An effective anti-inflammatory with real risks. The stomach, kidney and heart cautions are not small print.
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Naproxen is a non-steroidal anti-inflammatory drug, or NSAID. It blocks COX enzymes, reducing the prostaglandins that drive inflammation, pain and fever.
It is longer-acting than ibuprofen, so it is taken twice daily rather than three or four times, and it is generally considered to carry a lower cardiovascular risk than some other NSAIDs — which is why it is often the preferred choice where an NSAID is genuinely needed.
A low-dose version for period pain is available over the counter.
Usually twice daily.
Always with or just after food. This reduces stomach irritation, though it does not eliminate the ulcer risk — that risk comes from the drug's effect on the stomach lining from within the bloodstream, not just from local contact.
Use the lowest effective dose for the shortest necessary time. This is not a formality; nearly all of the serious risks rise with dose and duration.
For period pain, starting it a day before the period is due works better than waiting for the pain to establish.
Do not combine with ibuprofen, aspirin at anti-inflammatory doses, or another NSAID. They multiply risk without adding benefit. Paracetamol can be taken alongside.
Stomach: indigestion, nausea, and — the one that matters — ulceration and gastrointestinal bleeding, which can occur without warning symptoms. A proton pump inhibitor is frequently prescribed alongside for anyone at increased risk.
Kidneys: NSAIDs reduce blood flow to the kidneys. In someone dehydrated, elderly, or already on an ACE inhibitor and a diuretic, this combination — sometimes called the triple whammy — can cause acute kidney injury.
Heart: NSAIDs as a class carry a small increased risk of heart attack and stroke, rising with dose and duration. Naproxen is generally considered lower risk than several alternatives but is not risk-free.
Also: raised blood pressure, fluid retention, headache, dizziness, and worsening of asthma in some people.
Stop and seek urgent help for black or tarry stools, vomiting blood or material like coffee grounds, or severe abdominal pain.
Care in anyone over 65, with asthma, with inflammatory bowel disease, or already on a steroid or an SSRI.
The combinations that matter most:
Monitoring: for short courses, none. For regular long-term use, kidney function, blood pressure and full blood count are worth checking periodically — and the question of whether it is still needed should be asked each time.
Yes, where appropriate — but this is a drug where the assessment genuinely matters, because the risks are meaningful and depend entirely on who is taking it.
What that involves: reviewing your other medicines (the interaction list above is not theoretical), your kidney function, stomach history, blood pressure and cardiovascular risk, and deciding whether stomach protection should be prescribed alongside.
Where we will suggest something else: for long-term musculoskeletal pain, NSAIDs are not a good indefinite answer. Physiotherapy, topical NSAIDs (which carry a fraction of the systemic risk and are underused), and graded exercise all have a place. For fibromyalgia specifically, NSAIDs work poorly and we will say so.
We do not prescribe opioids or other controlled drugs remotely.
This page is information, not an offer to supply.
Naproxen is cheap. A lower-dose version is available over the counter for period pain, and prescription-strength naproxen costs little — usually less than the England NHS prescription charge of around £10. NHS prescriptions are free in Wales.
Many people who need regular naproxen also need a proton pump inhibitor alongside it to protect the stomach lining. That is not an upsell; it is standard practice, and it is frequently omitted.
Budget for both, or reconsider whether regular naproxen is the right approach at all.
Topical NSAID gel. For a knee, an ankle, a shoulder or a hand — anything close to the surface — rubbing an anti-inflammatory gel into the joint delivers useful drug locally with a fraction of the absorption into the bloodstream.
That means far less risk to the stomach, kidneys and heart, and it is available over the counter. For localised joint pain it is genuinely first-line and is routinely skipped in favour of tablets.
Naproxen can be stopped at any time — there is no withdrawal. It is designed for the shortest effective course at the lowest effective dose, not for indefinite use.
An anti-inflammatory taken alongside an ACE inhibitor or ARB and a diuretic is sometimes called the triple whammy, and it is a well-recognised cause of avoidable kidney injury — particularly during any illness that causes dehydration.
If you take blood pressure medication, regular naproxen deserves a proper conversation rather than a casual purchase.
Topical NSAID gel for localised joint pain, and paracetamol taken regularly rather than occasionally.
For persistent pain, exercise and physiotherapy consistently outperform anti-inflammatories over months, which is unwelcome advice but is what the evidence shows.
We do not prescribe opioids remotely under any circumstances, and for most musculoskeletal pain they are the wrong answer regardless.
Pain that has inflammation behind it — arthritis and joint pain, back pain and musculoskeletal injury, period pain, acute gout, and inflammatory arthritis.
It is not a general-purpose painkiller. For pain without an inflammatory component, paracetamol is often as effective and carries a fraction of the risk. Naproxen earns its place where swelling, stiffness and inflammation are part of the picture.
It is a full therapeutic dose of an anti-inflammatory, not a strong painkiller in the way people usually mean.
500mg twice daily is the standard prescription strength — roughly double the over-the-counter dose. It is genuinely more effective than the pharmacy version for inflammatory pain. But it is not in the same category as an opioid, and it works differently: it reduces the inflammation causing the pain rather than blocking the pain signal.
For period pain, gout and acute musculoskeletal injury it frequently outperforms codeine, because those are inflammatory problems. For nerve pain it does very little.
The dose matters for risk as well as effect. Stomach, kidney and cardiovascular risks all rise with dose and duration, which is why 500mg twice daily should be a short course with a reason, not an open repeat.
Pain relief begins within about an hour, and peaks at two to four hours.
The anti-inflammatory effect is slower — reduced swelling and stiffness build over two to three days of regular dosing, and take up to a week to reach full effect in arthritis.
That gap matters. People often conclude naproxen is not working after a single dose, when the part they are waiting for has not had time to happen. If it is prescribed for inflammation, take it regularly for a few days before judging it.
For period pain, start it the day before your period is due. Waiting for the pain to establish gives it a much harder job.
Very often, yes. Anyone over 65, on regular treatment, taking steroids, aspirin, an anticoagulant or an SSRI, or with a history of ulcers should be on a PPI alongside.
It is one of the commonest omissions in prescribing.
It lasts longer rather than being fundamentally stronger, so it is taken twice a day rather than three or four times.
Naproxen also has a comparatively favourable cardiovascular profile among the anti-inflammatories, which matters with regular use.
Yes — they work differently and can be taken together.
Do not combine it with ibuprofen, aspirin or any other NSAID, which multiplies the risk without adding benefit.
It needs care. NSAIDs raise blood pressure and reduce the effect of most blood pressure medicines.
Combined with an ACE inhibitor and a diuretic, the risk to the kidneys is genuine, especially during a dehydrating illness.
Usually yes, but a minority of people with asthma react badly to NSAIDs — particularly those with nasal polyps.
If aspirin or ibuprofen has ever caused wheeze, avoid it.
Yes — it reduces stomach irritation. Food does not prevent ulcers, which is why a PPI is separate advice.
Avoid it, particularly after 20 weeks and definitively in the third trimester. It affects the baby's circulation and kidneys.
Paracetamol is the usual alternative.
Only with a clear plan and monitoring. Long-term NSAID use carries cumulative risk to the stomach, kidneys and heart.
Topical gel, exercise and weight management do more over years, and periodic review of whether it is still needed is essential.
Yes — SSRIs combined with NSAIDs raise the risk of stomach bleeding.
That combination usually warrants a PPI, and is a very common pairing nobody flags.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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