Can you take naproxen and celecoxib together?

October 14, 2025 •

4 min read

A study reviewing NSAID use found that taking two or more of these drugs simultaneously was associated with a significant excess risk of adverse effects, including gastrointestinal bleeding and acute renal failure. This is why healthcare professionals strongly advise against taking naproxen and celecoxib together due to the serious additive risks and lack of benefit.

Quick Summary

Combining naproxen and celecoxib is unsafe due to a significantly increased risk of serious gastrointestinal bleeding, ulcers, cardiovascular events, and kidney damage. This practice offers no additional therapeutic benefit and should be avoided.

Key Points

Never Combine: Combining naproxen and celecoxib is medically inadvisable due to a serious and increased risk of side effects, without additional therapeutic benefit.
Increased GI Risk: Taking both NSAIDs multiplies the risk of severe gastrointestinal bleeding, ulceration, and perforation.
Heightened Cardiovascular Risk: The combination significantly increases the risk of serious cardiovascular events such as heart attack and stroke.
Kidney Damage: Concurrent use places a much higher strain on the kidneys, raising the risk of acute renal failure.
Acetaminophen is Safer: A safer alternative for additional pain relief is acetaminophen (Tylenol), as it works through a different mechanism and can be combined with a single NSAID.
Consult a Doctor: Always talk to your healthcare provider about all medications you are taking to ensure a safe and effective treatment plan.

Understanding Naproxen and Celecoxib

To understand why you should not take naproxen and celecoxib together, it is important to first know how these medications work individually. Both are nonsteroidal anti-inflammatory drugs (NSAIDs), but they belong to different classifications based on their primary mechanism of action.

Naproxen (Aleve, Naprosyn)

Naproxen is a traditional, or non-selective, NSAID. It works by inhibiting both cyclooxygenase (COX) enzymes, COX-1 and COX-2.

COX-1 Inhibition: This enzyme is found in most tissues and plays a protective, "housekeeping" role. It helps maintain the stomach's protective lining and supports kidney function. Inhibiting COX-1 is what causes the common gastrointestinal side effects associated with naproxen, such as stomach upset, ulcers, and bleeding.
COX-2 Inhibition: This enzyme is primarily induced during inflammation and injury. Its inhibition is responsible for naproxen's anti-inflammatory and pain-relieving effects.

Celecoxib (Celebrex)

Celecoxib is a selective COX-2 inhibitor, often referred to as a "coxib". It was developed to specifically target the COX-2 enzyme responsible for pain and inflammation, while largely sparing the protective COX-1 enzyme. The aim was to offer similar pain relief with a lower risk of gastrointestinal side effects compared to non-selective NSAIDs like naproxen.

The Serious Risks of Taking Them Together

Despite their different selectivity, combining naproxen and celecoxib is strongly discouraged by medical professionals. The risk of adverse effects is significantly increased, with no evidence of additional therapeutic benefit.

Additive Side Effects, Not Additive Benefit

All NSAIDs, including celecoxib, carry risks of serious cardiovascular and gastrointestinal side effects. By taking two different NSAIDs, you are not doubling your pain relief; you are essentially taking a double dose of medication that inhibits the same inflammatory pathway. This leads to an increased risk of toxicity. Health authorities consider this combination contraindicated because the risk outweighs any potential benefit.

Gastrointestinal (GI) Bleeding and Ulcers

This is one of the most significant and well-documented risks of combining NSAIDs. The risk of serious GI complications, such as inflammation, bleeding, ulceration, and perforation, dramatically increases with concomitant use. A study published in a French pharmacovigilance database found that using two or more NSAIDs simultaneously significantly increased the risk of gastrointestinal bleeding compared to using a single NSAID.

Cardiovascular Risks

Both naproxen and celecoxib carry black box warnings for cardiovascular thrombotic events, including myocardial infarction and stroke. These risks may increase with prolonged use, and combining two NSAIDs can amplify this danger. For patients with pre-existing heart conditions or risk factors, this combination is particularly hazardous.

Renal (Kidney) Impairment

NSAIDs can negatively impact kidney function, especially with chronic use. Combining two different NSAIDs places an even greater burden on the kidneys and significantly increases the risk of acute renal failure. This is a serious concern for older patients or those with pre-existing kidney issues.

