Naproxen
Is It Right for You?
A complete guide to Naproxen — what it treats, how it works, dosages, side effects, and when a clinician may prescribe it following an online consultation.
What Is Naproxen?
Naproxen is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce inflammation, and lower fever. It is one of the most widely prescribed NSAIDs in the UK and is distinguished from many of its class by its relatively favourable cardiovascular safety profile -- making it the preferred NSAID choice for patients with cardiovascular risk factors when an NSAID is clinically necessary.
First approved in the 1970s, naproxen has a longer duration of action than ibuprofen and diclofenac, allowing twice-daily dosing compared to the three or four times daily regimens required by shorter-acting NSAIDs. This convenience, combined with its established efficacy and cardiovascular profile, makes it a commonly used option for both acute and chronic painful and inflammatory conditions.
Naproxen is available in standard tablets, gastro-resistant (enteric-coated) tablets, and oral suspension. Lower-dose formulations (250 mg) are available over the counter in the UK for short-term pain relief in adults, while higher doses and longer courses require a prescription. It is available generically and under brand names including Naprosyn and Feminax Ultra (for dysmenorrhoea).
Prescription-strength naproxen is required for many indications, including the management of inflammatory arthritis and longer-term pain conditions. A licensed clinician must assess your symptoms, medical history, and risk factors before prescribing -- which can now be done quickly and conveniently through a telehealth consultation.
What Conditions Is Naproxen Used For?
Naproxen is used across a wide range of acute and chronic painful and inflammatory conditions:
reduces synovial inflammation, joint pain, and morning stiffness; used as part of a broader disease management strategy.
reduces spinal inflammation, pain, and stiffness; NSAIDs including naproxen are a first-line pharmacological treatment for this condition.
naproxen has antipyretic properties and can be used to reduce elevated body temperature, though paracetamol is usually preferred for fever alone.
sprains, strains, back pain, neck pain, and soft tissue injuries; reduces both pain and inflammatory swelling.
highly effective for primary dysmenorrhoea; prostaglandins drive menstrual pain and uterine contractions, and naproxen's longer duration of action means less frequent dosing during periods.
one of the first-line NSAIDs for the treatment of acute gout attacks; reduces the intense joint inflammation, pain, and swelling.
effective for the treatment of acute migraine headache, particularly in combination with other agents; also used in combination with sumatriptan (as Treximet in some markets) for migraine.
effective for post-procedural and acute dental pain.
Like all NSAIDs, naproxen carries risks of gastrointestinal, cardiovascular, and renal adverse effects that increase with dose, duration of use, and in patients with pre-existing risk factors. Although naproxen has a more favourable cardiovascular profile than diclofenac and selective COX-2 inhibitors, it is not risk-free. Always use the lowest dose that controls your symptoms for the minimum necessary duration, and discuss long-term use with your clinician.
How Does Naproxen Work?
Naproxen is a non-selective cyclooxygenase (COX) inhibitor, inhibiting both COX-1 and COX-2 enzymes with broadly similar potency. This is the same fundamental mechanism shared by all traditional NSAIDs, though the specific pharmacokinetic properties of naproxen -- particularly its long half-life -- distinguish it clinically from shorter-acting agents.
The cyclooxygenase enzymes convert arachidonic acid -- released from cell membrane phospholipids in response to tissue injury or irritation -- into prostaglandins, prostacyclin (PGI2), and thromboxane A2 (TXA2). These eicosanoids play critical roles in inflammation, pain sensitisation, fever, platelet aggregation, and protection of the gastric mucosa.
By inhibiting COX enzymes, naproxen reduces the synthesis of pro-inflammatory prostaglandins (PGE2, PGI2) at sites of tissue damage, producing its analgesic and anti-inflammatory effects. Inhibition of hypothalamic prostaglandin synthesis accounts for its antipyretic effect. COX-1-derived prostaglandins in the gastric mucosa and thromboxane A2 in platelets are also reduced, which underlies naproxen's gastrointestinal side effects and its effect on platelet function (prolonging bleeding time).
Naproxen's cardiovascular profile is generally considered more favourable than diclofenac and COX-2 selective inhibitors. While all NSAIDs reduce COX-2-derived prostacyclin (a vasodilator and platelet inhibitor), naproxen also substantially inhibits COX-1-derived thromboxane A2 (a platelet aggregator and vasoconstrictor) in a more balanced manner. This means naproxen's inhibition of platelet aggregation more closely resembles the profile of low-dose aspirin than drugs that predominantly inhibit COX-2, partially offsetting the prothrombotic tendency. However, naproxen is not equivalent to aspirin for cardiovascular protection and should not be substituted for it.
Naproxen has a half-life of approximately 12--17 hours -- significantly longer than ibuprofen (2 hours) or diclofenac (1--2 hours) -- which allows effective twice-daily dosing and more sustained plasma levels, reducing the peaks and troughs associated with more frequent dosing of shorter-acting NSAIDs.
Dosages & Administration
The correct dose depends on the type and severity of infection, age, weight, and kidney function. Always follow your clinician's instructions. The table below is for general reference only.
