Aleve (naproxen) is a non-steroidal anti-inflammatory drug (NSAID) that is sold over-the-counter (OTC) in 220 mg doses. Prescription-strength Aleve is available in doses ranging from 250 mg to a 750 mg extended-release form.

People use Aleve to manage many symptoms, including:

  • Headaches
  • Back pain
  • Fever
  • Symptoms of chronic disease, especially arthritis

This article explains Aleve’s dosage, safety, side effects, and drug interactions. It also covers precautions to consider while taking Aleve.

It’s important to follow your doctor’s dosage recommendations to avoid potential side effects.

Aleve Dosage

Aleve comes in capsule and gel form. One dose of OTC Aleve contains 200 mg naproxen and 20 mg sodium.

Prescription naproxen is available in regular and extended-release formulations. It is also available in combination with a sleep aid—25 milligrams (mg) diphenhydramine hydrochloride.

As with all NSAIDs, you should aim for the lowest effective dose for the shortest duration possible. According to the manufacturer, dosages of OTC Aleve for pain management is as follows:

  • Take one pill every 8-12 hours.You can take two pills within one hour for your first dose.

Missed Dose of Aleve

If you miss a dose, you can skip it or take one as soon as you remember. Then wait for 12 hours before taking your next dose. Stay as close to your regular dosing schedule as possible.

After your first dose, you should not take more than two pills in any 8-12 hour time or more than three in any 24 hours.

How to Store

Safely store Aleve by keeping it tightly closed in the container it came in. It should be kept at room temperature and away from heat and moisture.

Never double-dose this medication.

Get rid of medication that is outdated or if you don’t need it anymore. As an extra precaution, you can mix the drugs with something undesirable, such as used coffee grounds, dirt, or cat litter before throwing them away.

In addition, some pharmacies accept unwanted drugs so they can properly dispose of them. Keep naproxen out of the reach of children.

Safety and Side Effects

All medicines in the NSAID class, including naproxen, work by blocking the formation of chemicals in the body known as prostaglandins. Prostaglandins contribute to the effects of inflammation, including swelling, fever, and pain.

Your doctor will advise you about how to take your medication. It is essential to follow their directions and the package instructions carefully. Pharmacists can answer any questions you have about the medication.

Some of the common side effects include:

  • Heartburn
  • Stomach pain or nausea
  • Constipation
  • Diarrhea
  • Gas
  • Headache
  • Dizziness
  • Drowsiness
  • Difficulty sleeping
  • Bruising
  • Itching
  • Ringing in your ears (tinnitus)

Naproxen is usually safe, but it has been associated with severe and even fatal side effects. These include GI tract, kidney, and heart complications.

Allergic Reaction

This drug has the potential to cause an allergic reaction. This kind of reaction may show up as:

Since the side effects of this drug can be pretty serious, you should only take Aleve under the guidance of your doctor. In addition, it’s best to take no more than the recommended dosage for the shortest time necessary.

  • Hives
  • Facial swelling
  • Asthma
  • Skin rash
  • Blisters
  • Shock

Stomach Bleeding

Prostaglandins naturally help protect your stomach from damage. Therefore, when Aleve reduces your prostaglandin production, it can cause stomach bleeding.

If any of these symptoms occur, stop taking naproxen and seek emergency medical attention.

Signs and symptoms of stomach bleeding include:

  • Severe stomach painBlack, tarry stoolsBloody stoolsVomiting blood

Cardiovascular Risks

Based on research findings, the U.S. Food and Drug Administration (FDA) has required manufacturers to strengthen their warnings about cardiovascular health risks on NSAID packages and labeling.

Seek immediate medical attention if you experience any of these effects.

These risks include:

  • Elevated blood pressure
  • Heart attack
  • Heart failure
  • Stroke

You can have these effects even if you only use NSAIDs for a few weeks. Taking higher doses for more extended periods may increase your risk.

