When your back hurts, your knees ache, or a headache won’t quit, you reach for something that works. Aleve, the blue and white bottle with the bold lettering, is one of the most common choices. But is it the best? And what happens if it doesn’t help-or gives you stomach trouble? You’re not alone in wondering if there’s something better out there.
What is Aleve, really?
Aleve is the brand name for naproxen, a nonsteroidal anti-inflammatory drug (NSAID). It’s sold over the counter in the UK and US at 220 mg per tablet. That’s the same active ingredient doctors prescribe for arthritis, tendonitis, and other inflammatory conditions, just in lower doses.
Naproxen works by blocking enzymes called COX-1 and COX-2, which your body uses to make prostaglandins-chemicals that cause pain, swelling, and fever. Unlike acetaminophen (Tylenol), which only reduces pain and fever, naproxen actually cuts down inflammation. That’s why it’s often recommended for sprains, menstrual cramps, or gout flare-ups.
One dose of Aleve lasts up to 12 hours. That’s longer than ibuprofen, which usually wears off in 4 to 6 hours. For people who don’t want to take pills every few hours, that’s a big plus.
How does naproxen stack up against ibuprofen?
The most common alternative to Aleve is ibuprofen-brands like Advil or Nurofen. Both are NSAIDs, so they work similarly. But they’re not the same.
Here’s how they compare:
| Feature | Naproxen (Aleve) | Ibuprofen (Advil) |
|---|---|---|
| Typical OTC dose | 220 mg | 200 mg |
| Duration of effect | 8-12 hours | 4-6 hours |
| Time to start working | 30-60 minutes | 20-30 minutes |
| Best for | Chronic pain, inflammation, arthritis | Quick relief, fever, mild headaches |
| Stomach upset risk | Higher | Lower, but still present |
| Cardiovascular risk | Slightly higher with long-term use | Lower risk compared to naproxen |
If you need fast relief for a sudden headache or fever, ibuprofen kicks in quicker. But if you’re dealing with ongoing joint pain or muscle soreness that lasts all day, naproxen’s longer duration means fewer pills. One Aleve in the morning and another at night can cover you for 24 hours. With ibuprofen, you’d need to take it three or four times.
But here’s the catch: naproxen is harder on your stomach. Studies from the British Journal of Clinical Pharmacology show that long-term naproxen use increases the risk of ulcers and internal bleeding more than ibuprofen. If you’ve ever had stomach issues, acid reflux, or are over 65, this matters.
What about acetaminophen (Tylenol)?
Acetaminophen isn’t an NSAID. It doesn’t reduce inflammation at all. But it’s still a top pick for pain relief-especially if you can’t take NSAIDs.
Here’s why people switch:
- No stomach irritation
- Safe for people with ulcers or kidney disease
- Doesn’t interfere with blood pressure meds
- Safe during pregnancy (when used as directed)
But if your pain comes from swelling-like a swollen ankle or inflamed tendon-acetaminophen won’t touch it. It only masks the pain signal. That’s why many people use it for headaches, toothaches, or fevers, but not for arthritis or sports injuries.
Also, acetaminophen has a narrow safety window. Taking more than 4,000 mg in a day can cause serious liver damage. That’s easier than you think-many cold and flu meds contain it. Mixing them with Tylenol is a common mistake.
Are there other NSAID alternatives?
Yes. Other NSAIDs exist, but most require a prescription in the UK and US. Still, knowing them helps you understand your options.
- Aspirin - Older NSAID, good for heart protection at low doses, but not ideal for daily pain. Can cause bleeding and isn’t recommended for kids.
- Diclofenac - Stronger than naproxen, often used as a gel for joint pain. Available as a prescription pill or topical cream. Less likely to upset your stomach if applied to the skin.
- Ketoprofen - Used in some European countries, rarely available OTC in the US. Higher risk of skin reactions.
Topical NSAIDs-gels, creams, or patches-are worth considering. They deliver the drug right to the sore spot with far less risk to your stomach or kidneys. Studies in The Lancet show topical diclofenac works just as well as oral NSAIDs for knee and hand arthritis-with 70% fewer side effects.
Who should avoid naproxen?
