents mistakenly believe that because a medicine is sold over the counter, it’s safer.  That’s not the case.  An overdose can be very serious,” Dr. Doyle said. In addition, she notes that the active ingredients in Tylenol and Advil are also found in other medications, such as cough and cold medicines. Parents are advised to read the list of ingredients in all medications a child is receiving to prevent double dosing.

Dr. Doyle also recommends that parents set up a schedule. “It’s a good idea to write down the time a medication is given so it’s easier to keep track of how much a child is receiving,” she says. “If a parent has any questions about which over-the-counter medication to use or the proper dose, it’s best to call the child’s doctor.”

Advil and Aleve: What’s the Difference?

Maybe you have a headache or your arthritis is acting up. You open your cupboard and see both Advil and Aleve. What’s the difference between them and which one should you take?

Advil and Aleve are both nonsteroidal anti-inflammatory drugs (NSAIDs) used to relieve pain and reduce fever. Though they are different drugs, they fall within the same drug class. Here, we explore similarities and differences between the two.

Verywell / Jessica Olah


Advil and Aleve are sold over-the-counter in pharmacies, which means they don’t require a prescription. They temporarily relieve minor aches and pains that occur with a headache, toothache, backache, menstrual cramps, sprains, the common cold, muscular aches, and minor arthritis pain.

Advil and Aleve both have the same action: they inhibit cyclooxygenases, COX-1 and COX-2, which are enzymes that are involved in the inflammatory process and other processes in the body. The main target to relieve pain and inflammation is inhibiting COX-2, but both of these drugs also inhibit COX-1, which isn’t desirable.

Because COX-1 maintains the normal lining of the stomach, inhibiting it can produce gastrointestinal symptoms like ulcers and upset stomach. COX-1 is also involved with kidney and platelet function, so there can be side effects with prolonged bleeding times and kidney function.


There are several differences between the two NSAIDs, including these key ones.

Active Ingredients

The active ingredient in Advil is ibuprofen. Each Advil tablet contains 200 milligrams (mg) of ibuprofen.

The active ingredient in Aleve tablets is naproxen sodium. Each Aleve tablet contains 220 mg of naproxen sodium.


Each drug has different lasting effects and dosing instructions:

  • Advil: Adults and children 12 years old and over should take one tablet every four to six hours while symptoms persist. If one is not effective, two tablets can be taken together, but you should not exceed six tablets in 24 hours unless directed by a doctor.
  • Aleve: Take one Aleve every eight to 12 hours while symptoms last. For the first dose, you can take two Aleve within the first hour. You should not exceed two Aleve in any eight to 12-hour period and should not exceed three Aleve in any 24-hour period unless directed by your doctor.

Essentially, the effects of Advil last for four to eight hours while Aleve lasts for eight to 12 hours, however, Advil has a faster onset (but doesn’t last as long as Aleve).

Additionally, Advil comes in 200 milligram (mg) tabs, which allows for more dosage fine-tuning, as the range can vary from 200 mg to 2400 mg per day, whereas with Aleve, which starts at 220 mg, the max daily dose is 880 mg.

Side Effects

Advil (ibuprofen) has the lowest incidence of digestive reactions of the non-selective NSAIDs, including Aleve (naproxen). It is favored for people who have ulcers or acid reflux disease. Aleve is more likely to cause pseudoporphyria, a type of photosensitivity.

The FDA warned about increased heart attack and stroke risk with all NSAIDs, including Aleve and Advil, in 2015. Further research may or may not show a difference in the risk of heart attack and stroke between the two NSAIDs.There are several studies that suggest that naproxen (found in Aleve) is associated with lower cardiovascular risk.

Can You Take Them Together?

Taking Advil and Aleve together is not recommended. The risk of side effects and adverse events increases if both are taken together. You should stick to taking one or the other, and only as directed, using the lowest effective dose.

Aspirin vs Aleve | Uses, Side Effects, Dosage and Ingredients

The active ingredient in aspirin is acetylsalicylic acid. It’s available over-the-counter in brand names and generics. Aleve’s active ingredient is naproxen sodium, and it’s available over-the-counter in generic.

Aspirin and Aleve work in similar ways to relieve pain. They inhibit an enzyme called cyclooxygenase (COX). COX has two forms, COX-1 and COX-2. COX-1 protects the stomach lining from digestive acids and enzyme damage. COX-2 causes swelling and pain. COX-1 narrows arteries and makes platelets in the bloodstream sticky. COX-2 widens arteries.

Older NSAIDs such as aspirin and naproxen inhibit COX-1 and COX-2. This eases swelling and pain but causes an upset stomach and other gastrointestinal effects.

In general, most people tolerate aspirin and Aleve well. But both drugs increase the risk of stomach pain and more serious problems such as ulcers or bleeding.


What Do They Treat?

In general aspirin and Aleve have similar uses such as relieving pain and reducing fevers. Unlike Aleve, aspirin may prevent second heart attacks and strokes. Some formulas of aspirin, such as Bayer Advanced Aspirin work in as little as 16 minutes.

Because Aleve lasts longer, it may be a better choice for people with chronic pain. More doctors prescribe non-aspirin NSAIDs such as Aleve for different types of arthritis. It lasts longer, but it takes longer to start working. So it’s not a good choice for quick pain relief.

Aspirin and Aleve uses include:

  • Headache

  • Menstrual pain

  • Minor pain of arthritis

  • Muscle pain

  • Pain and fever of colds

  • Toothache

Heart Attack Prevention

Low-dose aspirin is the only NSAID used by medical professionals in the United States to help reduce the risk of another heart attack or stroke in people who have had previous heart attack or stroke. It thins the blood which helps prevent blood clots.

The American Heart Association warns against taking daily low-dose aspirin without a doctor’s recommendation because of the risk for bleeding.

If you take aspirin for heart therapy, taking it with ibuprofen or another NSAID may reduce the benefit.

Inflammatory Arthritis

Aspirin and Aleve are indicated for treating arthritis, but doctors are more likely to recommend a non-aspirin NSAID, such as Aleve, for arthritis and other inflammatory diseases.

Naproxen at higher doses may relieve pain from chronic conditions such as rheumatoid arthritis, osteoarthritis, acute gout and ankylosing spondylitis — a type of inflammatory arthritis of the spine. It may help people living with chronic pain better manage long-term pain symptoms.

Some doctors may recommend if off label to treat migraines.


Aspirin and Aleve come in different strengths and have different dosages. Each drug comes in different forms, such as extended release, liquids and suppositories. Because aspirin and Aleve can cause stomach problems, they should be taken with food or a full glass of water.

Children and adults can take aspirin and Aleve, but children younger than 12 years old should not use Aleve.

Aspirin Dosages and Forms

Aspirin comes in strengths ranging from 60 mg to 800 mg. It comes in extended-release tablets, delayed-release tablets, a chewable tablet, a gum to take by mouth, a powder, and a suppository to use rectally. Higher strengths are only available by prescription.

The most common doses are low-dose aspirin, regular strength aspirin and extra strength aspirin. Doctors may adjust the dose depending on the condition being treated.

The maximum daily dose for aspirin is 4,000 mg.

Common Recommended Aspirin Dosages

Low-dose 81 mg Regular Strength 325 mg Extra Strength 500 mg
Dose and Frequency 4 to 8 tablets every 4 hours 1 or 2 pills every 4 hours, or 3 pills every 6 hours 1 or 2 pills every 4 to 6 hours
Daily Limit Do not take more than 48 tablets in 24 hours unless directed by a doctor Do not take more than 12 pills in 24 hours Do not take more than 8 pills in 24 hours

Aleve Dosages and Forms

Aleve over-the-counter comes in 220 mg. But other naproxen brands are available by prescription and dosages can go as high as 750 mg.

Aleve OTC is available in tablet, gelcap, caplet or liquid gel. But other formulas are available in delayed release tablets, extended release tablets, capsules and oral suspension.

