What is the downside of Aleve? A Comprehensive Guide to Side Effects

October 8, 2025 •

5 min read

According to the FDA, all non-aspirin NSAIDs, including Aleve, can increase the risk of a heart attack or stroke, even with short-term use. Understanding what is the downside of Aleve? involves weighing its effectiveness against these potential serious health risks.

Quick Summary

Aleve, an NSAID, carries risks including serious gastrointestinal bleeding, ulcers, and an increased risk of heart attack and stroke, especially with high doses or long-term use. Other downsides include potential kidney and liver damage, fluid retention, and numerous drug interactions.

Key Points

Cardiovascular Risk: Aleve, like other non-aspirin NSAIDs, can increase the risk of heart attack and stroke, especially with long-term, high-dose use.
Gastrointestinal Dangers: The medication poses a risk of serious, potentially fatal, stomach bleeding, ulcers, and perforations, particularly for older adults and long-term users.
Kidney and Liver Damage: Chronic use of naproxen can lead to kidney impairment or failure and, in rare cases, severe liver problems.
Significant Drug Interactions: Aleve should not be mixed with blood thinners, certain antidepressants (SSRIs), or other NSAIDs due to increased bleeding risks.
Risk Mitigation: The lowest effective dose for the shortest duration possible is recommended to minimize serious side effects.
Pregnancy Warning: Avoid taking Aleve after 20 weeks of pregnancy due to potential harm to the unborn baby's heart and kidneys.

Understanding the Risks of Aleve (Naproxen)

Aleve, the brand name for naproxen sodium, is a popular over-the-counter nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce inflammation, and lower fever. While effective, it is crucial to understand the potential downsides and serious risks associated with its use, particularly with long-term or high-dose intake. The following details potential serious health concerns, common side effects, and important precautions for anyone considering or currently taking this medication.

Serious Cardiovascular Risks and Warnings

Perhaps the most critical risk associated with Aleve and other NSAIDs is the potential for serious, and even fatal, cardiovascular events. The U.S. Food and Drug Administration (FDA) has issued a boxed warning concerning the increased risk of heart attack and stroke.

Increased Risk of Heart Attack and Stroke: The risk can begin as early as the first few weeks of use and may increase with longer treatment duration and higher dosages. This applies to individuals with or without pre-existing heart conditions, though the risk is higher for those with existing cardiovascular disease.
Contraindicated for Heart Surgery: Aleve should not be used before or immediately after heart bypass surgery (Coronary Artery Bypass Graft, or CABG).
Impact on Blood Pressure: Naproxen can cause the body to retain salt and water, which may lead to increased blood pressure or worsen existing high blood pressure. This fluid retention can also strain the cardiovascular system and contribute to heart failure.

Gastrointestinal Complications

NSAIDs work by inhibiting enzymes called cyclooxygenases (COX), which reduces pain and inflammation. However, this inhibition can also affect the protective lining of the stomach and intestines, leading to several serious gastrointestinal issues.

Stomach Bleeding and Ulcers: One of the most well-known downsides is the risk of stomach or intestinal bleeding, ulceration, or perforation. These complications can be fatal and may occur without warning symptoms, especially in older adults.
Risk Factors: The risk of GI issues increases with age, higher dosages, prolonged use, and a history of ulcers or bleeding. Taking Aleve with other medications like corticosteroids or blood thinners also elevates this risk significantly.
Symptoms: Symptoms of severe GI issues include bloody or black, tarry stools; vomiting blood or material that looks like coffee grounds; and severe, persistent stomach pain.

Kidney and Liver Health Concerns

The long-term use of Aleve can place a strain on the kidneys and liver, potentially leading to serious complications. The kidneys play a vital role in filtering waste and maintaining fluid balance, and NSAIDs can impair this function.

Kidney Damage: Chronic NSAID consumption can reduce blood flow to the kidneys, potentially causing chronic kidney disease or acute kidney failure. This risk is heightened in older adults and those with pre-existing kidney conditions. Signs of kidney problems can include swelling in the feet or ankles, decreased urination, and shortness of breath.
Liver Problems: Although rare, Aleve can cause liver problems, including hepatitis and jaundice. Signs of liver damage can include nausea, upper stomach pain, yellowing of the skin or eyes, dark urine, and fatigue.

Common Side Effects to Monitor

Beyond the more severe health risks, Aleve can also cause a range of common, less serious side effects. While generally manageable, they can still impact daily life.

