Why Do Doctors Tell You Not to Take Aleve (Naproxen)?

October 8, 2025 •

3 min read

According to the Food and Drug Administration (FDA), all non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) carry a warning that they can increase the risk of a heart attack or stroke, especially with long-term or high-dose use. This critical safety information is a primary reason doctors advise caution or warn against using Aleve in specific circumstances.

Quick Summary

This article explores the major health risks associated with Aleve, an NSAID, such as dangerous cardiovascular events, severe gastrointestinal issues, and potential kidney damage. It details which individuals should avoid naproxen and outlines key drug interactions to prevent adverse health outcomes.

Key Points

Cardiovascular Warning: Aleve increases the risk of heart attack and stroke, especially with higher doses or long-term use.
Gastrointestinal Bleeding: Naproxen can cause serious stomach or intestinal bleeding, a risk that is higher for older adults, heavy drinkers, and those with a history of ulcers.
Kidney Damage Risk: Aleve can cause or worsen kidney damage, particularly in older adults and those with existing kidney disease.
Dangerous Drug Interactions: Aleve interacts negatively with various medications, including blood thinners, certain antidepressants, and blood pressure drugs.
Interference with Aspirin: Aleve can interfere with the cardioprotective effects of low-dose aspirin.
Alternatives for Pain Management: Safer alternatives to Aleve for certain populations include acetaminophen or non-drug therapies.

The Mechanism Behind Naproxen's Side Effects

Aleve, the brand name for naproxen sodium, is an NSAID that works by inhibiting COX enzymes, reducing inflammation, pain, and fever. However, blocking these enzymes can also lead to serious side effects. These systemic effects are the main reason doctors issue warnings about Aleve.

Cardiovascular Risks: Increased Heart Attack and Stroke

A major concern with Aleve is its link to serious cardiovascular events, including heart attack and stroke. The FDA notes this risk can occur early in treatment and increases with duration and dosage. The risk exists for individuals with and without heart disease, though it is higher for those with existing cardiovascular conditions. Doctors often advise patients with a history of heart disease, heart failure, or those recovering from heart bypass surgery to avoid naproxen.

Gastrointestinal Dangers: Ulcers and Bleeding

Aleve's effect on COX enzymes can also harm the stomach lining, which relies on prostaglandins for protection. Reducing prostaglandins increases the risk of ulcers and potentially life-threatening GI bleeding or perforation. This risk is elevated in older adults (over 60) and those with a history of GI problems.

Factors that Increase GI Bleeding Risk with Aleve:

Age: Individuals over 60 are at higher risk.
History of GI Issues: A past history of ulcers or bleeding increases recurrence risk.
Alcohol Use: Regular consumption (3 or more drinks daily) significantly increases bleeding risk.
Concurrent Medications: Taking other NSAIDs, blood thinners, or steroids simultaneously raises the risk.

Potential for Kidney Damage

Naproxen can affect kidney function. NSAIDs can decrease blood flow to the kidneys, which is particularly dangerous for individuals with pre-existing kidney conditions. For those with Chronic Kidney Disease (CKD), this can worsen function or lead to acute injury. Individuals over 60, with high blood pressure, or diabetes are also at increased risk. Kidney damage can occur.

Drug Interactions and Contraindications

Aleve can interact negatively with several medications. This includes interactions with blood thinners, blood pressure medications, other NSAIDs, and certain antidepressants. Aleve can also interfere with the antiplatelet effect of low-dose aspirin.

Comparison Table: Aleve vs. Other Pain Relievers


Feature	Aleve (Naproxen)	Ibuprofen (Advil, Motrin)	Acetaminophen (Tylenol)	Aspirin
Drug Class	NSAID	NSAID	Non-NSAID Analgesic/Antipyretic	NSAID
Mechanism	Inhibits COX enzymes to reduce pain and inflammation.	Inhibits COX enzymes to reduce pain and inflammation.	Blocks pain signals to the brain; reduces fever but not inflammation.	Inhibits COX enzymes; anti-inflammatory, antiplatelet effects.
Cardiovascular Risk	Increased risk of heart attack, stroke.	Increased risk of heart attack, stroke.	No increased cardiovascular risk.	Antiplatelet effects can reduce blood clot risk; bleeding risk.
GI Bleeding Risk	Significant risk, especially for high doses, long-term use, and certain individuals.	Significant risk, especially for high doses, long-term use, and certain individuals.	Lower risk of stomach bleeding compared to NSAIDs.	Significant risk of stomach bleeding and ulcers.
Kidney Risk	Can reduce blood flow and cause damage, especially in those with pre-existing conditions.	Can reduce blood flow and cause damage, especially in those with pre-existing conditions.	Safe for kidneys in recommended doses; liver toxicity with overdose.	Kidney risks similar to other NSAIDs.
Use Considerations	Longer-acting, lower dose frequency.	Shorter-acting, higher dose frequency.	Safer for many at-risk groups; careful with liver function.	Should not be used for pain/fever in children due to Reye's syndrome risk.

Conclusion: When is Aleve Not the Right Choice?

Aleve is an effective pain reliever but carries specific, serious risks that make it unsuitable for certain individuals and situations. Doctors warn against its use due to potential cardiovascular events, severe GI bleeding, and kidney damage. Those with heart disease, kidney disease, a history of stomach ulcers, or those on blood thinners should generally avoid Aleve. Older adults are also more susceptible to side effects. In such cases, alternative pain management like acetaminophen or non-drug therapies may be safer. A doctor's advice is based on a personalized health assessment to ensure safe and effective treatment. Always consult a healthcare professional for guidance.

This article is for informational purposes only and is not a substitute for professional medical advice. Always consult your doctor before starting or stopping any medication.

Frequently Asked Questions

You should not take Aleve if you have high blood pressure without consulting your doctor. NSAIDs like naproxen can cause fluid retention and increase blood pressure, potentially interfering with your medication's effectiveness.

Signs of stomach bleeding include bloody or black, tarry stools, vomiting blood or material that looks like coffee grounds, and persistent stomach pain. If you experience these symptoms, stop taking Aleve and seek immediate medical help.

Older adults, particularly those over 60, have a greater risk of experiencing serious side effects from NSAIDs like Aleve, including gastrointestinal bleeding, kidney damage, and cardiovascular issues.

No, it is generally not safe to combine Aleve with blood thinners like warfarin. The combination significantly increases the risk of severe bleeding.

If Aleve is not recommended for you, acetaminophen (Tylenol) is often a safer alternative for pain and fever relief, though it doesn't reduce inflammation. Topical NSAIDs and non-drug options like physical therapy are also possibilities.

Aleve and other NSAIDs can reduce blood flow to the kidneys by blocking prostaglandins, which can strain kidney function. This is particularly risky for individuals with pre-existing kidney disease.

Even short-term use can increase the risk of adverse events like heart attack or stroke, though the risk is higher with long-term use and higher doses. The safest approach is always to use the lowest effective dose for the shortest duration necessary.