Doctor Answers: Naproxen vs Ibuprofen: What’s the Difference?

If you’ve ever reached for an over-the-counter pain reliever, chances are it was an NSAID, non-steroidal anti-inflammatory drug. These medications are common prescriptions in hospitals and are also widely used at home for treating everything from joint pain to headaches. 

Among the most popular options are Naproxen vs Ibuprofen. To better understand their differences, effects, and safety, we consulted Dr. Yi Xuan Lee, a board-certified specialist, for her expert insights. Dr. Lee provided detailed answers, backed by current research, to help you decide which option may work best for you. All answers have been medically reviewed for accuracy.

Q: What is Naproxen?

Dr. Yi Xuan Lee answers: Naproxen falls under the class of non-steroidal anti-inflammatory drugs (NSAIDs). It is beneficial in reducing inflammation-induced swelling and pain in joints and muscles. 

Due to its longer half-life (time taken for a drug to be half cleared out from the body), Naproxen is helpful in long-term pain control compared to other pain management options.

Q: What is Ibuprofen?

Dr. Yi Xuan Lee answers: Like Naproxen, Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). It is FDA-approved for treating inflammatory diseases and rheumatoid disorders. Besides chronic pain, Ibuprofen is also indicated for mild to moderate pain.

Q: Is Naproxen the same as Ibuprofen?

Dr. Yi Xuan Lee answers: Both Naproxen and Ibuprofen are classified under non-steroidal anti-inflammatory drugs (NSAIDs), but they are not the same. Continue reading to know their similarities and differences in the later part.  

Q: How do they work?

Dr. Yi Xuan Lee answers: Non-steroidal anti-inflammatory drugs (NSAIDs) are broadly classified into two groups: selective or non-selective inhibitors of cyclooxygenase (COX) 1 and 2. Naproxen and Ibuprofen are non-selective COX inhibitors.

COX 1 and 2 are involved in synthesizing prostaglandins, the culprit of causing pain, inflammation, and fever. By blocking COX 1 and 2, Naproxen and Ibuprofen suppress the inflammation and pain.

Q: What are Naproxen and Ibuprofen used for?

Dr. Yi Xuan Lee answers: Naproxen has been FDA-approved to treat a wide range of health conditions, including:

• Acute gout
• Osteoarthritis
• Period pain
• Musculoskeletal pain
• Ankylosing spondylitis
• Bursitis
• Polyarticular juvenile idiopathic arthritis
• Tendonitis
• Rheumatoid arthritis
• Migraines and migraine prophylaxis

Meanwhile, the indications of Ibuprofen are:

• Closure of patent ductus arteriosus (a hole in the heart) in premature babies
• Rheumatoid arthritis
• Osteoarthritis
• Mild to moderate pain
• Period pain

Q: What are the side effects of Naproxen and Ibuprofen?

Dr. Yi Xuan Lee answers: Naproxen and Ibuprofen cause adverse effects on many organs, including the heart, gut, kidneys, and blood. People taking long-term NSAIDs are prone to cardiovascular events such as heart attack and stroke. 

Common side effects

Below are some common side effects of Naproxen and Ibuprofen:

• Confusion
• Headache
• Ringing in the ears
• Visual changes
• Low energy or sleepiness
• Dizziness
• Rashes

Symptoms listed above happen in more than 1 in 100 people. 

Rare side effects

Although rare, some people may develop serious consequences after taking Naproxen and Ibuprofen. The presentations of these severe Naproxen side effects include:

• Gastrointestinal symptoms: This includes severe indigestion, heartburn, abdominal pain, nausea, vomiting, or diarrhea. They may indicate an ulcer or inflammation in the stomach or gut.
• Vomit blood or blood in stools: Fresh blood in the vomitus or stools, dark coffee grounds like vomitus, or black tarry stool suggest bleeding from the stomach or gut due to ulcer or perforation.
• Frequent sore throat, nosebleeds, and infections: These can be signs of a blood cell disorder known as agranulocytosis, which causes an extremely low number of white blood cells among the affected individuals.
• Dizziness, tiredness, or shortness of breath: These are signs of anemia. Swollen ankle, blood in the urine, and reduced amount of urine These symptoms suggest kidney injury.
• Jaundice: This hints at an injury or inflammation of the liver. The sclera (white part of your eyes) or your skin can turn yellow.
• Slow or irregular heartbeats (bradycardia or arrhythmia): This is caused by excessive blood potassium.
• Fever, stomach pain, nausea, and vomiting: These can be signs of pancreas inflammation (acute pancreatitis)
• Chest pain: This is alarming for a heart attack.
• Fever, nausea, vomiting, confusion, headache, neck stiffness, irritation by light: These are classical features of meningitis, the inflammation of the fluid and membranes surrounding the brain and spinal cord.
• Skin rash or blisters, wheezing, chest or throat tightness, difficulty breathing, and swelling of the mouth, face, lips, tongue, or throat: This condition is an absolute medical emergency,  anaphylaxis (severe allergic reaction). Call your local emergency number or go to the hospital as soon as possible if you have any of these warning symptoms.