For Aleve OTC, take one 220 mg pill every 8 to 12 hours. For the first dose, patients can take 2 pills within the first hour. Don’t take more than 2 pills in 12 hours, and do not take more than 3 pills in 24 hours.

Don’t take Aleve for more than 10 consecutive days unless your doctor tells you to. The maximum daily dose for naproxen is 660 mg.

Side Effects

Aspirin and Aleve are NSAIDs and they have similar side effects. The most common side effects for both are gastrointestinal side effects such as stomach pain, stomach bleeding and ulcers.

Because aspirin thins the blood, it is more likely to cause bleeding. People with any kind of blood or bleeding disorder should not take aspirin.

Aleve may increase the risk of aseptic meningitis – inflammation of the membrane covering the spinal cord and brain — especially in patients with lupus. Unlike aspirin, Aleve may cause drowsiness and blurred vision.


The FDA warns that non-aspirin NSAIDs such as Aleve may increase the risk of heart attack or stroke. Heart attack or stroke can occur as early as the first weeks of using the NSAID.

Aspirin Side Effects

Aspirin side effect information doesn’t include data on how common the side effects are.

Aspirin side effects include:

  • Central nervous system (CNS) changes

  • Excess fluid in lungs (pulmonary edema)

  • Hearing loss

  • Kidney damage

  • Liver toxicity

  • Nausea

  • Platelet problems

  • Premature destruction of red blood cells

  • Rash and skin problems

  • Spasm of airways in the lungs (bronchospasm)

  • Stomach pain, ulceration and bleeding

  • Swelling under the skin from accumulated fluid (angioedema)

  • Tinnitus, ringing in the ears

  • Urticaria (hives)

  • Vomiting

Severe allergic reactions to aspirin have happened, and people with a history of allergies to the drug, such as hives or breathing problems, should not use it. People with bleeding GI ulcers, anemia, hemophilia, hemorrhoids, nasal polyps associated with asthma or ulcerative colitis should not use the drug.

Like other NSAIDs, aspirin has the potential to trigger heart failure because it may lead to sodium and water retention. Long-term high-dose aspirin use should be avoided, especially during pregnancy. High doses may cause birth defects and prolong gestation and labor.

Aspirin enters breast milk. Lactating mothers should ask their doctor’s advice about whether they should stop breastfeeding or stop taking the drug.

Aleve Side Effects

Naproxen side effects gathered from drug labels include side effects that occur in 1 to 10 percent of people in OTC and prescription strength formulas.

Naproxen side effects include:

  • Abdominal pain (3 to 9 percent)

  • Constipation (3 to 9 percent)

  • Diarrhea (1 to 3 percent)

  • Diverticulitis (1 to 3 percent)

  • Dizziness (3 to 9 percent)

  • Drowsiness (3 to 9 percent)

  • Fluid retention (3 to 9 percent)

  • Gastrointestinal bleeding (1 to 4 percent)

  • Gastrointestinal perforation (1 to 4 percent)

  • Gastrointestinal ulcers (1 to 4 percent)

  • Headache (3 to 9 percent)

  • Hearing disturbances (less than 3 percent)

  • Heartburn (3 to 9 percent)

  • Inflammation of mouth and lips (stomatitis) (less than 3 percent)

  • Lightheadedness (less than 3 percent)

  • Nausea (3 to 9 percent)

  • Shortness of breath (3 to 9 percent)

  • Swelling (3 to 9 percent)

People who are allergic to aspirin shouldn’t take Aleve or any brand of naproxen. Aleve may cause serious skin reactions. Some can be life threatening. People should stop the drug at the first sign of a skin rash. Types of rashes include: exfoliative dermatitis, toxic epidermal syndrome, Stevens-Johnson syndrome and toxic epidermal necrolysis.

Taking naproxen may cause a person to develop high blood pressure. Like other NSAIDs, Aleve has the potential to trigger heart failure because it may lead to sodium and water retention. The risk is higher if taken in higher doses than directed or for longer than directed.

There aren’t enough studies in pregnant women who take Aleve. But women who take NSAIDs while pregnant may have a greater risk of having a stillbirth. Small amounts of naproxen have been detected in breast milk. Mothers should talk to their doctors if they are breastfeeding while taking Aleve.

Please seek the advice of a medical professional before making health care decisions.

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Ibuprofen vs. Naproxen: What’s the Difference?

The comparison of ibuprofen vs. naproxen is largely dependent upon how often you want to take your medicines and what other drugs you may be taking.

When you have pain from such ailments as the common headache, the last thing you want to do is an in-depth study of ibuprofen vs. naproxen to decide which is best to take. Thankfully, you don’t have labor too long over the the decision, because they both relieve headaches, and they both have a lower risk of bleeding than other non-steroidal anti-inflammatory drugs, commonly known by the acronym “NSAIDs.”

Ibuprofen vs. Naproxen

Ibuprofen (Motrin, Advil) and naproxen (Aleve) are both available under generic/store-brand formulations, as well as their original brand names. Although some people do report that generics work differently for them than brand drugs, the FDA requires generic formulations to perform similarly to brands. They acknowledge a possible slight variation at times, just as between batches of the brand medicine, but the FDA monitors them closely. Any undesired effects should be reported to the FDA.


According to Wikipedia, ibuprofen was discovered in 1961 by Stewart Adams and initially marketed as Brufen. It was first sold in 1969 in the United Kingdom and in the United States in 1974. Ibuprofen is on the World Health Organization’s List of Essential Medicines, the most effective and safe medicines needed in a health system.

The company Syntex first marketed naproxen in 1976 as the prescription drug Naprosyn. They sold naproxen sodium under the brand name Anaprox in 1980. It remains a prescription-only drug in much of the world. In the United States, however, the FDA approved it as an over-the-counter (OTC) drug in 1994.

One decision-maker when it comes to ibuprofen vs. naproxen may be how long the pain relief is expected to last. Naproxen lasts longer than ibuprofen. The half-life of ibuprofen is two to four hours, while naproxen is 12 to 17 hours. (Half-life is when half the original dose is still circulating in your bloodstream.) In layman’s terms, you take ibuprofen once every four to six hours, while naproxen is only repeated once every eight to 12 hours.

According to iodine.com, ibuprofen relieves pain, fever, and swelling. Naproxen is similar, relieving pain, fever, and inflammation. Ibuprofen is available for children, but naproxen is not.

Drug Interactions

“Be careful not to take more than one product that contains an NSAID at a time,” says Karen M. Mahoney, M.D., deputy director of Food and Drug Administration (FDA) Division of Nonprescription Drug Products. Taking two NSAIDs together can increase the risk of side effects and serious adverse events. For that reason, it can be wise to only have one NSAID in your medicine chest. It would avoid you reaching for the wrong bottle when you need a second dose.

Always discuss the use of OTC pain relievers with your physician, so you know what you can and cannot use with other medications.

Ibuprofen can interfere with the antiplatelet effect of aspirin, which is a serious warning for those on low-dose aspirin program. Timing is key. If you took the ibuprofen first, wait at least 30 minutes after taking aspirin to take the ibuprofen. If you took the aspirin first, you need to wait 8 hours, according to the FDA. (Timing may vary if you’re using enteric-coated aspirin.)

Another ibuprofen interaction involves the use of alcohol. That combination can increase the risk of gastrointestinal bleeding.

Naproxen comes with a list of drugs it can interact with, which means if you choose naproxen as your go-to pain reliever, you must discuss its use with any physician prescribing you drugs.

It may interfere with:

  • Antidepressents
  • Blood thinners
  • Blood-pressure medications
  • Diuretics
  • Heart medications
  • Lithium
  • Methotrexate
  • Probenecid
  • Steroids

Risks of Ibuprofen vs. Naproxen

Both ibuprofen and naproxen have a lower risk of bleeding compared to other NSAIDs, but both should be taken with food or milk to reduce the risk of stomach upset. Risks are similar, and neither should be taken during pregnancy. People who have cardiovascular disease, particularly those who recently had a heart attack or cardiac bypass surgery, are at the greatest risk for cardiovascular adverse events associated with NSAIDs, warns the FDA. Physicians frequently recommend acetaminophen as an OTC pain reliever for patients with cardiovascular issues.