Administration Tips
Take naproxen with food, milk, or an antacid. Naproxen can irritate the gastric mucosa and cause nausea and dyspepsia. Taking it at the start of a meal or with a glass of milk significantly reduces the risk of gastrointestinal upset. If prescribed alongside a proton pump inhibitor for gastroprotection, take both consistently as directed.
Take with a full glass of water and remain upright for at least 30 minutes after taking to minimise oesophageal irritation.
Do not exceed the prescribed dose or frequency. Unlike ibuprofen, which can be taken up to four times daily, naproxen's long half-life means doses accumulate if taken too frequently, increasing the risk of toxicity. Twice-daily dosing is the standard; more frequent dosing significantly increases the risk of adverse effects without improving analgesia.
Allow adequate time between doses. Because of its long half-life, naproxen provides sustained coverage between doses. It does not need to be taken more frequently than every 8 hours, and twice-daily dosing is usually sufficient for chronic conditions.
Do not combine naproxen with other NSAIDs -- including over-the-counter ibuprofen or diclofenac -- as this provides no additional pain relief and significantly increases the risk of serious adverse effects.
For gastro-resistant (enteric-coated) naproxen: these tablets are designed to pass through the stomach before dissolving, reducing direct gastric irritation. They have a slower onset of action than standard tablets and are not suitable when rapid pain relief is needed. They should be swallowed whole and not crushed or chewed.
Side Effects of Naproxen
Naproxen is generally well tolerated for short-term use in appropriate patients. Like all NSAIDs, the risk of serious adverse effects -- particularly gastrointestinal, cardiovascular, and renal -- increases with dose, duration, and the presence of pre-existing risk factors.
- Nausea and indigestion (most common)
- Heartburn or dyspepsia
- Abdominal discomfort or pain
- Constipation or diarrhoea
- Headache
- Dizziness
- Fluid retention and ankle swelling
- Elevated blood pressure
- Flatulence
Less Common Side Effects
- Tinnitus (ringing in the ears) -- naproxen is associated with tinnitus and reversible hearing disturbance at higher doses
- Skin rash or photosensitivity
- Drowsiness
- Visual disturbances
- Gastrointestinal bleeding and perforation -- vomiting blood, black tarry stools, or sudden severe abdominal pain; can be life-threatening and may occur without prior warning symptoms, particularly in elderly patients
- Cardiovascular events -- myocardial infarction, stroke, and heart failure; naproxen has a relatively favourable cardiovascular profile among NSAIDs but is not without risk, particularly with prolonged use at high doses
- Acute kidney injury -- particularly in patients who are dehydrated, elderly, or have pre-existing renal, cardiac, or hepatic disease; can present as reduced urine output, fluid retention, or rapidly rising creatinine
- Severe allergic reaction (anaphylaxis) -- urticaria, facial or throat swelling, difficulty breathing; requires immediate emergency treatment
- NSAID-exacerbated respiratory disease (AERD) -- bronchospasm and severe asthma attacks in susceptible individuals; requires immediate cessation and emergency care
- Severe skin reactions -- Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis; very rare but potentially life-threatening
- Hepatotoxicity -- jaundice, dark urine, severe fatigue; rare but requires immediate medical review
- Aseptic meningitis -- rare; more common in patients with autoimmune conditions such as lupus
Naproxen is associated with a higher rate of tinnitus (ringing or buzzing in the ears) and reversible hearing disturbance than some other NSAIDs. This is a dose-dependent effect and usually resolves on stopping treatment. If tinnitus develops during naproxen therapy, stop taking it and inform your clinician. Do not restart without medical guidance.
Drug Interactions
Naproxen shares many of the drug interactions common to all NSAIDs. Always disclose all prescription drugs, over-the-counter medicines, vitamins, and supplements to your clinician or pharmacist before starting naproxen.
Naproxen impairs platelet function and can cause gastrointestinal bleeding. When combined with anticoagulants, the risk of serious and potentially fatal bleeding is substantially increased. This combination should generally be avoided; if unavoidable, close monitoring and gastroprotection are essential.
Combining naproxen with other NSAIDs provides no additional analgesic benefit and substantially increases the risk of gastrointestinal bleeding and other adverse effects. This combination is contraindicated. Low-dose aspirin (75 mg) for cardiovascular protection can be continued alongside naproxen but increases gastrointestinal bleeding risk; gastroprotection is recommended.
NSAIDs antagonise the antihypertensive effects of ACE inhibitors and ARBs and reduce the efficacy of diuretics. The combination of an ACE inhibitor or ARB, a diuretic, and an NSAID (the "triple whammy") can cause acute kidney injury, particularly in elderly or volume-depleted patients. Blood pressure and renal function should be monitored.
SSRIs and SNRIs impair platelet aggregation by reducing platelet serotonin. Combined with naproxen, the risk of gastrointestinal bleeding is significantly increased. Gastroprotection should be considered if this combination is necessary.
Probenecid reduces the renal excretion of naproxen, increasing its blood levels and the risk of adverse effects. This combination should be used with caution.
