Aleve

What is Aleve?

Aleve (naproxen) is a nonsteroidal anti-inflammatory drug (NSAID). Naproxen works by reducing hormones that cause inflammation and pain in the body.

Aleve is used to temporarily relieve minor aches and pains due to arthritis, muscular aches, backache, menstrual cramps, headache, toothache,and the common cold. Aleve is also used to temporarily reduce fever.

Aleve may also be used for purposes not listed in this medication guide.

Important information

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You should not use Aleve if you have a history of allergic reaction to aspirin or other NSAID (nonsteroidal anti-inflammatory drug).

Aleve can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use Aleve just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.

Aleve may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using Aleve, especially in older adults.

Before taking this medicine

Aleve can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine.

Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Aleve may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using naproxen, especially in older adults.

You should not use Aleve if you are allergic to naproxen, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.

Ask a doctor or pharmacist if it is safe for you to use this medicine if you have:

heart disease, high blood pressure, high cholesterol, diabetes, or if you smoke;
a history of heart attack, stroke, or blood clot;
a history of stomach ulcers or bleeding;
asthma;
liver or kidney disease; or
fluid retention.
Taking Aleve during the last 3 months of pregnancy may harm the unborn baby. Do not use this medicine without a doctor’s advice if you are pregnant.

Naproxen can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Do not give Aleve to a child without medical advice.

How should I take Aleve?

Use Aleve exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. The smallest effective dose should be used.

Dosage for adults and children 12 years and older: Take 1 Aleve capsule or tablet every 8 to 12 hours while symptoms last. For the first dose you may take 2 capsules or tablets within the first hour. Do not exceed 2 capsules or tablets in any 8 to 12 hour period – do not exceed 3 capsules or tablets in a 24-hour period.

Drink a full glass of water with each dose. If taken with food, Aleve may take longer to work.

Store Aleve at room temperature away from moisture and heat.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

What happens if I miss a dose?

Since Aleve is sometimes used only when needed, you may not be on a dosing schedule. If you are on a schedule, use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Aleve?

Avoid drinking alcohol. It may increase your risk of stomach bleeding.

Avoid taking aspirin while you are taking Aleve.

Ask a doctor or pharmacist before using any cold, allergy, or pain medicine. Many medicines available over the counter contain aspirin or other medicines similar to naproxen. Taking certain products together can cause you to get too much of this type of medication. Check the label to see if a medicine contains aspirin, ibuprofen, ketoprofen, or naproxen.

Ask your doctor before using an antacid, and use only the type your doctor recommends. Some antacids can make it harder for your body to absorb Aleve.

Aleve side effects

Get emergency medical help if you have signs of an allergic reaction to Aleve: sneezing, runny or stuffy nose; wheezing or trouble breathing; hives; swelling of your face, lips, tongue, or throat.

Get emergency medical help if you have signs of a heart attack or stroke: chest pain spreading to your jaw or shoulder, sudden numbness or weakness on one side of the body, slurred speech, feeling short of breath.

Stop using Aleve and call your doctor at once if you have:

shortness of breath (even with mild exertion);
swelling or rapid weight gain;
the first sign of any skin rash, no matter how mild;
signs of stomach bleeding – bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
liver problems – nausea, upper stomach pain, itching, tired feeling, flu-like symptoms, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
kidney problems – little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath;
low red blood cells (anemia) – pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or
severe skin reaction – fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Common Aleve side effects may include:

indigestion, heartburn, stomach pain, nausea;
diarrhea, constipation;
headache, dizziness, drowsiness;
swelling in your hands or feet;
bruising, itching, rash, sweating; or
ringing in your ears.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

 

What other drugs will affect Aleve?

Ask your doctor before using Aleve if you take an antidepressant such as citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone. Taking any of these medicines with an NSAID may cause you to bruise or bleed easily.

