Naproxen (Aleve®) vs Ibuprofen (Advil®)

Medical references reviewed March, 2019

Which is better: Ibuprofen or Naproxen?

In comparative trials patients prefer naproxen to ibuprofen 2, 8.

Main difference between Naproxen and Ibuprofen

Ibuprofen has a shorter half-life and shorter duration of analgesic effect compared to naproxen. So ibuprofen may be a suitable choice for acute pain. Also, ibuprofen is accepted as the most appropriate NSAID for children.

Naproxen has a longer half-life, longer duration of analgesic effect, and is available in time release formulation. Therefore it represents a better choice for chronic conditions than ibuprofen.

Naproxen vs Ibuprofen head-to-head comparison

Naproxen	Ibuprofen
• Aleve® • Naprelan®	• Advil®, Advil® PM • Motrin® • Caldolor® • NeoProfen®

Drug class
• Non-steroidal anti-inflammatory drugs (NSAIDs) • Propionic acid derivative
Dose formulations
• Tablets • Controlled-release tablets • Gelcaps • Liquid gels • Oral suspension	• Tablets • Chewable tablets • Oral suspension • Gel caplets • Liqui-gels • Caplets • Intravenous solution
Legal status
• Non-controlled substance • Prescription • Over-the-counter
FDA-approved indications
• Rheumatoid arthritis • Osteoarthritis • Mild to moderate pain • Dysmenorrhea
• Ankylosing spondylitis • Tendonitis • Bursitis • Gout	• Fever • Headache, migraine • Patent ductus arteriosus (NeoProfen® only)
"Off-label" uses
• Inflammatory diseases
• Acute migraines • Migraine prophylaxis • Vascular headaches	• Rheumatic fever • Protection against cataract
Mechanism of action
• Nonsteroidal anti-inflammatory drugs have anti-inflammatory, analgesic, and antipyretic activities. • Non-selectively inhibit COX-1 and 2 COX-2.
Onset of action
• Analgesic: within 1 hour • Anti-inflammatory: ~2 weeks	• Analgesic: within 30 - 60 minutes • Liqui-gels provide faster onset of pain relief compared with tablets.
Duration of action
• 8 - 12 hours	• 6 hours
Half-life
• 14 hours	• 2 hours, as the dosage increases, the half-life ranges between 4 and 8 hours
Oral bioavailability
• 95%	• 80-90%
Metabolism, Elimination
• Naproxen undergoes hepatic metabolism (95%) with 30% of the drug being metabolized to 6-demethylation. • Unchanged naproxen and most of its metabolites are excreted as the glucuronide or other conjugate. After liver conjugation, 95% of the drug is eliminated by the kidneys.	• 90% of ibuprofen is hepatically metabolized to metabolite A (hydroxyibuprofen) and metabolite B (carboxyibuprofen). • Ibuprofen is almost completely excreted in the urine as unchanged drug and oxidative metabolites.
Contraindications
• Hypersensitivity to naproxen	• Hypersensitivity to ibuprofen
• History of asthma, urticaria, or allergic reactions after taking aspirin or other NSAID • Peri-operative pain in the setting of coronary artery bypass graft surgery
Warnings & precautions
• Potential adverse effects on the cardiovascular system. • Risk of GI ulceration, bleeding, and perforation. • Renal toxicity.
Side effects
• Naproxen is generally risk-neutral regarding to cardiovascular side effects.
• Hypersensitivity reactions are rare with both naproxen and ibuprofen9. • For more information see NSAIDs side effects
Pregnancy category
• C (prior to 30 weeks gestation) • D (after 30 weeks gestation, may cause premature closure of the ductus arteriosus)

Osteoarthritis

Both naproxen and ibuprofen significantly reduce the duration of inactivity stiffness, resting and movement pain, interference of the disease with everyday life and overall disease severity in patients with osteoarthritis of the hip, knee or spine.

Naproxen provides more effective relief of resting pain, movement pain, and night pain2, 3. Most patients favour naproxen.

Rheumatoid arthritis

Both medications significantly reduce the duration and severity of morning stiffness in patients with rheumatoid arthritis. However, naproxen is more effective in reducing the duration of morning stiffness4.

Dysmenorrhea (menstrual cramps)

Both are NSAIDs reduce pain and improve limitation of daily activity due to menstrual cramps5.

Dental pain following tooth extraction

Ibuprofen and naproxen are effective analgesics for pain following a tooth extraction. However, naproxen has superior analgesic efficacy compared with ibuprofen6.

Tension-type headache

Both NSAIDs equally relieve pain intensity in tension-type headache7.

References

1. Prescribing Information for Motrin® (ibuprofen) PDF
Prescribing Information for Naprelan® (naproxen) PDF
2. A study of naproxen and ibuprofen in patients with osteoarthritis seen in general practice. The Manchester General Practitioner Group. Curr Med Res Opin. 1984;9(1):41-6
3. Schiff M, Minic M.Comparison of the analgesic efficacy and safety of nonprescription doses of naproxen sodium and Ibuprofen in the treatment of osteoarthritis of the knee. J Rheumatol. 2004 Jul;31(7):1373-83
4. Taborn J, Anderson S, Goldberg M, Kantrowitz F, Menander-Huber K, Gross J.Relief of morning stiffness: a comparative study of naproxen and ibuprofen. Curr Med Res Opin. 1985
5. Hanson FW. Naproxen sodium, ibuprofen and a placebo in dysmenorrhea. J Reprod Med. 1982 Jul;27(7):423-7.
6. Kiersch TA, Halladay SC, Koschik M.A double-blind, randomized study of naproxen sodium, ibuprofen, and placebo in postoperative dental pain. ClinTher. 1993 Sep-Oct;15(5):845-54.
7. Lange R, Lentz R.Comparison ketoprofen, ibuprofen and naproxen sodium in the treatment of tension-type headache. Drugs ExpClin Res. 1995;21(3):89-96.
8. Gall EP, Caperton EM, McComb JE, Messner R, Multz CV, O'Hanlan M, Willkens RF. Clinical comparison of ibuprofen, fenoprofen calcium, naproxen and tolmetin sodium in rheumatoid arthritis. J Rheumatol. 1982 May-Jun;9(3):402-7.
9. McMahon AD, Evans JM, MacDonald TM. Hypersensitivity reactions associated with exposure to naproxen and ibuprofen: a cohort study. J ClinEpidemiol. 2001 Dec;54(12):1271-4

Published: March 23, 2019
Last reviewed: March 23, 2019

Written by eMedExpert staff