Gastrointestinal Upset: Indigestion, heartburn, stomach pain, gas, nausea, and constipation are frequently reported. Taking Aleve with food can help mitigate some of these symptoms.
Neurological Effects: Headaches, dizziness, drowsiness, and ringing in the ears (tinnitus) are also common. These effects can influence alertness and the ability to operate machinery safely.
Other Effects: Bruising, itching, skin rashes, and fluid retention leading to swelling are also possible side effects.

Aleve vs. Ibuprofen: Risk Profile Comparison

Both Aleve (naproxen) and ibuprofen are NSAIDs, but they have different durations of action and risk profiles, which is important to consider.


Feature	Aleve (Naproxen)	Ibuprofen	Takeaway for Patients
Duration of Action	Longer-acting (dosed every 8-12 hours)	Shorter-acting (dosed every 4-6 hours)	Aleve offers longer-lasting pain relief.
Cardiovascular Risk	Possibly a slightly lower risk than high-dose ibuprofen, but all NSAIDs carry a warning.	At higher doses, may have a greater cardiovascular risk than naproxen.	For cardiovascular concerns, lower doses and shorter durations are key for both.
Gastrointestinal Risk	Higher risk due to longer duration of action and greater impact on COX-1 enzyme.	Lower risk compared to Aleve, but still present.	Individuals with GI sensitivity may find ibuprofen preferable for short-term use.
Best Use Case	Chronic pain management (arthritis) due to longer action.	Acute pain, fever relief; generally safer for short-term use.	Choose based on the duration and type of pain, considering individual risk factors.

Drug Interactions and Precautions

Naproxen interacts with many medications, which can increase the risk of adverse effects. It is vital to inform a healthcare provider of all other medications, supplements, or herbal remedies being used.

Aleve should be used with caution with:

Blood thinners: Such as warfarin, which can significantly increase the risk of bleeding.
SSRIs: Some antidepressants, like sertraline (Zoloft), can increase the risk of bleeding when combined with NSAIDs.
Blood pressure medications: Including diuretics and ACE inhibitors, as Aleve can interfere with their effectiveness and raise blood pressure.
Alcohol: Drinking alcohol while taking Aleve increases the risk of stomach bleeding.
Other NSAIDs: Combining Aleve with other NSAIDs (including ibuprofen and aspirin, except for low-dose aspirin used for heart protection under a doctor's supervision) can cause an overdose and severely increase the risk of side effects.

Conclusion: The Final Word on Aleve's Downsides

While Aleve is an effective and accessible medication for many people, its use is not without significant risks. The potential for serious cardiovascular, gastrointestinal, kidney, and liver problems, especially with chronic use, necessitates caution. The FDA's warnings and the documented side effects serve as an important reminder to use the lowest effective dose for the shortest possible duration. It is highly recommended to consult a healthcare professional before beginning treatment with Aleve, particularly for individuals with pre-existing health conditions or those taking other medications. Always prioritize professional medical advice when balancing the benefits of pain relief against the potential downsides of Aleve.

Frequently Asked Questions

Yes, Aleve and other non-aspirin NSAIDs carry a risk of increasing the chance of a heart attack or stroke. The FDA has strengthened its warning, noting that this risk can occur even within the first weeks of use, especially with higher doses or in individuals with pre-existing heart conditions.

Yes, stomach bleeding is a significant downside of taking Aleve. It can cause ulcers and serious gastrointestinal bleeding, which can occur without warning and may be fatal. The risk is higher in older adults, those with a history of ulcers, and individuals taking high doses.

Long-term use of Aleve can be harmful to the kidneys, as it can decrease blood flow and potentially cause kidney damage or failure. Individuals with pre-existing kidney disease, older adults, and those taking high doses are at greater risk.

You should not take Aleve with other NSAIDs (like ibuprofen), blood thinners (like warfarin), certain antidepressants (SSRIs), corticosteroids, or blood pressure medications without consulting a doctor. Combining these can significantly increase the risk of adverse effects, particularly bleeding.

Because Aleve is longer-acting than ibuprofen, it can have a greater impact on the stomach lining, potentially posing a slightly higher risk for gastrointestinal issues like ulcers and bleeding. However, both medications can cause stomach problems, and individual risk factors are important to consider.

Those with a history of allergic reactions to NSAIDs or aspirin, active stomach ulcers or GI bleeding, severe kidney or liver disease, uncontrolled high blood pressure, or those who have recently had heart bypass surgery should avoid Aleve. It is also not recommended during the third trimester of pregnancy.

To minimize risks, always use the lowest effective dose for the shortest possible time. Taking Aleve with food or milk can help reduce stomach upset. If long-term pain management is needed, discuss alternative options with your doctor.