For related reading, please visit these posts:

How Do NSAIDs Work?

Choosing ibuprofen vs. naproxen has nothing to do with the way they work in the body because they both work by inhibiting the COX enzymes:

“Prostaglandins are produced within the body’s cells by the enzyme cyclooxygenase (COX),” explains medicinenet.com. “There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. NSAIDs block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.” This bleeding risk is why some physicians prefer to recommend acetaminophen.

A 1984 study by The Manchester General Practitioner Group looked at 226 patients with osteoarthritis. The participants were randomly assigned to take either naproxen or ibuprofen. Both drugs reduced stiffness, pain, and overall disease severity. However, naproxen was found to be superior to ibuprofen in relieving resting pain, movement pain, night pain, and interference with daily activities. The study found 45 patients had side-effects (mainly mild gastrointestinal problems) from naproxen and 30 with ibuprofen (11 were patients who had side effects on both drugs). One patient had a gastrointestinal bleed while taking naproxen. Overall treatment preference significantly favored naproxen, concluded the researchers.

90,000 Pain relievers – a threat to the heart?

  • James Gallagher
  • BBC Science Observer

Photo Caption,

Researchers note that high doses of drugs are regularly taken

According to recent research The two commonly used pain relievers ibuprofen and diclofenac may slightly increase the risk of heart disease when taken in large doses for long periods of time.

People with arthritis can use these drugs daily to relieve pain.

According to experts, some patients will accept this risk, but they need to be given a choice.

Research results, published in The Lancet, suggest that drugs are even more problematic for smokers and overweight people.

Detailed analysis

Side effects of NSAIDs have been known before.But a team of scientists from Oxford was able to conduct detailed analysis to help patients make decisions with greater awareness of the problem.

Scientists have analyzed the data of more than 353 thousand patients. They studied in detail the effect of powerful doses of drugs, in particular, taken daily with 150 mg of diclofenac or 2,400 mg of ibuprofen.

The study found that for every 1,000 people who took drugs every year, there were three heart attacks, four cases of heart failure, one more death than people who did not take drugs.Cases of gastric bleeding have also been reported.

On average over the year, the number of heart attacks increased from the usual 8 per thousand to 11 among those taking medication.

“Three cases in a thousand is considered a low risk, but the decision must be made by the patients themselves,” says research team leader Professor Colin Baigent.

According to him, those who take these drugs from time to time in small doses, for example, to relieve headaches, have no cause for concern.

But people with heart failure, taking large doses of drugs, increase the risk of heart attacks.

High blood pressure, cholesterol and smoking are also factors that increase the risk of heart disease.

According to Professor Baigent, some patients will have to look for ways to reduce their risk, including statin therapy.


Photo caption,

Doctors say some patients will seriously have to think about alternative medicines

A similar drug, marketed under the brand name Vioxx, was taken off the market in 2004 after reports of similar side effects.

Every year in the UK, doctors prescribe 17 million prescriptions for non-steroidal anti-inflammatory drugs. Two-thirds of prescriptions are for ibuprofen and diclofenac.

Another drug, naproxen, has less severe side effects and is recommended by some doctors for patients with increased health risks.

Like aspirin, this drug prevents the blood from clotting, while increasing the risk of stomach bleeding.

Professor Alan Silman, who leads research on arthritis, said that because of the potential side effects, it is necessary to look for alternative drugs that are just as effective but safer.

Professor Donald Singer, a member of the British Pharmacological Society, noted that research results show that strong drugs can have serious side effects.

“It is important for prescribing physicians to be aware of these risks and to fully inform patients about the drugs they are taking,” Singer said.

Treatment of pain associated with operations

This patient guide is based on the Estonian treatment guide “Perioperative management of acute pain”, approved in 2016. Treatment guidelines were compiled from a literature review based on scientifically proven evidence. The aim of the patient guide is to help patients manage postoperative pain and to provide answers to questions related to acute pain. Knowledge of pain management options helps patients actively participate in treatment.The importance of the topics covered in the patient guide, as well as the accessibility of its text, were assessed by patients with acute postoperative pain. The patient guide explains the following topics: what is acute postoperative pain, why is it important to treat acute pain, and how to evaluate it. Different chapters describe options for treating acute postoperative pain. The reader will receive an answer to the following questions: why the use of oral drugs is preferred for the treatment of pain, whether it is possible to take different pain relievers together, and what else can be done in addition to drugs to relieve pain. It also provides guidance on how to manage postoperative pain at home. The topics covered in the patient guide can be read in more detail on the web pages at the end of the guide (see Appendix 1).

  • Tell your doctor what medications (including pain relievers) you have used before, if you are allergic to any medications and if you have any side effects. This information is very important when prescribing the right pain reliever for you.
  • If you feel pain, tell the nurse right away. Report pain also when pain is mild or at night.
  • If you have any side effects with any medication, tell your nurse or your doctor right away.
  • Rate your pain on a ten-point scale, because based on the information received, you can be provided with the medicine for pain that is right for you. Do not exceed the maximum allowable daily dose of pain relievers.
  • If the pain relievers prescribed for your treatment at home do not relieve pain, and the pain intensity on a ten-point scale is still greater than five after taking pain relievers, please contact your family or attending physician.
  • For mild to moderate pain, use alternative pain relievers in addition to pain medication.
  • During the period after surgery, it is important to be active and move as much as possible, this will help the body to recover and reduce the occurrence of complications.
  • If pain interferes with movement, report it to the nurse.

What is acute postoperative pain?

Pain is a subjective and unpleasant sensation that affects consciousness and impairs well-being. Acute pain is short-term, it most often has a well-defined area, a certain time of onset, as well as subjective and objective physical signs: heart rate and breathing become more frequent and blood pressure rises.Severe pain interferes with sleep and creates feelings of fear and anxiety. Acute postoperative pain occurs due to a surgical procedure or surgery. The severity of pain depends both on the severity of the operation and the size of the surgical wound, and on the pain threshold of a person. People feel and react to pain in different ways. Pain can also be influenced by the patient’s early pain experience, age, gender, cultural background, and psychological factors. In the case of children, pain can also be influenced by their parents’ attitude to pain.

Why treat acute postoperative pain?

Postoperative pain should not be tolerated, as pain may increase the incidence of postoperative complications: recovery from surgery will be slower and therefore may increase the length of hospital stay. If the pain is not treated, chronic postoperative pain is more common. Effective treatment of postoperative pain relieves heart and lung function, reduces the risk of venous thrombosis, and helps normalize digestion.

How is the intensity of pain assessed?

Assessing the severity of pain after surgery is a routine part of monitoring a patient. Pain is assessed regularly, and the frequency of the assessment depends on the patient’s condition and the severity of the surgery. Since the sensation of pain is individual and subjective, only you yourself will be able to assess the strength of the pain experienced. The nurse will assess your pain regularly, both before and after taking pain relievers, both during rest and while moving. Based on the information received, it will be possible to draw up a pain treatment scheme that suits you personally.

Different pain scales are used to assess pain. For example, a scale for , a numerical rating of is used in adults. It is used to assess the severity of pain on a ten-point scale, where zero means there is no pain, and 10 means the most severe pain you can imagine. The patient is asked to rate pain experienced in the past 24 hours using three different methods.

  1. force of existing pain,
  2. the weakest feeling of pain and
  3. the most intense feeling of pain.

The arithmetic mean of the scores received will show the strength of the patient’s feeling of pain during the last 24 hours. Sometimes you are asked to choose words that would describe your pain. These words can be:

  • no pain
  • slight pain
  • moderate pain
  • severe pain
  • very severe pain
  • unbearable pain

Figure 1.