Safer Alternatives and Management Strategies

For effective and safe pain management, it is crucial to avoid combining naproxen and celecoxib. Here are some safer alternatives:

Use a single NSAID: Your doctor may prescribe a single NSAID, either naproxen or celecoxib, at the lowest effective dose for the shortest duration necessary to control symptoms.
Add Acetaminophen (Tylenol): Unlike NSAIDs, acetaminophen works differently to relieve pain and fever and does not carry the same GI or cardiovascular risks. It is often safe to take alongside a single NSAID for additional pain relief.
Explore topical NSAIDs: For localized musculoskeletal pain, a topical NSAID (such as diclofenac gel) can provide relief with lower systemic exposure and fewer side effects compared to oral NSAIDs.
Consider other therapies: Non-pharmacological interventions like physical therapy, ice/heat therapy, and rest can be very effective for pain management.

Comparison Table: Naproxen vs. Celecoxib


Feature	Naproxen (Aleve, Naprosyn)	Celecoxib (Celebrex)
Mechanism	Non-selective COX inhibitor (inhibits COX-1 and COX-2)	Selective COX-2 inhibitor (spares COX-1)
Gastrointestinal (GI) Risk	Higher risk of GI issues (ulcers, bleeding) due to COX-1 inhibition	Lower risk of GI issues compared to non-selective NSAIDs
Cardiovascular Risk	Carries a black box warning for cardiovascular events	Also carries a black box warning; considered no greater risk than naproxen in recent findings
Availability	Over-the-counter (OTC) and prescription strengths	Prescription only
Recommended Use	Acute and chronic pain, inflammation, menstrual cramps	Arthritis, acute pain, menstrual cramps; often for those with GI risk

Conclusion

In summary, you absolutely should not take naproxen and celecoxib together without explicit, professional medical advice, and even then it is highly unlikely to be recommended. The risk of serious adverse effects on the gastrointestinal tract, cardiovascular system, and kidneys is significantly elevated and outweighs any potential benefit. Always inform your healthcare provider of all medications, including OTC drugs and supplements, to ensure a safe and effective pain management plan. Always follow your doctor's instructions, and never mix different NSAIDs on your own.

Disclaimer

This article provides general information and should not be considered a substitute for professional medical advice. Always consult with a qualified healthcare provider regarding any medical conditions and before starting or stopping any medication.

NIH PMC: Association between concomitant use of several systemic non-steroidal anti-inflammatory drugs and adverse drug reactions

HSS: Guidelines to Reduce the Side Effects of NSAIDs

Frequently Asked Questions

You cannot take these two medications together because they are both NSAIDs and inhibit the same inflammatory pathway. This does not increase the pain-relieving effect but instead significantly elevates the risk of serious side effects, including gastrointestinal bleeding, heart attack, and kidney damage.

While celecoxib was designed to have a lower GI risk by selectively inhibiting COX-2, combining it with a non-selective NSAID like naproxen eliminates this advantage. The dual inhibition significantly increases the risk of GI bleeding and ulcers, negating the supposed safety benefit of celecoxib.

Combining these NSAIDs increases the risk of serious gastrointestinal side effects (bleeding, ulcers, perforation), cardiovascular thrombotic events (heart attack, stroke), and potential renal (kidney) failure.

If you need more pain relief, speak with your doctor or pharmacist. They may suggest a different pain management strategy, such as taking acetaminophen (Tylenol) in addition to your prescribed NSAID, as they work differently and are safe to combine.

Taking different NSAIDs on alternating days is also not recommended without specific medical advice. The half-lives of these drugs overlap, and there is still a potential for increased risk. Always consult your doctor to find the safest pain management schedule.

If you accidentally took both, contact your doctor immediately. Warning signs to look out for include severe stomach pain, black or tarry stools, vomit that looks like coffee grounds, chest pain, shortness of breath, or unusual swelling. Seek emergency medical attention for any severe symptoms.

For systemic use, it is a virtually never-recommended practice due to the lack of additive benefit and significantly increased risk of side effects. Always clarify with your healthcare provider if you have questions about your prescribed medications and their interactions.