Ask a doctor or pharmacist if it is safe for you to use Aleve if you are also using any of the following drugs:

lithium;
methotrexate;
probenecid;
a blood thinner (warfarin, Coumadin, Jantoven);
heart or blood pressure medication, including a diuretic or “water pill”; or
steroid medicine (such as prednisone).
This list is not complete. Other drugs may interact with naproxen, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

aspirin

Aspirin, also known as acetylsalicylic acid (ASA), is a salicylate medication, often used to treat pain, fever, and inflammation.

Aspirin also has an antiplatelet effect by stopping the binding together of platelets and preventing a patch over damaged walls of blood vessels. Aspirin is also used long-term, at low doses, to help prevent heart attacks, strokes, and blood clot formation in people at high risk of developing blood clots. Low doses of aspirin may be given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue.  Aspirin may be effective at preventing certain types of cancer, particularly colorectal cancer.

The main side effects of aspirin are gastric ulcers, stomach bleeding, and ringing in the ears, especially with higher doses. While daily aspirin can help prevent a clot-related stroke, it may increase risk of a bleeding stroke (hemorrhagic stroke). In children and adolescents, aspirin is not recommended for flu-like symptoms or viral illnesses, because of the risk of Reye’s syndrome.

Aspirin is part of a group of medications called nonsteroidal anti-inflammatory drugs (NSAIDs), but differs from most other NSAIDs in the mechanism of action. The salicylates have similar effects (antipyretic, anti-inflammatory, analgesic) to the other NSAIDs and inhibit the same enzyme cyclooxygenase (COX), but aspirin does so in an irreversible manner and, unlike others, affects the COX-1 variant more than the COX-2 variant of the enzyme.

The therapeutic properties of willow tree bark have been known for at least 2,400 years, with Hippocrates prescribing it for headaches.[12] Salicylic acid, the active ingredient of aspirin, was first isolated from the bark of the willow tree in 1763 by Edward Stone of Wadham College, University of Oxford. Felix Hoffmann, a chemist atBayer, is credited with the synthesis of aspirin in 1897, though whether this was of his own initiative or under the direction of Arthur Eichengrün is controversial. Aspirin is one of the most widely used medications in the world with an estimated 40,000 tonnes of it being consumed each year.  In countries where “Aspirin” is a registered trademark owned by Bayer, the generic term is acetylsalicylic acid (ASA). It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system.

Medical use

Aspirin is used in the treatment of a number of conditions, including fever, pain, rheumatic fever, and inflammatory diseases, such as rheumatoid arthritis, pericarditis, andKawasaki disease. Lower doses of aspirin have also shown to reduce the risk of death from a heart attack, or the risk of stroke in some circumstances. There is some evidence that aspirin is effective at preventing colorectal cancer, though the mechanisms of this effect are unclear.

Pain

Aspirin 325 mg / 5 grains for pain

Uncoated aspirin tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders

Aspirin is an effective analgesic for acute pain, but is generally considered inferior to ibuprofen for the alleviation of pain because aspirin is more likely to causegastrointestinal bleeding. Aspirin is generally ineffective for those pains caused by muscle cramps, bloating, gastric distension, or acute skin irritation. As with other NSAIDs, combinations of aspirin and caffeine provide slightly greater pain relief than aspirin alone. Effervescent formulations of aspirin, such as Alka-Seltzer or Blowfish, relieve pain faster than aspirin in tablets, which makes them useful for the treatment of migraines. Topical aspirin may be effective for treating some types of neuropathic pain.

Headache

Aspirin, either by itself or in a combined formulation, effectively treats some types of headache, but its efficacy may be questionable for others. Secondary headaches, meaning those caused by another disorder or trauma, should be promptly treated by a medical provider.

Among primary headaches, the International Classification of Headache Disorders distinguishes between tension headache (the most common), migraine, and cluster headache. Aspirin or other over-the-counter analgesics are widely recognized as effective for the treatment of tension headache.