Numeric Pain Rating Scale Sometimes the face scale (FPS-R) is used to assess pain (see Figure 1).Figure 2) or the so-called face scale. This scale can be used, for example, in older children. The child will need to explain the face scale so that he can use it to assess his pain. The child will need to explain the scale as follows: “This face (point to the leftmost face) shows that there is no pain at all. Other faces (point to each face from left to right) show that the pain is getting worse and worse. The face on the far right shows that he is in great pain. ” After the explanation, the child can be asked which face shows how much it hurts now?

According to the person chosen by the child, the evaluator will be able to give the indicated pain a score of 0, 2, 4, 6, 8 or 10 points, counting from right to left: 0 = not painful at all.10 = very painful. You cannot use the words “sad” or “joyful” in your assessment. It is imperative to clarify that we are talking only about how the child feels, and not about the external expression of the face.

Figure 2. Facial scale for assessing the severity of pain ( FPS-R )

The above scales are used not only to assess pain in older children, but also for patients with mild to moderate mental disorder. For young children, infants and patients with severe mental disorders, a behavior scale is used, in which the nurse assesses the severity of pain. Patient vital signs such as heart rate, blood pressure, blood oxygen, and behavior (facial expression, anxiety, sleep) are taken into account for these pain severity scales.

For better results in pain management immediately
inform the nurse if you feel pain – even when the pain is mild or if it started at night.
Do not endure pain!

How to treat pain after surgery?

In the treatment of postoperative pain, different medications are used with different routes of administration.In addition, the use of alternative methods is allowed, which can be used in case of mild to moderate pain.

In order to prescribe a suitable pain treatment, it is important to know which medications (including pain relievers) you have already used, if you are allergic to medications and if there have been side effects. When prescribing a medicine, modern principles from the medical field are taken into account regarding the operation performed to you and painkillers.

The choice of a suitable pain reliever, the dose of medication and the duration of treatment depends on both the severity of the pain (mild, moderate or severe pain), the type of pain (whether there was, for example, wound pain or nervous pain), the person himself (elderly, child, pregnant and dr.), as well as from concomitant diseases.

Take medication regularly (at regular intervals) to achieve the best effect of pain relievers. Pain relievers of different effects are often combined.

Groups of pain medications

As pain relievers, drugs are used, which are divided according to the type of mechanism of action into three main groups:

  1. Simple pain relievers. For example, paracetamol, ibuprofen, and diclofenac.
  2. Opioids. Medicines in this group are divided into weak opioids – for example, tramadol, codeine, and strong opioids – for example, morphine.
  3. Supportive medicines. They are used, for example, to treat nervous pain.


Paracetamol is often the first choice for mild to moderate pain. Paracetamol differs from other pain relievers (for example, from ibuprofen and diclofenac) primarily in that it does not have an irritating effect on the mucous membrane of the digestive tract.Side effects are rare when taking paracetamol. The most severe possible side effect is liver damage, which is rare and occurs most often due to drug overdose. Paracetamol should be used with caution in liver and kidney failure, chronic malnutrition, or alcoholism. The child should be prescribed paracetamol according to his age and weight.

If medications are additionally used (for example, the so-called teas for influenza), which include paracetamol in combination with an anesthetic, it is necessary to ensure that the amount of paracetamol taken per day does not exceed the permitted daily dose (for adults, 4 grams per day).

Nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen, diclofenac, ketoprofen, dexketoprofen, naproxen, etc.)

If the analgesic effect of paracetamol is too weak (an hour after taking paracetamol, the pain intensity is still more than five points), then in case of mild or moderate pain, for example, ibuprofen, ketoprofen, naproxen, diclofenac or other drugs from the same group should be taken according to the instructions for use the medicine listed on the medicine information sheet.

These drugs have analgesic, antipyretic and anti-inflammatory effects, but their use is contraindicated in case of gastrointestinal ulcers. These medicines should be used with caution by patients who have cardiovascular diseases. The risk of side effects in the digestive tract is greater in older people and in those who take large amounts of NSAIDs. The occurrence of side effects in the digestive tract does not depend on the way the medication is taken – medicinal suppositories with NSAIDs and injectable forms of drugs are also not suitable for patients with ulcers in the digestive tract. The strength of the harmful effect on the digestive tract differs for different drugs of the NSAID group. Ibuprofen is believed to be the least harmful to the digestive tract.

Depending on what comorbidities you have, some pain relievers belonging to this group may be more suitable for you than others, and this must be taken into account when prescribing treatment. For children, ibuprofen is most often used, it is prescribed according to the age and weight of the child.

Opioids or narcotic pain relievers (codeine, tramadol, morphine, fentanyl, oxycodone, pethidine, etc.)

In the case of severe pain, opioids are used in addition to the aforementioned groups of drugs. Common side effects of opioid use are nausea and vomiting. The nausea-inducing effect of opioids is weakened by long-term use. Constipation is another common side effect.

Supportive medicines such as gabapentin, pregabalin.

Supportive drugs are drugs that were not originally developed as pain relievers but were later discovered to be useful in relieving certain types of pain. For example, gabapentin and pregabalin were originally used to treat epilepsy. These medications are often used to treat chronic nerve pain. They are also effective in treating postoperative pain, reducing pain and the need for other pain relievers.

If you experience any side effects, notify your nurse or doctor right away!

After surgery, pain relievers can be taken:

  • Oral
  • by injection into a vein or muscle
  • through epidural catheter
  • with medicinal candle

Oral pain relievers are preferred after surgery.Oral medication is as effective as injected medication without pain or injection-related complications such as hemorrhage, inflammation of the injection site. Oral pain relievers are suitable for all types of pain relief, but you must be able to eat and drink.

Vein injection

If you cannot take the pills by mouth because of the operation, the nurse will inject your medicine through a cannula into a vein.The pain relieving effect will come within a few minutes. Once you start eating and drinking, you can return to your pill medication again.

After a major and painful operation, pain relievers can be taken using a special pain pump, with which you yourself can adjust the dose of the pain reliever (opioids) in the vein. This is called Patient Controlled Pain Relief or PCA (short for Patient Controlled Analgesia).

For painkillers, use a special pump that will allow you to receive painkillers as soon as you feel the need. The doctor will calculate the appropriate dose of the medicine for you and enter it into the pump’s memory. If you feel pain, press the button and the pump will inject the appropriate amount of medication through the cannula into the vein. There is no danger of medication overdose as the pain pump is programmed according to your needs.

The pump button must be pressed by yourself, you must not let anyone else do it.If the dose of the medication calculated for you is not sufficient and does not relieve pain, inform your nurse or doctor, who will adjust the dose of the medication given according to the severity of the pain. The PCA pump is also used for children if the child’s age allows it to be used and is able to understand how the pump works.

Figure 3. PCA pump

Muscle drug injection

The administration of painkillers by injections is tried to be avoided, since, due to heterogeneous absorption, the effect of anesthesia may be less than the expected effect.In addition, the injection can be painful.

Administration of medication using medicinal suppositories

Sometimes, if taking painkillers by mouth for some reason is not possible, medications can also be taken through the rectum. Medicated suppositories are often used to relieve pain in young children.

Medication through an epidural catheter

Using local anesthesia, if necessary, the anesthesiologist will place a thin plastic tube (epidural catheter) in the epidural space surrounding the spinal canal before the operation, if necessary.The epidural space is located in the spinal canal, where the roots of the nerves that transmit the feeling of pain pass. The medicine injected there affects the roots of the nerves and thus prevents the spread of the pain pulse. Therefore, the introduction of drugs into the epidural space is one of the most effective methods of pain relief.

Opioids and local anesthetics – a mixture for local anesthesia – are continuously injected into the epidural catheter through an automatic syringe throughout the day. The analgesic effect begins no later than 20 minutes after the start of the medication.

