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Aleve vs Ibuprofen: What's the difference?

We all have muscle aches and pains every once in a while, and sometimes, the pain gets to be enough that we need to take medication to help alleviate the symptoms. Over the counter medications like Aleve and Ibuprofen offer pain relief from pain associated with common ailments like arthritis, headache, toothache, acute injury, and gout and they are affordable and accessible. Many people assume that because these medications are available over the over the counter (otc), they’re safe and without risk, but recent studies have found that about 15 percent of adults take greater quantities of ibuprofen, Aleve, and other anti-inflammatory drugs than is recommended for daily use. Aleve and ibuprofen perform similar functions, but there are also significant differences between the two medications.  

Drug Class

Both Aleve (naproxen) and ibuprofen belong to a class of medications called nonsteroidal anti-inflammatory drugs, or NSAIDs. NSAIDs reduce the production of prostaglandins;  these substances in the body are responsible for causing inflammation, pain, and fever. In addition to causing these unpleasant symptoms, prostaglandins also perform helpful functions; they protect the stomach lining and intestines from stomach acid, aid in blood clotting by activating blood platelets and help the kidneys function normally. Two enzymes,  COX-1 and COX-2, produce prostaglandins. Prostaglandins produced by both enzymes produce inflammation, pain, and fever, but only COX-1 produces the beneficial prostaglandins that protect the stomach and intestinal lining and promote blood clotting. NSAIDs can be either selective, meaning they block only the action of COX-2 enzymes, or non-selective, meaning that they block the action of both COX-1 and COX-2 enzymes. Aleve and ibuprofen are both considered non-selective NSAIDs.

Conditions Treated

At first glance, it may seem like ibuprofen and Aleve both treat the same thing: mild to moderate pain and inflammation. While on the surface, this is correct, there are some important differences between the two medications. Ibuprofen is considered short-acting and is best used for the treatment of acute pain or fever, such as that associated with a sports injury, menstrual cramps,  or the onset of an illness. Aleve takes longer to begin producing pain reliever effects and is considered long-acting, so it is more appropriately suited for the management of chronic conditions, such as rheumatoid arthritis.  

Duration

As already established, one of the key differences between ibuprofen and Aleve is the duration of their effects. Ibuprofen is considered a fast-acting medication, meaning that tablets or capsules must be taken every four to six hours in order to keep pain and inflammation at bay. By contrast, Aleve is longer lasting and is given twice daily (every twelve to seventeen hours), making it more suited for use in treating chronic conditions. An extended-release version of the generic form of the drug, naproxen, is also available by prescription only; this medication needs to be taken just once per day.  

Benefits

Ibuprofen

Compared to Aleve, ibuprofen has a slightly lower risk of contributing to the development of ulcers or gastrointestinal bleeding. Stomach upset, ulcer, and gastrointestinal bleeding can still occur with prolonged use of ibuprofen, so it is recommended that the medication be taken along with a proton-pump inhibitor like Nexium if taken for more than a few days in a row. Ibuprofen is better suited to the management of acute pain than Aleve because it works more quickly, and it is also the safest NSAID for use in children for the management of pain, inflammation, and fever. Ibuprofen also comes in an oral suspension, making it easy to administer to those who cannot swallow pills.
 
Aleve

One of the major benefits of Aleve is that it lasts longer than ibuprofen; the medication only needs to be taken twice in a 24-hour period to receive a full day’s relief, compared to four to six times per day for ibuprofen. A prescription strength version of the generic form of Aleve, naproxen, is available 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.  

Risks and Warnings

NSAIDs like Aleve and ibuprofen both have the potential to cause damage to the stomach, kidneys, and heart when taken at high doses for extended periods of time. One of the most common risks associated with NSAID use is the risk of developing ulcers and gastrointestinal bleeding. As non-selective NSAIDs, Aleve and ibuprofen both block the action of COX-1 and COX-2; COX-1 produces prostaglandins that help protect the lining of the stomach. As a result, gastrointestinal bleeding and ulcers can occur, especially in patients with a history of these issues. The best way to prevent gastrointestinal bleeding and ulcers while taking NSAIDS is to take the lowest possible effective dose for the shortest amount of time possible to provide relief for your symptoms. If you must take Aleve or ibuprofen for longer than a few days, consider pairing it with a proton-pump inhibitor like omeprazole or esomeprazole to provide some protection for the stomach. Ibuprofen has been shown to have a lower risk of gastrointestinal bleeding and ulcer than Aleve.
 