Important Warnings
All NSAIDs, including naproxen, carry a risk of gastrointestinal ulceration, bleeding, and perforation. These events can occur without prior warning symptoms at any point during treatment and can be fatal. Elderly patients, those with a history of peptic ulcer disease, those on anticoagulants, corticosteroids, or SSRIs, and those who smoke or drink alcohol regularly are at the highest risk. Gastroprotection with a proton pump inhibitor should be co-prescribed in at-risk patients. Seek immediate medical attention if you experience vomiting of blood, black tarry stools, or sudden severe abdominal pain.
Although naproxen has a more favourable cardiovascular safety profile than diclofenac and selective COX-2 inhibitors, all NSAIDs increase the risk of serious cardiovascular events including myocardial infarction, stroke, and heart failure - particularly with prolonged use at higher doses. Naproxen should be used with caution in patients with established cardiovascular disease or multiple cardiovascular risk factors, and at the lowest effective dose for the shortest possible time. It should not be used as a substitute for low-dose aspirin in cardiovascular protection.
Naproxen reduces renal prostaglandin synthesis, which can compromise renal blood flow -- particularly in patients who are volume-depleted, elderly, or have pre-existing renal, cardiac, or hepatic impairment. Acute kidney injury can develop rapidly. Naproxen should be avoided or used with extreme caution in patients with chronic kidney disease, and patients should maintain adequate hydration during treatment. Stop naproxen and seek medical review if urine output decreases or oedema worsens.
Approximately 10% of adults with asthma have aspirin- or NSAID-exacerbated respiratory disease, in which NSAIDs trigger bronchospasm and severe asthma attacks. Patients with asthma who have not previously taken NSAIDs should use naproxen with caution and stop immediately if any worsening of breathing occurs. A history of NSAID-triggered wheeze is a contraindication to naproxen.
Naproxen is contraindicated from 20 weeks of pregnancy onwards due to the risk of foetal renal dysfunction, oligohydramnios, and premature closure of the ductus arteriosus, which can cause serious neonatal complications. It should be used with caution and only if clearly necessary before 20 weeks. Naproxen
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Naproxen FAQs
Both naproxen and ibuprofen are non-selective NSAIDs that work through the same COX-inhibiting mechanism. The key differences are in their duration of action and dosing frequency. Ibuprofen has a short half-life of approximately 2 hours and must be taken three to four times daily. Naproxen has a much longer half-life of 12--17 hours, allowing twice-daily dosing and providing more sustained and consistent plasma levels. This makes naproxen more convenient for chronic conditions and more appropriate when sustained analgesia throughout the day and night is needed. For acute, breakthrough pain relief, ibuprofen's faster offset may be advantageous.
Naproxen has a relatively more favourable cardiovascular safety profile compared to diclofenac and selective COX-2 inhibitors (coxibs), based on large epidemiological studies and meta-analyses. This is thought to be related to its more balanced inhibition of both COX-1 (reducing prothrombotic thromboxane A2) and COX-2 (reducing vasoprotective prostacyclin), resulting in less net prothrombotic effect. However, naproxen is not without cardiovascular risk -- particularly at high doses and with prolonged use -- and is not equivalent to aspirin for cardiovascular protection. It remains the preferred NSAID when an NSAID is necessary in a patient with cardiovascular risk factors, but only after a careful risk-benefit assessment.
Standard naproxen tablets are absorbed relatively rapidly and begin to provide pain relief within 30--60 minutes, with peak effect around 2--4 hours. Gastro-resistant (enteric-coated) tablets take longer to absorb -- typically 4--6 hours to peak effect -- and are not suitable when rapid pain relief is needed. For chronic inflammatory conditions, the full anti-inflammatory benefit may take several days of consistent dosing to be fully established.
Yes. Naproxen and paracetamol work through different mechanisms and can be safely combined for additional pain relief -- this is a commonly recommended approach in multimodal analgesia, particularly for musculoskeletal pain and osteoarthritis. Do not combine naproxen with other NSAIDs (such as ibuprofen or diclofenac), as this provides no additional benefit and significantly increases the risk of adverse effects.
Many patients benefit from co-prescribing a proton pump inhibitor such as omeprazole (20 mg daily) alongside naproxen, particularly those who are elderly, have a history of peptic ulcer disease or gastrointestinal bleeding, are also taking corticosteroids, anticoagulants, or SSRIs, or who smoke or drink alcohol regularly. Your clinician will assess your gastrointestinal risk profile and advise on whether gastroprotection is appropriate.
Yes. Naproxen is one of the first-line NSAID treatments for acute gout attacks. The recommended approach is to start with a higher initial dose (750 mg) followed by 250 mg every 8 hours until the attack resolves, which is typically within 3--5 days. Like all NSAIDs, naproxen treats the inflammation of an acute gout attack but does not lower serum uric acid levels or prevent future attacks. Long-term management of gout also requires urate-lowering therapy such as allopurinol.
Naproxen is licensed for use in children with juvenile idiopathic arthritis and is one of the NSAIDs with established paediatric dosing, calculated at approximately 10 mg/kg/day in two divided doses. It is generally not recommended for children under 5 years of age. For most acute pain and fever in children, paracetamol and ibuprofen are preferred first-line options. A clinician should always be consulted before giving naproxen to a child.