Figure 4. Epidural cutter insertion

Epidural pain relief can cause:

  • Nausea and vomiting – these are helped by anti-nausea medication
  • Weakness and numbness of the legs – they go away on their own
  • Disorders of urination – if necessary, a catheter is placed in the bladder
  • Decreased blood pressure – blood pressure monitored regularly
  • Head or back pain – Inform your nurse or healthcare professional.If a headache occurs after surgery while undergoing home treatment, contact your doctor immediately.

Nerve plexus block

Nerve plexus blocks are used most often for anesthetizing the extremities. Blockages are done both with a single injection and with the use of a catheter, which is installed next to the nerve plexus, and is needed for the constant administration of the drug (local anesthesia).Medicines are injected through the plexus catheter either with a single injection or with an automatic syringe.

The effect of alternative pain treatment methods on postoperative pain is small, so you should not use such methods separately, but only in conjunction with pain relievers. Alternative methods reduce anxiety and feelings of tension throughout the hospital stay. Most methods, such as music therapy or distraction, are safe and can be used without special training or additional tools.If the pain is mild or moderate, then in addition to pain relievers, you can use the methods from the list below. For more information on the different methods, ask your ward nurse.

Cold compress

Cold leads to constriction of blood vessels and bleeding in the damaged area slows down. If you have no contraindications, you can use a cold compress to reduce swelling and pain in the area of ​​the operation. As a cold compress, you can use special gel packs sold in pharmacies, any packaging from the freezer is also suitable.Wrap the cold bag in a towel and then place it on the damaged area and fix the compress if necessary. The towel will protect fabrics from possible local exposure to cold. Keep the cold compress in place for 20-30 minutes in a row, then pause for 10-15 minutes and repeat the procedure if necessary.

Transcutaneous electrical nerve stimulation or TENS

TENS, or transdermal electrical nerve stimulation, is a pain management method in which electrical impulses are used to relieve postoperative pain.


Physiotherapy is recommended to be added to the postoperative treatment regimen, as it reduces the risk of complications and facilitates the recovery of the body after surgery. Physiotherapy is performed by a specialist. He will explain to you why you need to start moving as quickly as possible after the operation, teach you how to take the most comfortable and relaxed posture after the operation, how to prop your body with pillows or the operating area with a bandage. In addition, he will teach you breathing techniques, as well as movement exercises.

Music therapy

Listening to music reduces anxiety, slightly reduces the severity of postoperative pain, and the stress response associated with pain is less common with music. Therefore, the need for opioids is also reduced.

If you enjoy listening to music and it relaxes and calms you down, we recommend that you take your favorite music with you to the hospital with you.You just need to remember that your favorite music may not be liked by other patients, so we recommend that you use headphones when listening to music.

Psychological Methods

This includes various relaxation techniques, daily self-activity training, distraction, and positive visualization techniques.

Using a variety of psychological methods throughout your hospital stay can help reduce feelings of tension and anxiety.With the help of them, you will more easily cope with the situation that has arisen. Both the severity of the pain and the need for pain relievers will decrease to a small extent.

For distraction, you can solve crosswords, put puzzles, play electronic games, etc. You can also use relaxation techniques to relax specific muscles or to reduce general feelings of anxiety and tension.

In the case of children, it is also important to use different psychological techniques to reduce feelings of anxiety and pain, and to do so throughout the hospital stay.The child becomes more calm if he is already explained to him what awaits him before admission to the hospital.

Play is an effective method of distracting attention for a child: both during the postoperative period and during procedures. Games in which the child will be an active participant (for example, electronic games) are more effective than the usual distraction.

Listening to your favorite music is particularly good at reducing pain and anxiety in older children. For newborns, physical contact is important (being on the breast of mom or dad), the benefits for reducing pain during procedures and after surgery will be from massage, and from breastfeeding, and from sucking the nipple.

When you are discharged from the hospital, you will be given recommendations on how to treat pain at home: what painkillers you may need, how much and how often you will need to take them. They will also tell you about possible side effects and what to do if they occur.Pain relievers for home use may not necessarily be the same as those you received at the hospital.

Ask your doctor where you can go if you have a problem. Make sure your doctor is aware of which medications have previously caused you problems. This will help avoid possible complications associated with medications.


  • Take pain relievers regularly as directed by your doctor. You can always check information about the prescribed prescriptions, including the regimen for taking the medicine prescribed by your doctor, in the prescription center of the state portal (www.eesti.ee → Services → Citizen → Health and healthcare → Prescriptions).

  • Get plenty of rest. If you have trouble sleeping, tell your doctor.

  • While sleeping or doing deep breathing exercises, prop your body with pillows.

  • To reduce pain, you can use alternative methods approved by your doctor: cold or warm compresses, listening to music, massage, substitution therapy (staying in a position that relieves pain, supporting the body with pillows, etc.)

  • If you must use opioids at home to treat acute postoperative pain, then driving will be prohibited, and you will not be able to use devices / mechanisms that require special attention.

  • If the pain relievers prescribed by your doctor do not relieve your pain (the pain intensity is still greater than five on a ten-point scale), then contact your doctor or family doctor.

In Estonian and Russian:
Website of the Estonian Association of Anesthesiologists
video: Amanda goes to operation

In English:
www.cuh.org.uk/sites/default /files/publications/PIN1304_TENS_pain_service_v4.pdf
patient.info/health www.painaustralia.org.au/healthcare-professionals/patient-resources.html

Used literature

Allred KD, Byers JF, Sole ML. The effect of music on postoperative pain and anxiety. Pain Manag Nurs Off J Am Soc Pain Manag Nurses. 2010 Mar; 11 (1): 15-25.

Crowe L, Chang A, Fraser JA, Gaskill D, Nash R, Wallace K. Systematic review of the effectiveness of nursing interventions in reducing or relieving post-operative pain. Int J Evid Based Healthc. 2008 Dec; 6 (4): 396-430.

Engwall M, Duppils GS. Music as a nursing int ervention for postoperative pain: a systematic review.J Perianesthesia Nurs Off J Am Soc PeriAnesthesia Nurses Am Soc PeriAnesthesia Nurses. 2009 Dec; 24 (6): 370–83

Johansson K, Nuutila L, Virtanen H, Katajisto J, Salanterä S. Preoperative education for orthopedic patients: systematic review. J Adv Nurs. 2005 Apr; 50 (2): 212-23

Macintyre PE, David A Scott, Stephan A Schug, editors. Acute Pain Management: Scientific Evidence (3rd edition) 2010.

Vaajoki A, Pietilä A-M, Kankkunen P, Vehviläinen-Julkunen K. Effects of listening to music on pain intensity and pain distress after surgery: an intervention.J Clin Nurs. 2012 Mar; 21 (5-6): 708-17.

Wood S. Postoperative pain 2: patient education, assessment and management. Nurs Times. 2010 Nov 23; 106 (46): 14-6.

IASP Taxonomy. (2012). International Association of the Study of Pain.
www.iasppain.org/Education/Content. aspx? ItemNumber = 1698 & navItemNumber = 576 # Paintolerancelevel

90,000 Naproxen – the best of all non-steroidal anti-inflammatory drugs for cardiac patients

One of the largest studies of non-steroidal anti-inflammatory drugs (NSAIDs) found naproxen to have the best safety profile compared to diclofenac, ibuprofen, and high-dose rofecoxib (Vioxx, Merck) and celecoxib (Celebrex, Pfizer). The study was published in May 2009 in Circulation: Cardiovascular Quality and Outcomes

The incidence of serious cardiovascular disease (CVD) and serious CVD and death in patients treated with various NSAIDs.

Medicinal product

IRR (serious CVD)

IRR (serious CVD / death)
















http: // cme.medscape.com/viewarticle/703986?src=cmenews&uac=130123DJ

90,000 Nimesulide No. 1? Of course, NIMESIL®!