Use of NSAIDs like Aleve and ibuprofen can also cause acute kidney injury, especially in patients who are over the age of 65 and have pre-existing kidney problems. All NSAIDs carry similar rates of kidney damage,  so there is no advantage of taking one medication over the other where the kidneys are concerned.
 
When used for long periods of time at a high dose, all NSAIDs carry a risk of causing a heart attack or stroke. Therefore, patients with heart disease or heart failure should use caution and speak to their doctor before taking NSAIDS for long periods of time. Studies have shown that for patients who are planning to take NSAIDs consistently for more than a month, Aleve is the safest alternative, as it has the least risk of causing stroke or heart attack among the common NSAIDs. 

Dosing

Aleve

Aleve is sold over the counter in the form of 220 mg oral tablets and 220 mg liquid-filled oral capsules. Naproxen, the generic form of the drug, can also be purchased over the counter at a similar strength, or it can be ordered by prescription at strengths up to 500 mg and in an extended-release form. When purchased over the counter, the recommended dosing for Aleve is one to two tablets or capsules taken every eight to twelve hours as needed for mild pain. Due to the increased risk for gastrointestinal bleeding and ulcers associated with NSAIDs like Aleve, the maximum dosage and frequency instructions should not be exceeded.

Ibuprofen

Ibuprofen can be purchased over the counter in either the generic form or under one of a number of branded names, including Advil, Motrin, and Midol, and it can also be prescribed at higher strengths in the generic form. Ibuprofen is typically available over the counter as an oral tablet or oral capsule at a strength of 200 mg, but it is also available for children in forms such as chewable tablets and oral liquids. Ibuprofen is taken every four to six hours for pain, inflammation, and fever.  Due to the increased risk for gastrointestinal bleeding and ulcers associated with NSAIDs like ibuprofen, the maximum dosage and frequency instructions should not be exceeded. 

Side Effects

Side effects associated with both Aleve and ibuprofen are generally mild, but as previously discussed, serious side effects, such as 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:

  • Abdominal pain
  • Heartburn
  • Indigestion
  • Constipation
  • Nausea
  • Headache

Common side effects associated with ibuprofen include:

  • Diarrhea
  • Abdominal pain
  • Nausea
  • Flatulence
  • Headache
  • Rash
  • Indigestion
  • Constipation
  • Vomiting
  • Dizziness
  • Pruritus
  • Abnormal renal function

Drug Interactions

Both Aleve and ibuprofen have very similar drug interactions. Both medications interact with the following medications and substances:

  • Warfarin
  • Methotrexate
  • Pemetrexed
  • Blood pressure medications such as ACE inhibitors, ARBs, beta blockers, and diuretics) for high blood pressure or low blood pressure
  • Lithium
  • Aspirin
  • Cyclosporine
  • SSRIs/SNRIs
  • Alcohol

Use in Pregnant Women

Ibuprofen
Ibuprofen is an FDA Category D medication for pregnant women, meaning that it should not be taken during pregnancy. Use of ibuprofen during the first 30 weeks of pregnancy has been shown to lead to an increased risk of complications, including miscarriage. Use of ibuprofen after the 30th week of pregnancy is also associated with an increased risk of complications, including fetal heart problems and reduced levels of amniotic fluid.
 
Aleve
Aleve is an FDA Category C medication for pregnant women, meaning that the effects of the medication on developing fetuses has not been conclusively studied. However, due to the risks associated with taking other NSAIDs, such as ibuprofen, during pregnancy, the use of Aleve is not recommended, particularly in the third trimester.
 
Pregnant women should speak to their doctors before taking any medication, including over the counter medications, during pregnancy to ensure that there is no risk of harm to the unborn baby associated with taking the medication.

Published May 12th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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