That said, a 2016 Danish study found an association between short-term ibuprofen or diclofenac treatment and cardiovascular events. However, it did not identify a link specifically between naproxen and such events.

Liver Damage

Liver damage is another potential complication of taking naproxen or other NSAIDs. Symptoms of a liver problem include:

Symptoms to Watch For

Symptoms that may indicate cardiovascular side effects that require immediate attention include:

  • Nausea
  • Vomiting
  • Appetite loss
  • Itching
  • Yellowing of skin and eyes or dark urine (jaundice)
  • Flu-like symptoms

Precautions and Contraindications

Aleve is not the proper medication for everyone. People with certain risk factors or existing health conditions should consider other drug options.

If you have any of these, stop taking naproxen and seek immediate medical attention.

Conditions that may increase the risk of adverse effects include:

  • Before or after a heart bypass operation
  • Heart disease
  • Gastrointestinal (GI) problems
  • Liver problems
  • Kidney problems
  • History of stroke

Other conditions that may increase your risk for the dangerous side effects of naproxen include: 

Using alcohol in combination with naproxen can increase your risk for stomach and GI problems.

  • Asthma
  • Nasal polyps
  • Bleeding and clotting disorders
  • Being a smoker
  • Skin that’s sensitive to sunlight

Pregnant or Breastfeeding

If you are pregnant or trying to conceive, you should speak to your doctor before taking Aleve. They might recommend that you avoid this medication or that you use it with caution.

Children

Aleve is not for children under 12 unless directed by their doctor. If your child is using Aleve or any form of naproxen, be sure to tell your doctor about any changes in their weight, as the dose is weight-based.

This drug may cause birth defects when taken in the last trimester of pregnancy. It may also pass through breast milk.

Older Adults

NSAIDs come with the risk of ulcers, bleeding in the stomach lining, and other GI problems. Older adults may be at an even higher risk of GI complications.

These side effects can be severe. Keep in mind that they can occur at any time and may show up without warning.

Drug Interactions and Overdose

Many OTC medications contain NSAIDs. For this reason, it’s crucial to read all medication labels (OTC and prescribed) before using them. Also, be sure you’re getting only one dose of an NSAID at a time.

Recap

Contraindications include people with heart, liver, kidney, and gastrointestinal problems. In addition, children under 12 should not take Aleve unless under the direction of their doctor. If you are pregnant or breastfeeding, talk to your doctor about alternatives to Aleve.

Nutritional supplements, herbs, recreational drugs, and caffeine can interact with naproxen and change the way it works in your body. Speak with your doctor about all medications and supplements you take before taking Aleve.

Medications that may interact with naproxen in a harmful way include:

  • Alendronate, taken to prevent bone loss
  • Other NSAIDs, including aspirin
  • Other anti-inflammatory drugs (such as ibuprofen or prednisone)
  • Entecavir, for hepatitis-B infections
  • Cidofovir, taken for eye infections in people with HIV
  • Cyclosporine, given to transplant patients
  • Water pills (diuretics)
  • Blood pressure medications, such as ACE inhibitors
  • Blood thinners such as Coumadin or other medications that treat or prevent blood clots
  • Methotrexate, a chemotherapy drug
  • Pemetrexed, a chemotherapy drug
  • Herbal products that contain feverfew, garlic, ginger, or Ginkgo biloba
  • Lithium medication such as Eskalith and Lithobid

Summary

Aleve is an NSAID fever and pain reducer that people frequently use to manage chronic pain. The medication is available OTC and by prescription. You should follow your doctor’s guidance regarding dosage. OTC instructions are to take one 220 mg pill every 8-12 hours.

If you think you may have overdosed, call 911 or your local poison control center.

A Word From Verywell

Aleve may be helpful for your condition, but to make the most of it, you need to use it safely. OTC medications, including Aleve, need to be used correctly and with caution.

Make sure to follow the dosage instructions and be aware of the possible side effects and interactions. If you feel that something isn’t right, contact your healthcare provider.