The success of a particular drug can be judged by different indicators. Among these are the sales volumes of the drug, the dynamics of its prescription by doctors, as well as the demand and recognition among both healthcare professionals and, which is extremely important, consumers! To boast of stable success on all fronts is a sign of the highest professionalism of the company’s employees, which has achieved similar results.At the same time, the proper level of quality and effectiveness of drugs in this case is a matter of course. In Ukraine, such a “pioneer” is deservedly NIMESIL ® , which occupies a leading position in retail sales and in prescriptions of doctors, and is also the “Drug of the Year 2018” among prescription drugs 1 . And its manufacturer is BERLIN-CHEMI / A. MENARINI UKRAINE GMBH ”- in the same year was recognized as“ Company of the Year ”in the high-price segment.

Nimesulide is the key to success!

And it is not surprising that NIMESIL ® was chosen as the drug of the year.Indeed, it is the non-steroidal anti-inflammatory drugs (NSAIDs), to which it belongs, that are the drugs most often used in real clinical practice (Lesnaya O.A., 2018).

Also, the prevalence and frequency of use of drugs in this group are due to the variety of their therapeutic effects, namely analgesic, antipyretic, and anti-inflammatory effects.

Some of the NSAIDs, for example nimesulide, have more than 30 years of experience in medicine and have, in addition to traditional, a number of pharmacological effects that do not depend on the effect on cyclooxygenase (COX) of type 1, 2 or 3.

The use of NSAIDs is an integral part of the work of therapists, rheumatologists, neurologists, anesthesiologists, surgeons, traumatologists, gynecologists and representatives of other medical specialties (Lesnaya O.A., 2018).

At the same time, the appointment of NIMESIL is also widely used in the practice of doctors of various specialties ( Fig. 1 ) 2

Nimesulide, unlike many other NSAIDs, has “alkaline” properties that impede its penetration into the mucous membrane of the upper gastrointestinal tract (GIT), thereby significantly reducing the risk of contact damage.At the same time, this feature allows nimesulide to easily penetrate and accumulate in the foci of inflammation in a higher concentration than in the blood plasma (Lesnaya O.A., 2018).

Fig. 1

Shared contribution of specialties of doctors to the appointment of NIMESIL

According to the EMA, nimesulide is one of the 5 safest NSAIDs for the liver

According to the report of the European Medicines Agency (EMA, 2012), nimesulide is one of the 5 safest NSAIDs for the liver (celecoxib, diclofenac, ketoprofen, naproxen and nimesulide).

The safety of nimesulide in relation to the stomach is also well known. So, according to the same EMA report, this drug is considered one of the safest NSAIDs for the stomach. It is twice as safe as ibuprofen and diclofenac, and three times as safe as meloxicam.

It should be noted that the cardiovascular safety of nimesulide is also at an altitude – significantly higher than meloxicam, ketoprofen, diclofenac, indomethacin, piroxicam and celecoxib (EMA, 2012).

According to the latest recommendations for the treatment of osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases – ESCEO, nimesulide has a rapidly developing high clinical effect, safety profile and can be recommended for symptomatic treatment of osteoarthritis of the knee joint (Belyaeva I.B., 2019).

From inflammation and pain – NIMESIL

® !

If we talk about the drug NIMESIL ® , then in addition to the well-known positive properties of this drug (and this is high efficiency, good tolerance profile, convenience of the form of release and the mode of administration), I would like to dwell on the presence of so-called non-COX -dependent effects.

Some of these are the ability to additionally inhibit collagenase, reduce the activity of cytokines (primarily interleukin-6) and substance P, prevent and reduce induced apoptosis of chondrocytes – all this allows many authors to consider this drug as an effective tool in the complex therapy of osteoarthritis and other diseases joints.

Convenience, safety and ease of administration – 1 sachet 2 times a day – is also a very important factor of adherence to NIMESIL on the part of doctors, pharmacists and patients

Granular form of release provides optimal absorption and speed of action, high adherence to treatment (Fokina N.M. et al., 2013).

Who chooses NIMESIL

® ?

Apart from the fact that NIMESIL ® has been the sales leader among nimesulide preparations for 5 years in a row ( tab.1 ), he also received the palm among other non-steroidal anti-inflammatory and antirheumatic drugs ( tab. 2 ) 3 .

Table 1. Top-10 drugs of ATC group M01A X17 “Nimesulide”

Table 2. Top-10 drugs of ATC group M01A X “Other non-steroidal anti-inflammatory and antirheumatic drugs”


2013 2014 2015 2016 2017 2018
NIMESIL 1 1 1 1 1 1
NIMID 5 2 2 2 2 2
MUKOSAT 2 20 7 4 3 3
AFFIDA 31 10 4 3 4 4
DONA 4 4 9 8 6 5
SINARTA 6 6 5 6 5 6
STRUCTUM 7 8 10 9 9 7
ARTIFLEX 9 5 6 7 7 8
NICE 10 9 8 10 10 9
HONDROSAT 23 11 14 10

Leadership according to these indicators indicates a high, and most importantly – stable interest and adherence of patients to the drug NIMESIL ® in Ukraine

Doctors’ trust in the brand is reflected in the rates of their prescriptions for NIMESILA.

Thus, NIMESIL ® is the brand most prescribed by doctors of all specialties in total among nimesulide preparations ( Fig. 2 ) 5

Fig. 2

Top-10 brands by prescriptions of doctors of all specialties in 2018 among nimesulide drugs (INN)

Including it is No. 1 in the appointment of nimesulide for respiratory diseases, where its share is 62.2% of all drugs prescribed by a doctor of this international non-proprietary name (INN) 6 .

NIMESIL ® is also the most prescribed nimesulide in the class of diseases ICD-10 S00-T99 injuries, poisoning and some other consequences of external causes 7 ( Fig. 3 ).

Fig. 3

Top-10 brands of nimesulide drugs by doctor’s prescriptions for the ICD-10 class of diseases S00-T99 injuries, poisoning and some other consequences of external causes in 2018

The efficacy, quality and safety of BERLIN-CHEMI / A. MENARINI UKRAINE GMBH “, which includes NIMESIL ® , give the doctor the opportunity to be sure that the prescribed medications will provide the desired result. In addition, the appointment of effective and safe treatment significantly increases the authority of the doctor, which is of great importance in the context of the reform of medicine. At the same time, a pharmacist, dispensing company drugs to a patient in a pharmacy, can get a grateful and loyal client!

“BERLIN-CHEMIE / A.MENARINI ”- works for a life that is worth living!

Press service of “Weekly Apteka”

Tsikava information for you:

Musculoskeletal drug: created the strongest anti-inflammatory | Articles

An innovative drug has been developed in Russia for the treatment of diseases of the musculoskeletal system, including arthritis and arthrosis. It belongs to non-steroidal anti-inflammatory drugs. Medicines available on the market only temporarily relieve the symptoms of joint diseases. The new remedy is capable not only of effectively treating chronic inflammatory processes, but also much less toxic to the body. The product has been tested on animals and is ready for clinical trials. It may appear on the market in 2023.

Chronic problem

A new non-steroidal anti-inflammatory drug (NSAID) has been developed at the Kazan (Volga Region) Federal University. Chronic diseases of the musculoskeletal system, such as arthritis and arthrosis, often lead to disability, and the drugs that are prescribed for them (ibuprofen, diclofenac and others) are not effective enough and at the same time destroy the gastric mucosa, have a negative effect on human cardiac activity …

Photo: Izvestia / Dmitry Korotaev

Rheumatoid arthritis and osteoarthritis affect up to 30% of the adult population worldwide. , – Konstantin Balakin, one of the drug developers, leading specialist of the Scientific and Educational Center of Pharmacy of the Kazan Federal University, told Izvestia. – Among people over the age of 60, this pathology is even more common. In 50% of the population, joint diseases are diagnosed, and almost every person faces sciatica (inflammation of the sciatic nerve) and lumbago (lumbago in the lower back) during their life.Another serious problem is the high gastro- and cardiotoxicity of the available drugs. There is an urgent need for effective and safe anti-inflammatory drugs.

