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Fact Checked

Aleve vs Advil: What are the Main Differences?

Everyone wakes up with the occasional muscle aches and back pain that are strong enough to require medication. When faced with this type of mild to moderate pain, most people turn to their medicine cabinet for over the counter pain medications like Aleve or Advil to manage their symptoms. Whether associated with ailments like arthritis, headache, gout, toothache, or acute injury, many types of pain are treated successfully with these affordable and accessible medications. Although Aleve and Advil are available over the counter, they’re not without risk. Recent studies have concluded that approximately 15 percent of American adults take greater quantities of Aleve, Advil, and other pain relievers than what's actually recommended for daily use. Although Aleve and Advil perform similar functions, there are also differences between the medications. In the showdown of Aleve vs Advil, what’s the difference? 

FDA Drug Class: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Aleve and Advil are two big brand names of naproxen and ibuprofen, respectively, that both belong to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs), which also include Motrin (a common fever reducer) and naproxen sodium. NSAIDs work by reducing the body’s production of prostaglandins, which are responsible for causing pain, inflammation, and fever. Prostaglandins aren’t all bad, though; they also perform helpful functions like protecting the stomach lining and intestines from stomach acid, helping the blood to clot by activating blood platelets, and aiding the kidneys in normal functioning. There are two enzymes in the body that produce prostaglandins: COX-1 and COX-2. Although both enzymes produce the type of prostaglandins that cause inflammation, pain, and fever, only COX-1 produces the beneficial prostaglandins that promote blood clotting and protect the stomach and intestinal lining. Therefore, there are two types of NSAIDs. Some NSAIDs are referred to as selective because they only block the action of COX-2 enzymes, while non-selective NSAIDs block the action of both COX-1 and COX-2 enzymes. Aleve and ibuprofen are both considered non-selective nonsteroidal anti-inflammatory drugs.

Duration

One of the biggest differences between Advil and Aleve lies in how long they last. Advil is considered a fast-acting painkiller, so it must be taken every four to six hours in order to maintain pain relief and keep inflammation at bay. Therefore, it is best used for the treatment of acute pain or fever, like symptoms associated with menstrual cramps/dysmenorrhea, the onset of illness, or sports injuries and sprains. 

Aleve is longer lasting and can be taken every twelve to seventeen hours (about twice per day), making it more suited for use in treating chronic conditions like rheumatoid arthritis. Symptoms that require longer-lasting treatment can be treated with a prescription-only strength of the generic form of Aleve, naproxen, which is taken just once per day. 

The Benefits of Aleve (naproxen)

As previously established, Aleve lasts longer than Advil, which is one of the major benefits of taking this otc drug over the other. Patients using Aleve for pain relief need only take the medication twice in a 24-hour period to receive a full day’s relief, while Advil must be taken four to six times per day. The generic version of Aleve, naproxen, is available in prescription strength as an extended-release capsule that lasts a full 24 hours. All NSAIDs have the potential to cause heart attack or stroke when used for a long period of time at a high dose, but Aleve has the lowest risk among the common NSAIDs. 

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The Benefits of Advil (ibuprofen) 

Aleve is associated with a higher risk of gastrointestinal bleeding and ulcers compared to Advil. Although prolonged use of Advil can still result in stomach upset, ulcer, and gastrointestinal bleeding, it is less likely to occur. It is recommended that NSAIDs like Advil and Aleve be taken along with a proton-pump inhibitor like omeprazole if taken several days in a row in order to avoid gastrointestinal side effects. Because Advil works more quickly than Aleve, it is better able to manage acute pain. Additionally, Advil is considered the safest NSAID for use in children for the management of pain, inflammation, and fever. 

Risks and Warnings

Advil and Aleve both have several risks and warnings in common. Both Advil and Aleve can cause damage to the kidneys, stomach, and heart if they are taken at high doses for long periods of time. NSAIDs like Advil and Aleve are most commonly associated with the risk of developing ulcers and gastrointestinal bleeding, although Aleve is more likely to cause this issue. Non-selective NSAIDs like Aleve and Advil both block the action of enzymes COX-1 and COX-2.  Because COX-1 produces prostaglandins that help protect the lining of the stomach, blocking the action of this enzyme can cause gastrointestinal bleeding and ulcers, especially in patients with a history of these issues. 

Patients looking to prevent and avoid gastrointestinal bleeding and ulcers should take the lowest possible effective dose for the shortest amount of time possible to provide relief for your symptoms. If it is necessary to take Aleve or Advil for more than a few days in a row, the medication should be taken in conjunction with a proton-pump inhibitor like omeprazole or esomeprazole to protect the stomach.

Risk factors include patients who are over the age of 65 or have pre-existing kidney issues can experience acute kidney injury when taking NSAIDs like Aleve and Advil. There is no advantage of taking one medication over the other where the kidneys are concerned because all NSAIDs report similar rates of kidney damage.

If used at a high dose for an extended period of time, all NSAIDs carry a risk of causing a heart attack or stroke. Patients with heart disease or heart failure should check with their doctors before taking NSAIDS for an extended period of time.

Side Effects

Side effects associated with both Aleve and ibuprofen are generally mild, but serious side effects like gastrointestinal bleeding and stomach ulcers, decreased kidney function, and increased risk of heart attack or stroke in patients with cardiovascular disease are also possible. 

Common side effects  or allergic reactions associated with Aleve include:

  • Indigestion

  • Constipation

  • Abdominal pain

  • Heartburn

  • Nausea

  • Headache

Common side effects associated with ibuprofen include:

  • Nausea

  • Flatulence

  • Headache

  • Diarrhea

  • Abdominal pain

  • Vomiting

  • Dizziness

  • Pruritus

  • Rash

  • Indigestion

  • Constipation

  • Abnormal renal function 

References:

https://www.reuters.com/article/us-health-nsaids-overdosing/many-people-take-dangerously-high-amounts-of-ibuprofen-idUSKBN1FS336 

https://www.drugs.com/medical-answers/aleve-ibuprofen-difference-3125179/ 

https://www.healthline.com/health/pain-relief/ibuprofen-vs-naproxen 

https://www.medicinenet.com/ibuprofen_vs_naproxen/article.htm

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Published July 31st, 2020 by Bridget Reed
Fact Checked by Chris Riley

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