Aspirin, especially as a component of an acetaminophen/aspirin/caffeine, is considered a first-line therapy in the treatment of migraine, and comparable to lower doses ofsumatriptan. It is most effective at stopping migraines when they are first beginning.

Fever

Like its ability to control pain, aspirin’s ability to control fever is due to its action on the prostaglandin system through its irreversible inhibition of COX. Although aspirin’s use as an antipyretic in adults is well-established, many medical societies and regulatory agencies (including the American Academy of Family Physicians, the American Academy of Pediatrics, and the U.S. Food and Drug Administration (FDA)) strongly advise against using aspirin for treatment of fever in children because of the risk ofReye’s syndrome, a rare but often fatal illness associated with the use of aspirin or other salicylates in children during episodes of viral or bacterial infection.Because of the risk of Reye’s syndrome in children, in 1986, the FDA required labeling on all aspirin-containing medications advising against its use in children and teenagers.

Inflammation

Aspirin is used as an anti-inflammatory agent for both acute and long-term inflammation, as well as for treatment of inflammatory diseases, such as rheumatoid arthritis.

Heart attacks and strokes

Aspirin is an important part of the treatment of those who have had a myocardial infarction (heart attack). One trial found that among those likely having a ST-segment elevation MI, aspirin saves the life of 1 in 42 by reducing the 30-day death rate from 11.8% to 9.4%. There was no difference in major bleeding, but there was a small increase in minor bleeding amounting to roughly 1 in every 167 people given aspirin.

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COX-1

Cox-1 inhibitor: An agent that inhibits the action of the enzyme cox-1(cyclooxygenase-1). The common anti-inflammatory drugs such as aspirin,ibuprofen, and naproxen block the action of both cox-1 and cox-2. Cox-1 inhibitors can reduce inflammation, but they may also decrease the natural protective mucus lining of the stomach. Therefore, these medications can cause stomach upset, intestinal bleeding, and ulcers. In some cases, using a buffered form of a cox-1 inhibitor can eliminate or reduce these adverse effects.

COX-2

COX-2 inhibitors are a subclass of nonsteroidal antiinflammatory drugs (NSAIDs). NSAIDs work by reducing the production of prostaglandins, chemicals that promote inflammation, pain, and fever. Prostaglandins also protect the lining of the stomach and intestines from the damaging effects of acid, promote blood clotting by activating platelets, and also affect kidney function.

The enzymes that produce prostaglandins are called cyclooxygenase (COX). There are two types of COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever; however, only COX-1 produces prostaglandins that activate platelets and protect the stomach and intestinal lining.

NSAIDs block the COX enzymes and reduce production of prostaglandins. Therefore, inflammation, pain, and fever are reduced by all COX inhibitors. Since the prostaglandins that protect the stomach and promote blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and intestines, and increase the risk of bleeding. Unlike older NSAIDs that block both COX-1 and COX-2, the newer COX-2 inhibitors only block the COX-2 enzyme. Since COX-2 inhibitors do not block COX-1 (which primarily produces prostaglandins that protect the stomach and promote blood clotting) they do not cause ulcers or increase the risk of bleeding as much as the older NSAIDs. Nevertheless, COX-2 inhibitors are as effective as the older NSAIDs for treating inflammation, pain and fever.

For what conditions are COX-2 inhibitors used?

COX-2 inhibitors are used for treating conditions that cause inflammation, mild to moderate pain, and fever. Examples include:

Unlike aspirin, also an NSAID, they are not effective for preventingstrokes and heart attacks in individuals at high risk for such events.

Are there any differences among the different types of COX-2 inhibitors?

Celecoxib is the only COX-2 inhibitor currently available in the United States. Rofecoxib (Vioxx) and valdecoxib (Bextra) are no longer available because they increased the risk of heart attacks and strokes with long term use. Rofecoxib was discontinued in 2004 and valdecoxib was discontinued in 2005.

What are the side effects of COX-2 inhibitors?

