Can you take naproxen if you are on steroids?: Understanding the Combined Risks

October 12, 2025 •

4 min read

According to a large, case-control study, concurrent use of corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the risk of gastrointestinal hemorrhage by up to 15 times compared to non-users. This is why you must understand the serious risks before asking, "Can you take naproxen if you are on steroids?"

Quick Summary

Combining naproxen, an NSAID, with steroids is generally inadvisable due to a significantly higher risk of severe gastrointestinal complications, including bleeding and ulcers. A healthcare provider should always be consulted to evaluate the risks, determine if the combination is necessary, and explore safer pain management options, like acetaminophen.

Key Points

High GI Risk: Combining naproxen with steroids dramatically increases the risk of severe stomach ulcers and internal bleeding.
Synergistic Toxicity: The harmful effects of each drug on the stomach lining are compounded when taken together, leading to a much greater risk than with either drug alone.
Acetaminophen is Safer: For pain relief while on steroids, acetaminophen (Tylenol) is the generally recommended alternative because it does not carry the same gastrointestinal risk.
Medical Supervision is Essential: Any combined use of naproxen and steroids requires strict medical supervision, often involving the use of prophylactic stomach-protecting medication.
Monitor for Bleeding: Patients should be vigilant for warning signs of GI bleeding, such as black, tarry stools or vomiting blood, and seek immediate medical attention if they occur.
Risk Increases with Duration and Dose: The likelihood of adverse events is higher with longer treatment periods and higher doses of either medication.
Prioritize Medical Guidance: Never self-prescribe or combine these medications without first consulting a healthcare professional to assess individual risks and safer options.

Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, fever, and swelling. Steroids, or corticosteroids like prednisone, are powerful anti-inflammatory medications used to treat a variety of conditions, from autoimmune disorders to severe allergic reactions. While both are effective at fighting inflammation, their combined use presents a significant and serious risk to your health, particularly concerning your gastrointestinal (GI) tract.

The Significant Dangers of Combining Naproxen and Steroids

On their own, both naproxen and corticosteroids carry a risk of causing gastrointestinal side effects. When taken together, these risks are dramatically amplified, leading to potentially life-threatening complications. This effect is often described as synergistic, meaning the combined effect is far greater than the sum of their individual effects.

Heightened Gastrointestinal Risks

Both medication classes affect the protective lining of the stomach. Naproxen reduces the production of prostaglandins, which are essential compounds that help maintain the stomach's protective mucus layer. Corticosteroids, meanwhile, can compromise the GI tract's ability to heal itself from damage, essentially delaying the repair process for any NSAID-induced erosions. This dual attack leaves the stomach lining highly vulnerable to irritation, ulcers, and bleeding.

Other Systemic Risks

Beyond the GI tract, combining these medications can also increase the risk of other issues. For instance, both naproxen and corticosteroids can raise blood pressure, and their combined use could lead to an even more significant increase. Prolonged steroid use is also associated with weakened bones (osteoporosis), and adding NSAIDs does not mitigate this risk.

Factors That Increase Your Risk

Several factors can further elevate the risk of experiencing severe side effects when taking both naproxen and steroids:

Dosage and Duration: Higher doses and longer treatment periods increase the likelihood of complications. The risk is highest with chronic, long-term use.
Age: Older adults, particularly those over 60, face a higher risk of GI bleeding and other adverse events.
Pre-existing Conditions: A history of peptic ulcer disease, H. pylori infection, or kidney problems can dramatically increase risk.
Concurrent Medications: Taking other drugs that thin the blood, like warfarin or certain antidepressants (SSRIs), further raises the risk of bleeding.
Lifestyle Choices: Heavy alcohol consumption and smoking can also contribute to gastrointestinal damage and increase the risk of problems.

Safer Alternatives for Pain and Inflammation

Because of the risks involved, combining naproxen and steroids is typically avoided whenever possible. Your healthcare provider will likely suggest a safer alternative, especially if you need mild to moderate pain relief.