Q: What are their similarities and differences?

Dr. Yi Xuan Lee answers: Naproxen and Ibuprofen have the same mechanism of action, therefore, have the same side effects and contraindications. However, they do have a few distinctive differences:

1. Timing of onset. Ibuprofen acts faster than Naproxen. It takes 20 to 30 minutes for the effect of Ibuprofen to kick in, while Naproxen needs around 1 hour. 
2. Duration of effect. Ibuprofen is short-acting, so it is more suitable for acute pain relief for a shorter period. Naproxen is long-acting and needs a longer time to start working. Therefore, it qualifies better as a chronic pain reliever.
3. Prevalence of gastrointestinal side effects. Due to a more extended period of stay in our body, Naproxen is more likely to cause gastrointestinal symptoms than Ibuprofen.

Q: What are the Naproxen vs Ibuprofen effectiveness levels?

Dr. Yi Xuan Lee answers: In comparing the effectiveness of Naproxen vs Ibuprofen for period pain, a team of researchers analyzed thirty-five trials that involved 4383 participants who took different over-the-counter pain medications. 

The study revealed a significantly higher efficacy of Ibuprofen (83.7%) than Naproxen (48.3%). Ibuprofen is also recommended as the best choice of painkiller, considering its exceptional effectiveness and safety.

Another study reviewed the performance of Naproxen vs Ibuprofen for knee pain due to osteoarthritis. Among 33,243 patients, 61.6% in the Ibuprofen group showed improvement in pain control, compared to 50.1% in those taking Naproxen. 

Q: Is Naproxen stronger than Ibuprofen?

Dr. Yi Xuan Lee answers: Based on the two examples illustrated above, it seems like Ibuprofen is more effective than Naproxen. But does being more effective equivalent to being stronger?

Now, let’s look at the third research paper comparing Naproxen vs Ibuprofen for headaches. Again, Ibuprofen is more effective than Naproxen. 

1 in 3 patients experienced pain relief 2 hours after taking Ibuprofen. In contrast, only 1 in 6 patients had lesser pain 2 hours after Naproxen. 

However, Naproxen (half-life of 14 hours) continues to perform longer than Ibuprofen (half-life of 2 hours). 

In short, Ibuprofen generally has a higher efficacy as a pain reliever, but Naproxen has the advantage of exerting its therapeutic effect for a more extended period. 

More studies are needed to compare the performance of these drugs in different pharmacology effects, such as bringing down fever and reducing inflammation.

Q: How quickly do they work?

Dr. Yi Xuan Lee answers: Usually, your symptoms should improve in about 1 hour after taking Naproxen. However, if you are on long-term Naproxen treatment, you will need to take Naproxen regularly for up to 3 days for it to work properly.

For Ibuprofen, the effect kicks in much faster than Naproxen. You should start to feel better in 20 to 30 minutes after taking Ibuprofen in edible forms. 

Topical Ibuprofen (spray or stick pack) will begin to work within 1 to 2 days. For chronic pain, it might take up to 3 weeks to achieve the full action of the medication.

Q: Which medication lasts longer?

Dr. Yi Xuan Lee answers: Despite having slower action, the effect of Naproxen lasts much longer than Ibuprofen. Naproxen has a longer half-life (time taken for a drug to reduce to half of its original amount) of 12 to 17 hours than Ibuprofen, which has 1.8 to 2 hours of half-life. 

This means Naproxen will stay in our body longer and require less dose frequency.

You should always take Naproxen or Ibuprofen with food or just after a meal to maximize the absorption of medications by your body. Also, remember to start with the lowest possible dose; only step up if your symptoms are failed to be controlled.

Q: Which medication is cheaper?