Two in one

KFU has developed and patented a new generation non-steroidal anti-inflammatory drug called KFU-01. This is a so-called prodrug, which, after entering the body under the influence of biochemical factors, releases two active components: pyridoxine (one of the forms of vitamin B6) and naproxen (a potent NSAID), which have a unique synergistic effect.As a result, efficacy and safety are achieved, which are not possessed by any of the known drugs in this category.

Photo: Global Look Press / Felix Kästle / dpa

Animal studies have shown that KFU-01 provides the onset of a pronounced anti-inflammatory effect in both acute and chronic inflammation models, which distinguishes it among all available NSAIDs, – said Konstantin Balakin.- The analgesic effects are also significantly enhanced. The principal feature is that, unlike any non-steroidal anti-inflammatory drug, KFU-01 practically does not have a negative effect on the gastric mucosa.

Scientists emphasize that the effect of multiple enhancement of the properties of active ingredients was achieved due to the peculiarities of pharmaceutical molecular design. The metabolism and pharmacokinetics of the resulting compound provide an optimal ratio of the concentrations of active components in the foci of inflammation, which makes it possible to effectively suppress them.At the same time, if you just take pyridoxine and naproxen at the same time, such a synergistic effect is not observed.

As prescribed by a doctor

A project to create a new anti-inflammatory drug is supported by the National Technology Initiative. The development has good prospects in the pharmaceutical market, Deputy Head of the Biomedicine Department of the Working Group of the National Technology Initiative Helsnet Andrey Lomonosov told Izvestia.

– The most ingenious solutions are always very simple. Here we see just such a case when something completely unique was obtained from two existing drugs, – he noted.

More than 300 million people annually take NSAIDs in the world, while only one third are prescribed by a doctor, Tatyana Ageeva, head of the hospital therapy clinic at Siberian State Medical University, told Izvestia.

Photo: RIA Novosti / Alexander Kondratyuk

The consequence of treatment and especially uncontrolled drug intake is a high incidence of adverse events, the spectrum of which is quite extensive, – she said.- The most serious are erosive and ulcerative lesions of the gastrointestinal tract, which are sometimes accompanied by life-threatening bleeding. Therefore, the development of drugs that combine high analgesic and anti-inflammatory activity with minimization of harmful effects on other systems and organs is highly relevant.

The new drug is entering the stage of clinical trials; it may appear on the market in 2023. The developers expect that they will be able to sell the international license.

As Izvestia wrote, Russian scientists from the State Research Center Institute of Immunology of the FMBA of Russia have created the world’s first genetically engineered drug for allergic rhinitis. The medicine in the form of an ordinary nasal spray relieves not only unpleasant symptoms – a runny nose and sneezing, but also the inflammation of the nasal mucosa itself. The experts who patented the substance have proven its effectiveness and safety in animals. The new drug is currently undergoing clinical trials.


Through the Looking Glass Killer

The right and left hand are mirror images of each other.Their anatomical structure is absolutely the same, but the right hand will never become the left, no matter how you twist it or turn it over, these are fundamentally different geometric objects. The same can be said for most complex drug molecules. The point is that each carbon atom forms four bonds. If there are no multiples (double or triple) among them, then the carbon atom is in the center of the tetrahedron. The vertices of the tetrahedron can be colored in four colors in two ways – you get two “mirror” tetrahedrons.So it is with a carbon atom – there are two “mirror” ways to arrange four different groups of atoms around it.

Molecules that are mirror images of each other are called optical isomers. They have absolutely similar physical and chemical properties, they cannot be distinguished by their melting point or, for example, solubility in water. It is rather difficult to synthesize only one specific isomer; nature copes with this much better than modern organic synthesis.Because of this, many drugs used to be produced as a mixture of isomers. But if both the left and right hand are in some sense equally useful, then the mirror reflections of a number of medicinal molecules turn out to be not just inactive, but poisonous, which sometimes led to tragic consequences. Can you guess which of the two molecules is the real medicine and which is the evil looking glass?

1.R-Carnitine is an important biomolecule that helps our cells break down fats. And its mirror-like cousin, S-carnitine, is toxic. Which molecule is safe?

The letters R- and S- indicate a specific isomer and are determined using specific rules. In all the pictures, carbon atoms are gray, hydrogen is white, oxygen is red, nitrogen is blue, sulfur is yellow.

  1. On right

  2. Left


S-carnitine is dangerous because, like R-carnitine, it binds to proteins involved in the breakdown of fats, but it turns out to be completely useless and slows down the metabolism.This process is called inhibition. As a result, the effect of S-carnitine can be cardiotoxic, for example.

Usually, R-carnitine is produced in sufficient quantities by the body, but in some diseases, for example, in case of primary systemic carnitine deficiency, it is prescribed as a medicine.


S-carnitine is dangerous because, like R-carnitine, it binds to proteins involved in the breakdown of fats, but it turns out to be completely useless and slows down the metabolism.This process is called inhibition. As a result, the effect of S-carnitine can be cardiotoxic, for example.

Usually, R-carnitine is produced in sufficient quantities by the body, but in some diseases, for example, in case of primary systemic carnitine deficiency, it is prescribed as a medicine.

2. S-penicillamine is an effective drug for Wilson’s disease, and its mirror image, R-penicillamine, is neurotoxic. Find a safe molecule.
  1. On right

  2. Left


Wilson’s disease – copper metabolism disorder. During treatment, penicillamine plays the role of a chelating agent that strongly binds to copper.And if both the S- and R-forms bind copper equally well, it turns out that the R-form is also capable of binding to the same proteins as pyridoxine, vitamin B6. Because of this, she becomes neurotoxic.


Wilson’s disease – copper metabolism disorder. During treatment, penicillamine plays the role of a chelating agent that strongly binds to copper. And if both the S- and R-forms bind copper equally well, it turns out that the R-form is also capable of binding to the same proteins as pyridoxine, vitamin B6.Because of this, she becomes neurotoxic.

3. The active ingredient of the well-known non-steroidal anti-inflammatory drug “Nalgezin” is S-naproxen. And its mirror isomer is toxic to the liver. Where is the remedy in the picture?
  1. On right

  2. Left


Indeed, R-naproxen is not only worse as an NSAID, but also toxic.Interestingly, S-naproxen, when it gets into water, is isomerized during water treatment and turns into the R-form.


Indeed, R-naproxen is not only worse as an NSAID, but also toxic. Interestingly, S-naproxen, when it gets into water, is isomerized during water treatment and turns into the R-form.

4. Salbutamol is a well-known drug for asthmatics that dilates the bronchi.In a mixture of mirror isomers, only the R-isomer of salbutamol is active. Where is he?
5. S, S-ethambutol is prescribed for tuberculosis, and its reflection R, R-ethambutol can cause blindness. Choose a medicine.
  1. On right

  2. Left


S, S-ethambutol disrupts the metabolism of Koch’s bacilli and, due to this, allows the treatment of tuberculosis.And R, R-ethambutanol appears to be toxic to the optic nerve and causes temporary or, in rare cases, permanent vision loss.


S, S-ethambutol disrupts the metabolism of Koch’s bacilli and, due to this, allows the treatment of tuberculosis. And R, R-ethambutanol appears to be toxic to the optic nerve and causes temporary or, in rare cases, permanent vision loss.

6.Of course, this test would not be complete without the classic example of R-thalidomide, a sedative approved in 1957-1962 for use in pregnant women. Its S-form, which appears during isomerization in the body, caused fetal deformities. Indicate the structure of the molecule in the drug.
  1. On right

  2. Left


As a result of the fact that the activity of thalidomide measurements was poorly understood, more than 10 thousand children around the world (mainly in West Germany, where the drug was developed) were born with congenital malformations of the limbs (phocomelia).In an acidic medium of gastric juice, the R isomer could freely convert to S and vice versa.