Acetaminophen (Tylenol): This is generally considered the safest over-the-counter pain reliever to use with steroids. It effectively reduces pain and fever but does not carry the same risk of gastrointestinal irritation as NSAIDs.
Topical Pain Relievers: For localized pain, topical options such as ibuprofen gel or patches can offer relief with a much lower risk of systemic side effects.
Prescription Alternatives: Depending on your condition, your doctor may suggest other prescription medications for pain and inflammation that do not have the same interactive risks as NSAIDs.

Comparison of Naproxen and Acetaminophen


Feature	Naproxen (NSAID)	Acetaminophen (Non-NSAID)
Inflammation Relief	Yes	No (or very little)
Pain Relief	Yes	Yes
Stomach Irritation	Yes, high risk	No, minimal risk
Used with Steroids	Use with extreme caution	Generally safe
Risk of GI Bleeding	Significantly increased with steroids	No increased risk with steroids
Mechanism of Action	Inhibits prostaglandins	Central analgesic action
Effect on Blood Pressure	Can increase blood pressure	Minimal effect
Primary Use	Pain, fever, swelling	Pain, fever

What to Do If Combination Therapy Is Unavoidable

In rare cases, your doctor may determine that the benefits of using naproxen and a steroid together outweigh the risks. This decision requires careful consideration and close medical monitoring. If this situation arises, a doctor might recommend these precautions:

Gastroprotective Medication: A prescription for a proton pump inhibitor (PPI) like omeprazole (Prilosec) or an H2-receptor antagonist may be used to protect the stomach lining.
Lowest Effective Dose: Using the smallest dose possible for the shortest period necessary can help minimize risk.
Taking with Food: Taking both medications with a full meal can help reduce direct irritation to the stomach.
Regular Monitoring: Your doctor may request more frequent check-ups to monitor for any side effects.

Conclusion

While both naproxen and steroids are effective medications, combining them creates a significant risk of severe gastrointestinal complications that should not be taken lightly. It is a general medical practice to avoid this combination unless absolutely necessary and under strict supervision. For most individuals, safer pain relief alternatives, such as acetaminophen, are available and should be discussed with a healthcare provider. Never begin or stop taking either medication without consulting your doctor or pharmacist to ensure your safety and well-being. For more information on drug interactions, the resource provided by Drugs.com is highly informative.

Warning Signs of Serious GI Bleeding

If you are on steroid treatment and experience pain, it is crucial to recognize the signs of internal bleeding and seek immediate medical help:

Black or tarry stools: This is a key indicator of upper GI bleeding.
Vomiting blood: This may appear fresh and red or dried and dark like coffee grounds.
Severe abdominal pain or cramping: A worsening, persistent stomachache can be a symptom.
Unusual dizziness or weakness: These can be signs of blood loss.

Frequently Asked Questions

The primary risk is a significantly increased chance of serious gastrointestinal complications, including stomach ulcers, internal bleeding, and, in rare cases, perforation of the stomach or intestine. The combination creates a synergistic effect that damages the stomach lining.

Yes, in some specific clinical situations, a doctor might decide the benefits outweigh the risks. However, this is done with great caution, typically for a short duration, at the lowest effective doses, and often with additional medication to protect the stomach, such as a proton pump inhibitor.

Both drugs can independently harm the stomach lining. Naproxen, an NSAID, inhibits protective prostaglandins, while steroids can interfere with the healing process. The combined effect creates a much higher risk of injury and bleeding.

Acetaminophen (Tylenol) is generally considered the safest over-the-counter alternative for pain relief when on steroid therapy. It does not carry the same risk of irritating the stomach lining or causing bleeding as naproxen.

If the combination is unavoidable, your doctor may prescribe a gastroprotective medication, such as a proton pump inhibitor (PPI) like omeprazole (Prilosec), to help reduce stomach acid and protect the stomach lining.

You should seek immediate medical attention if you experience severe abdominal pain, black or tarry stools, vomit that looks like coffee grounds, or unusual dizziness and weakness.

Yes, topical NSAID gels can be an option for localized pain relief and are less likely to cause systemic gastrointestinal side effects compared to oral NSAIDs. However, you should still discuss this with your doctor to ensure it is appropriate for your situation.