Dr. Yi Xuan Lee answers: The price of medications differs greatly depending on the patent status. Brand medications are much more expensive than generic medications, despite having similar formulations and efficacy. Here, we compare only the generic versions.

Based on a study, 250 mg of Naproxen is comparable to 400 mg of Ibuprofen in osteoarthritis pain relief. The average price of Naproxen sold at major pharmacies in the U.S. is $13.53 for 20 tablets of 250 mg. In contrast, 20 tablets of 400 mg Ibuprofen cost $11.45. 

The cost of these medications may fluctuate further depending on the number of tablets bought and your health insurance coverage percentage. Therefore, it is best for you to purchase medicine based on your doctor’s advice instead of looking for a lower price.

Q: What interactions should I be aware of?

Drugs

Dr. Yi Xuan Lee answers: The action of Naproxen and Ibuprofen can affect or be affected by more than 300 types of drugs. Below is a list of widely used medication types that have significant interaction with Naproxen and Ibuprofen:  

• Other non-steroidal anti-inflammatory drugs (NSAIDs)
• Steroids
• Anti-blood clotting medicines
• Medications that increase urination (diuretics)
• Heart and high blood pressure medications
• Antidepressants
• Rheumatoid arthritis medications
• Antibiotics

If Naproxen or Ibuprofen alone does not work for you, topping up with Tylenol or paracetamol for a short period should be safe. Otherwise, do not take two or more types of painkillers at once unless instructed by your doctor.  

Herbs and supplements

Dr. Yi Xuan Lee answers: Gingko biloba, commonly known as maidenhair, can slow down our blood coagulation process. Therefore, it is best not to take gingko together with Naproxen or Ibuprofen, which can also impede blood clotting, to prevent the risk of bleeding. 

Other herbs, supplements, or complementary medicines have insufficient information to prove their safety when used together with Naproxen or Ibuprofen. Therefore, always tell your doctor if you are taking any additional remedies.

Food and drinks

Dr. Yi Xuan Lee answers: It is generally safe to eat any food or drink while on Naproxen or Ibuprofen treatment, including alcohol. However, ​​do not consume the medications while drinking alcohol. 

Also, bear in mind that drinking too much alcohol can irritate your stomach and cause vomiting, thus reducing your body’s absorption of the medications.

Health conditions

Dr. Yi Xuan Lee answers: Naproxen and Ibuprofen need to be used with caution. You may not be able to use them if you have below health conditions:

• History of allergy to any non-steroidal anti-inflammatory drugs (NSAIDs)
• Stomach ulcers, bleeding in the stomach or gut, or stomach perforation
• High blood pressure
• Severe liver or kidney failure
• Heart failure or other heart diseases
• History of stroke
• Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis
• Lupus
• Blood coagulation disorder
• Pregnancy, preparing for pregnancy or breastfeeding
• Asthma, hay fever or allergies (Ibuprofen only)
• Chickenpox or shingles (Ibuprofen only)

Q: What is the strongest anti-inflammatory drug?

Dr. Yi Xuan Lee answers: Besides Naproxen and Ibuprofen, there are a few other main types of NSAIDs, such as:

• Diclofenac
• Celecoxib
• Mefenamic acid
• Etoricoxib
• Indomethacin
• Aspirin

They are all effective in reducing inflammation in different health conditions. A blanket recommendation like “the best NSAID for inflammation” or “the best pain relief medicine” is not valid. Nevertheless, some people may find a particular NSAID works magic in improving their symptoms.

Q: What are natural tips for managing pain?

Dr. Yi Xuan Lee answers: Aside from pharmacological interventions, you may consider these natural pain management options. They are particularly beneficial for those living with chronic pain.  

1) Do gentle exercises

Simple activities like walking, gardening, and dancing can help block pain signaling to the brain, thus relieving pain. Gently stretching your muscles and joints can improve the pain caused by stiffness and tension. 

2) Deep breathing

When you are in pain, take a deep breath and concentrate on your breathing– you may notice your pain is lesser and more bearable. 

Deep breathing activates our body’s parasympathetic response, a “relaxation” mechanism which can slow down the heart rate and blood pressure and regulate the pain perception by our brain. 

3) Distract yourself

Keep your focus on something else, so the pain is not dominating your thoughts. Indulge in activities you enjoy, like watching a movie, reading a book, or even chit-chatting with friends or family. 

All these are simple, practical ways of pain control, especially for people with limited mobility, such as severe knee arthritis or post-operative recovery.