Common side effects include:

Other side effects include:

  • fainting,
  • kidney failure,
  • aggravation of hypertension,
  • ringing in the ears,
  • bleeding,
  • blurred vision,
  • anxiety,
  • light sensitivity,
  • weight gain,
  • water retention,
  • drowsiness, and
  • weakness.

Allergic reactions also can occur. Individuals who have developed allergic reactions (rash, itching, difficulty breathing) from sulfonamides [for example, trimethoprim and sulfamethoxazole Bactrim)], aspirin or other NSAIDs may experience an allergic reaction to celecoxib and should not take celecoxib.

COX-2 inhibitors and other NSAIDs may increase the risk of heart attacks, stroke, and related conditions, which can be fatal. This risk may increase with duration of use and in patients who have underlying risk factors for disease of the heart and blood vessels. NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

Other NSAIDs and, to a lesser extent, COX-2 inhibitors may increase the risk of serious, even fatal, stomach and intestinal adverse reactions such as bleeding, ulcers, and perforation of the stomach or intestines. These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these types of reactions.

With which drugs do COX-2 inhibitors interact?

Concomitant use of celecoxib with aspirin or other NSAIDs [for example,ibuprofen, naproxen (Naprosyn,Naprelan), etc.) may increase the occurrence of stomach and intestinal ulcers. It may be used with low dose aspirin.

Alcohol consumption increases the risk of developing stomach ulcers when taking NSAIDs; this may also apply to celecoxib.

Fluconazole (Diflucan) increases the concentration of celecoxib (Celebrex) in the body by inhibiting the elimination of celecoxib in the liver.

Celecoxib (Celebrex) increases the concentration of lithium (Eskalith) in the blood by 17% and may increase the blood thinning effect of warfarin (Coumadin).

 

Which COX-2 inhibitors are available?

Celecoxib (Celebrex) is the only COX-2 inhibitor available in the United States.

NSAIDs

Nonsteroidal anti-inflammatory drugs — are among the most common pain relief medicines in the world. Every day more than 30 million Americans use them to soothe headaches, sprains, arthritissymptoms, and other daily discomforts, according to the American Gastroenterological Association. And as if that wasn’t enough, in addition to dulling pain NSAIDs also lower fever and reduce swelling.

But how do those little pills do so much? And if they’re so good in some ways, why do they also raise the risk of heart problems in some people? The answer is complicated. Even researchers don’t fully understand how NSAIDs work.

Nonetheless, with the benefits and risks of NSAIDs in the headlines frequently, WebMD turned to four experts for a rundown of what researchers do know. Our panel consisted of:

  • Byron Cryer, MD, a spokesman for the American Gastroenterological Association and an associate professor of medicine at the University of Texas Southwestern Medical Center in Dallas.
  • Nieca Goldberg, MD, a spokeswoman for the American Heart Association and chief of Women’s Cardiac Care at Lennox Hill Hospital in New York.
  • John Klippel, MD, president and CEO of the Arthritis Foundation in Atlanta.
  • Scott Zashin, MD, clinical assistant professor at the University of Texas Southwestern Medical Center in Dallas and author of Arthritis Without Pain.

The following list is an example of NSAIDs available:

  • aspirin
  • celecoxib (Celebrex)
  • diclofenac (Cambia, Cataflam,Voltaren-XR, Zipsor, Zorvolex)
  • diflunisal (Dolobid – discontinued brand)
  • etodolac (Lodine – discontinued brand)
  • ibuprofen (Motrin, Advil)
  • indomethacin (Indocin)
  • ketoprofen (Active-Ketoprofen [Orudis – discontinued brand])
  • ketorolac (Toradol – discontinued brand)
  • nabumetone (Relafen – discontinued brand)
  • naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
  • salsalate (Disalsate [Amigesic – discontinued brand])
  • sulindac (Clinoril – discontinued brand)
  • tolmetin (Tolectin – discontinued brand)