The thalidomide case led to major changes in drug testing legislation. Despite the withdrawal of the drug, now it is again among the recommended – it is sometimes prescribed for leprosy, but with a strict ban on sperm or blood donation, as well as with the requirement for the mandatory use of contraception.


As a result of the fact that the activity of thalidomide measurements was poorly understood, more than 10 thousand children around the world (mainly in West Germany, where the drug was developed) were born with congenital malformations of the limbs (phocomelia).In an acidic medium of gastric juice, the R isomer could freely convert to S and vice versa.

The thalidomide case led to major changes in drug testing legislation. Despite the withdrawal of the drug, now it is again among the recommended – it is sometimes prescribed for leprosy, but with a strict ban on sperm or blood donation, as well as with the requirement for the mandatory use of contraception.

7.Finally, let’s offer a simpler choice. Our olfactory organs are armed with receptors that also have mirror isomerism. Therefore, some optical isomers can be distinguished by their smell. Let’s say you like the scent of mint, R-carvone has it. Its mirror isomer, S-carvone, has a caraway (or dill seed) scent. Choose a “mint molecule”.
  1. On right

  2. Left


Now you can tell how to determine – the R- or S-isomer in front of you.Step one: find the carbon atom to which four different groups of atoms are attached. It is called asymmetrical. Find the atom with the lowest atomic number among those attached to the carbon atom (here, in all questions of the test, this is hydrogen, a white ball).

Mentally unfold the structure so that this atom is left behind. The remaining three groups of atoms should be numbered in order of precedence. The higher the atomic number of the first atom of the group attached to the asymmetric one, the “older” the group.If the atomic numbers of these first atoms of the groups coincide, then one must look at the atoms attached to them.

If in one group there is an “older” atom attached to the first than in the other, then this group is older. If the atoms are the same, but there are multiple bonds, then the multiple bond group is older. If the resulting numbering goes clockwise, then the configuration of the molecule is R, if against – S.


Now you can tell how to determine – the R- or S-isomer in front of you.Step one: find the carbon atom to which four different groups of atoms are attached. It is called asymmetrical. Find the atom with the lowest atomic number among those attached to the carbon atom (here, in all questions of the test, this is hydrogen, a white ball).

Mentally unfold the structure so that this atom is left behind. The remaining three groups of atoms should be numbered in order of precedence. The higher the atomic number of the first atom of the group attached to the asymmetric one, the “older” the group.If the atomic numbers of these first atoms of the groups coincide, then one must look at the atoms attached to them.

If in one group there is an “older” atom attached to the first than in the other, then this group is older. If the atoms are the same, but there are multiple bonds, then the multiple bond group is older. If the resulting numbering goes clockwise, then the configuration of the molecule is R, if against – S.

Congratulations, your result is

out of

Black king

It looks like you were asleep during the test.

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out of


You are not quite familiar with the laws of the looking glass yet.

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Humpty Dumpty

You have completed almost half of the tasks!

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out of

White King

Not bad, but you still can’t keep up with the White Queen.

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out of

White Queen

You seem to understand the rules of the game, but you have not been able to win the game yet.

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Lewis Carroll

You probably have a mathematical mindset and you guessed how to distinguish the R-isomer from S.Or are you just a chemist and knew about everything in advance!

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Naproxen-acry 0.25 30 pcs

Pharmacological action

NSAIDs, a derivative of naphthylpropionic acid. It has anti-inflammatory, analgesic and antipyretic effects.

The mechanism of action is associated with inhibition of the enzyme COX, which leads to inhibition of the synthesis of prostaglandins from arachidonic acid.

Suppresses platelet aggregation.

Reduces pain syndrome, incl. joint pain at rest and during movement, morning stiffness and swelling of the joints, helps to increase the range of motion. The anti-inflammatory effect occurs by the end of the 1st week of treatment.


After oral administration, naproxen is rapidly absorbed from the gastrointestinal tract.C max in plasma is reached after 1-4 hours. Food slows down the rate of absorption, but does not reduce the degree of absorption. Naproxen is well absorbed when administered rectally, but absorption is slower than when taken orally.

At therapeutic concentrations, naproxen binds to plasma proteins by more than 99%. The concentration of naproxen in plasma increases proportionally at doses up to 500 mg; at higher doses, an increase in clearance is observed due to saturation of plasma proteins.

Naproxen diffuses into synovial fluid.

T 1/2 is about 13 hours. Approximately 95% of the dose is excreted in the urine as unchanged substance and 6-O-desmethylnaproxen and its conjugates. Less than 5% is administered in the feces.


Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, articular syndrome with exacerbation of gout; back pain, neuralgia, myalgia, traumatic inflammation of soft tissues and musculoskeletal system.As an adjuvant in infectious and inflammatory diseases of the upper respiratory tract, adnexitis, primary dysmenorrhea, headache and toothache.

Instructions for use / dosage

Set individually, taking into account the severity of the disease.

Orally for adults – 0.5-1 g / day. in 2 steps. The daily dose for maintenance treatment is 500 mg.

Maximum dose: 1.75 g / day.

Children aged 1 to 5 years – 2.5-5 mg / kg / day in 1-3 doses, the maximum course of treatment is 14 days. In juvenile arthritis in children over 5 years of age, the daily dose is 10 mg / kg.

Side effects

From the digestive system: nausea, vomiting, epigastric discomfort; rarely – erosive and ulcerative lesions of the gastrointestinal tract, bleeding and perforation of the gastrointestinal tract, liver dysfunction.

From the side of the central nervous system and peripheral nervous system: headache, drowsiness, slowing down of the speed of psychomotor reactions; rarely – hearing impairment.

From the hematopoietic system: rarely – thrombocytopenia, granulocytopenia, aplastic anemia, hemolytic anemia.

Respiratory system: rarely – eosinophilic pneumonia.

From the urinary system: rarely – renal dysfunction.

Allergic reactions: skin rash, urticaria, Quincke’s edema.

For rectal administration: the appearance of mucous discharge mixed with blood, painful defecation.


Erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, “aspirin triad”, hematopoiesis disorders, severe renal dysfunction (CC less than 20 ml / min), severe liver dysfunctions, children under 1 year of age; hypersensitivity to naproxen and other NSAIDs.

Application during pregnancy and lactation

Used with caution during pregnancy (especially in I and III trimesters) and during lactation.

Naproxen crosses the placental barrier, excreted in breast milk in small amounts.

Special instructions

It is used with caution in liver and kidney diseases, gastrointestinal tract diseases in history, in the presence of dyspeptic symptoms, in arterial hypertension, heart failure, immediately after major surgical interventions.

In the course of treatment, systematic monitoring of the function of the liver and kidneys, the picture of peripheral blood is necessary.

If it is necessary to determine the concentration of 17-ketosteroids, naproxen should be discontinued 48 hours before the study.

Influence on the ability to drive vehicles and use mechanisms

During the period of application, one should refrain from potentially hazardous activities associated with the need for concentration of attention and increased speed of psychomotor reactions.

Drug Interactions

When used simultaneously with antacids containing magnesium and aluminum, sodium bicarbonate, the absorption of naproxen decreases.

With simultaneous use with indirect anticoagulants, cases of a slight increase in the effect of anticoagulants have been described.

With simultaneous use with amoxicillin, a case of nephrotic syndrome has been described; with acetylsalicylic acid – a decrease in the concentration of naproxen in blood plasma is possible.

With simultaneous use, it is possible to change the pharmacokinetic parameters of diazepam; with caffeine – the effect of naproxen is enhanced; with lithium carbonate – an increase in the concentration of lithium in the blood plasma is possible; with methotrexate – the toxicity of methotrexate may increase.

There are reports of the development of myoclonus with simultaneous use with morphine.

With simultaneous use with prednisolone, a significant increase in the concentration of prednisolone in blood plasma is possible; with probenecid – a decrease in the concentration of naproxen in the blood plasma; with salicylamide – the effect of salicylamide is enhanced.

With simultaneous use with furosemide, it is possible to reduce the diuretic effect of furosemide.