Key FAQs on Ibuprofen vs Naproxen

Q: Can I alternate between Naproxen and Ibuprofen for chronic pain?

Dr. Yi Xuan Lee answers: We generally don’t recommend alternating between naproxen and ibuprofen. As these two drugs are NSAIDs and work in a similar mechanism, that is, inhibition of COX enzymes, leading to reduced inflammation and pain. So, alternating between them or taking them together does not increase their efficacy but adds to cumulative side effects, especially gastric bleeding, ulceration, renal damage, and cardiovascular events.

Therefore, for your chronic pain management, it is important for you to use a consistent treatment plan under the guidance of a doctor. If NSAID therapy falls short or is not tolerated by the patient, the physician can supplement or substitute it with other medications, physical therapy, or targeted interventions.

Q: How do Naproxen and Ibuprofen affect sleep quality?

Dr. Yi Xuan Lee answers: Ibuprofen and naproxen may interfere with sleep in some individuals by inhibiting prostaglandin synthesis, which in turn can influence sleep-wake regulation. However, current evidence is that their effect on sleep is limited in most cases.

A controlled study involving 30 healthy adults revealed that a daily dose of 1200 mg ibuprofen had no clinically or statistically significant influence on the sleep quality or its efficiency.  Both groups of control and ibuprofen subjects had improved sleep quality on night three, with no sleep-disruptive effect of ibuprofen in normal conditions.

There is also evidence to indicate that NSAIDs may suppress the production of melatonin or blunt the natural drop in core body temperature, both of which are necessary for deep, restful sleep. But for many, alleviation of pain can improve sleep continuity and quality. Relieving pain or stiffness at night in the joints or muscles, especially in diseases such as arthritis, often makes it easier to fall asleep and stay asleep.

Q: Are there any age-specific precautions for children or the elderly?

Dr. Yi Xuan Lee answers: Yes, both elderly patients and children must exercise special care when using NSAIDs like ibuprofen or naproxen.

• For Children: Ibuprofen is commonly used in paediatric care, but it needs to be given by weight so it does not cause toxicity. Naproxen is usually not given to children under the age of 12 unless a doctor prescribes it. The medication can affect kidney and gastrointestinal function if used long-term in children.
• For Elderly: Older patients are more susceptible to side effects, such as gastrointestinal bleeding, renal dysfunction, and cardiotoxicity. Age-related reduction in renal function slows the clearance of NSAIDs, thereby boosting the risk of toxicity. Co-prescribing PPIs and routine renal and cardiovascular index monitoring are usually advisable in elderly patients on chronic NSAID treatment.

Q: Do Naproxen or Ibuprofen interfere with vaccines?

Dr. Yi Xuan Lee answers: There is some concern that NSAIDs such as naproxen and ibuprofen may blunt the immune response to vaccines when taken near the time of vaccination. They lower inflammation by blocking prostaglandin production, which plays a role in initiating the immune response.

Whereas short-term use for fever or pain following immunization is acceptable, prophylactic or routine use before vaccination is not recommended, particularly in children, as it could interfere with the formation of antibodies. The clinical effect is mild, but wherever possible, it is best to avoid the administration of NSAIDs except in the event of severe symptoms.

Q: Can these medications worsen existing mental health conditions like anxiety or depression?

Dr. Yi Xuan Lee answers: There is no direct causative relationship between NSAIDs and exacerbating mental illness like depression or anxiety. However, they can indirectly affect mood and mental status in some patients.

• Long-term NSAID treatment has, in some instances, been associated with the risk of depression, perhaps as a consequence of long-term cytokine level changes and disruption of the gut-brain axis. 
• NSAIDs may also cause sleep disturbances, gastrointestinal disturbances, or decreased physical activity – factors that are likely to exacerbate symptoms in patients with depression or anxiety.
• The use of NSAIDs and SSRIs can also enhance the risk of gastrointestinal bleeding, and thus, caution is necessary when using both together.

In previous mental health disease presentations, it is important to monitor for any changes and consult with both primary care and mental health providers when using NSAIDs regularly.

Conclusion

Both Naproxen and Ibuprofen are effective, readily available, and widely used for pain relief. However, if you compare naproxen vs ibuprofen, they can have serious side effects if used improperly. 

Always start with the lowest dose, take them with food, and consult a doctor if you’re unsure which one is best for your condition.

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