Not everyone should take Aleve. You should skip it if you:
- Have had a stomach ulcer or bleeding in the past
- Have heart disease, high blood pressure, or kidney problems
- Are pregnant (especially after 20 weeks)
- Are allergic to aspirin or other NSAIDs
- Take blood thinners like warfarin or SSRIs like fluoxetine
Even if you’re healthy, don’t take naproxen for more than 10 days without checking with a doctor. Long-term use increases the risk of heart attack and stroke-even in people without prior heart issues. The FDA warns that NSAIDs raise this risk as early as the first week of use.
What if Aleve doesn’t work?
If you’ve tried Aleve for a few days and still feel the same pain, don’t just up the dose. You might be chasing the wrong solution.
Here’s what to do next:
- Switch to ibuprofen for 3 days. Sometimes your body responds better to one NSAID than another.
- Try a topical NSAID gel. Apply it directly to the painful area-knee, shoulder, wrist-twice a day.
- Use acetaminophen if inflammation isn’t the issue. Pair it with heat or cold therapy.
- See a doctor if pain lasts more than 7 days. It could be something deeper: a pinched nerve, tendon tear, or early arthritis.
Don’t assume stronger painkillers are better. Opioids like codeine aren’t recommended for routine pain. They’re addictive and don’t fix inflammation. Physical therapy, stretching, or even weight loss can be more effective long-term than any pill.
Real-world advice: What works for most people?
In my experience working with patients in Birmingham, here’s what actually helps:
- For occasional headaches or menstrual cramps: ibuprofen is faster and gentler.
- For chronic back or knee pain: naproxen is more convenient, but take it with food and never for more than a week straight.
- For joint pain you can reach: diclofenac gel works wonders without pills.
- For anyone over 60 or on blood pressure meds: stick with acetaminophen unless a doctor says otherwise.
And always read the label. Many OTC products mix naproxen or ibuprofen with antihistamines, caffeine, or sleep aids. You might be taking more than you think.
Final thoughts: No single best option
There’s no magic pill that’s perfect for everyone. Aleve (naproxen) is great for long-lasting pain and inflammation-but it’s not the safest for long-term use. Ibuprofen is quicker and gentler on the stomach, but you’ll need to take it more often. Acetaminophen is safer for your gut and heart, but useless if swelling is the problem.
The right choice depends on your pain type, your health history, and how long you need relief. If you’re unsure, talk to your pharmacist. They see dozens of these questions every day. They can help you pick the safest, most effective option-without pushing a brand.
Don’t just reach for the bottle you’ve always used. Your body changes. Your pain changes. Your meds should too.
Is Aleve stronger than ibuprofen?
Aleve (naproxen) lasts longer-up to 12 hours-so one dose can do the work of two ibuprofen pills. But in terms of pain-blocking strength per milligram, they’re very similar. The difference isn’t potency, it’s duration. Naproxen is better for all-day pain; ibuprofen is better for quick, short-term relief.
Can I take Aleve and Tylenol together?
Yes, you can safely combine naproxen and acetaminophen. They work in different ways and don’t interfere with each other. Many people use this combo for severe pain-like after surgery or a bad injury. Just stick to the maximum daily dose for each: no more than 2,000 mg of acetaminophen and 660 mg of naproxen in 24 hours unless a doctor says otherwise.
Does naproxen cause weight gain?
Naproxen itself doesn’t cause weight gain. But it can lead to fluid retention, which might make you feel bloated or see a temporary rise on the scale. This is more common in people with heart or kidney issues. If you notice sudden swelling in your ankles or hands, stop taking it and see a doctor.
Is Aleve safe for seniors?
Aleve is riskier for older adults. The body processes naproxen slower after age 65, so it builds up more easily. This increases the chance of stomach bleeding, kidney damage, and high blood pressure. Seniors should start with the lowest dose, avoid long-term use, and prefer topical NSAIDs or acetaminophen unless directed by a doctor.
What’s the safest OTC painkiller overall?
For most people without stomach, heart, or kidney issues, ibuprofen is the safest daily option because it’s gentler on the gut than naproxen and doesn’t carry the liver risks of acetaminophen. But if you have liver disease or can’t take NSAIDs at all, acetaminophen is the best choice. Always use the lowest effective dose for the shortest time possible.
Nov 2, 2025 — Zach Harrison says :
Aleve works great for my back pain, but I always take it with food and never more than 2 days in a row. Learned that the hard way after a stomach scare last year. Now I stick to ibuprofen for quick stuff and save naproxen for when I need it to last.