Is it safe to take naproxen and acetaminophen together

The first line of treatment for many knee and hip problems includes taking over-the-counter pain medications. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are the most common pain medication options. However, these pain medications have a variety of side effects, so it's important to discuss your personal health risks with your doctor when considering long-term use for chronic conditions such as osteoarthritis.

Acetaminophen (Tylenol and other brands) is usually effective for mild pain and is easy on the stomach. However, it is toxic to the liver at high doses. The recommended maximum per day is generally set at 4 grams (4,000 milligrams), which is the equivalent of eight extra-strength Tylenol tablets. But that dosage can still cause liver problems for some people. To be safe, aim for 3,000 milligrams or less, and be cautious of mixing multiple products containing acetaminophen, such as a pain reliever and a cold medication or a prescribed narcotic.

The FDA now recommends using products containing no more than 325 milligrams per pill or capsule (the equivalent of regular-strength Tylenol rather than extra-strength) in order to avoid excessive dosages. Don't take acetaminophen if you drink more than a moderate amount of alcohol on a regular basis or if you have liver disease.

NSAIDs such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Anaprox) may be more effective than acetaminophen for certain conditions because they reduce inflammation as well as relieve pain. But NSAID medications have side effects, the most common is stomach irritation. It can also cause stomach and intestinal ulcers, which can lead to internal bleeding. You can ask your doctor about taking a stomach acid inhibitor to reduce these risks. NSAIDs also carry an increased risk of heart attack, stroke, and kidney failure when taken at high doses or for long periods of time.
Taking acetaminophen along with an NSAID may provide equivalent pain relief with lower doses of both pain medications, thus minimizing side effects. You can also alternate between the two to reduce the risk from either type of medication.

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Acetaminophen is an over the counter medication frequently recommended by doctors for the treatment of pain and fever. While widely used, people still have a lot of questions about acetaminophen, and the most common include whether it can be taken with drugs like Advil, Aleve, aspirin and other painkillers.

Common Acetaminophen Drug Interactions

Acetaminophen is a highly effective pain reliever and fever reducer, sold in both generic and brand name forms, most notably as Tylenol. In fact, acetaminophen is so effective that drug makers often use it as a key ingredient in other medications, especially those that treat symptoms of cold, flu and sinusitis.

The drug is safe when its warning label is followed, but there can be severe acetaminophen side effects, particularly liver complications, in people who exceed its dosage guidelines.

Consumers must monitor their acetaminophen dosage, being mindful of how much is consumed over a 24-hour period. This includes adding up the amount of acetaminophen ingested from other medications also taken during this period.

Without knowing it, you risk overdosing on acetaminophen when you use it while on cold or flu medications like NyQuil and DayQuil, both of which contain the pain reliever. Most pain management opioids and antihistamines like diphenhydramine contain the analgesic too, which they clearly indicate on their packaging. Protect your liver and avoid countless side effects of acetaminophen by always reading the dosage instructions on the medication’s label.

Can You Take Acetaminophen with Ibuprofen?

Yes, you can combine acetaminophen with a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, but you should be aware of the amount of each medication you take at any one time and over the course of a 24-hour period. Two popular ibuprofen drugs are Advil and Motrin.

However, while both ibuprofen and acetaminophen relieve pain and fever, acetaminophen cannot ease inflammation. Ibuprofen usually does.

To take an NSAID with acetaminophen safely, refer to your prescribed or recommended dosage. You probably don’t need the recommended maximum amount of acetaminophen per day (4,000 milligrams) when you’re also taking ibuprofen.

Studies also show that if you do combine acetaminophen with an NSAID, it’s best to reduce doses of both drugs — or take the medications alternately instead of concurrently — to lower the risk of overdose and side-effects. Even at lower dosages, the combination of medications still delivers needed pain relief.

Can You Take Acetaminophen with Aleve?

Yes, you can also take acetaminophen at the same time you take Aleve, whose active ingredient is naproxen. Like other NSAIDs, naproxen has anti-inflammatory properties, so it’s also a solid option for alleviating inflammation and pain in conditions like arthritis.

Concurrent use of the two drugs in lower doses can help you safely ease pain and swelling, minimizing possible side effects from both. If taking the medications without a prescription, read and follow the dosing directions on each product’s label to avoid harm.

Can You Take Acetaminophen with Aspirin?

As with ibuprofen and Aleve, aspirin is an NSAID with which acetaminophen agrees. In fact, there are multiple pain-relief brands that combine both ingredients to form their pain-relief medication.

Aspirin has multiple medical uses besides pain and inflammation management. Doctors often prescribe aspirin to prevent heart attacks or blood clots that can cause strokes.

If you have a headache while using this prescription NSAID for a heart problem, you can take acetaminophen for pain relief.

However, if you are someone who takes aspirin daily, or even regularly, you should consider taking acetaminophen (Tylenol) instead of an ibuprofen-based drug when you need pain relief. Otherwise, you could limit the positive effects of aspirin.

How Does Acetaminophen Work?

Though a widely studied and used medication, acetaminophen’s exact mechanism for altering your body’s responses to pain and fever is still relatively unknown to date.

Acetaminophen may block the natural production of pain-causing substances called prostaglandins, which thus suppresses pain sensitivity when you’re injured or have a body ache. In this way, the drug could reduce the amount of pain your nerves can detect and register in the brain.

It’s not clear whether acetaminophen suppresses pain triggers in the brain (within the central nervous system) only or also outside of it. According to one school of thought, the drug doesn’t have as powerful an effect on the site of pain (peripheral nerves) as does an NSAID.

Is Acetaminophen an NSAID?

Acetaminophen, which is available in various forms like pills, capsules, liquids and chewable tablets, is not an NSAID. Although both acetaminophen and NSAIDs are pain relievers and fever reducers, that’s where their similarities end.

Acetaminophen doesn’t provide the anti-inflammatory benefits of a typical NSAID like ibuprofen.

To effectively manage mild to moderate pain and fever from swelling, you must at least take an NSAID. If necessary, you can combine that with measured doses of acetaminophen. Though as previously noted, it’s important to not exceed recommended doses of acetaminophen because of risks of potential liver damage.

Is Acetaminophen a Blood Thinner?

Unlike NSAIDs, acetaminophen is not a blood thinner. It has no properties that slow down the blood clotting mechanism or prevent platelets from forming clots. The benefit of this is that you can take acetaminophen before surgery or a minor medical procedure with blood thinning medication without risking excess bleeding.

If you need surgery at a time when you are taking ibuprofen for pain, such as for arthritis, you should discuss with your doctor safe ways to taper off your acetaminophen dosage or halt it prior to your procedure. (The same pre-surgery discussion is needed if you are on blood thinners.)

Can You Take Acetaminophen While Pregnant?

Acetaminophen is among the safest pain-relievers you can take when you’re pregnant. As with any other medication during pregnancy, you should discuss safety and proper dosages with your doctor before using this painkiller.

One medical study linked acetaminophen use during pregnancy to children being born with attention deficit hyperactivity disorder (ADHD).

Managing pain during pregnancy is a reality for optimal physical and mental health. If you want to consider taking acetaminophen or medications that contain acetaminophen, have a serious discussion with your pediatrician or physician ahead of time.

Can You Drink Alcohol While Taking Acetaminophen?

For most healthy people, acetaminophen is safe at the recommended doses. However, people should not take acetaminophen while drinking alcohol because it may cause liver damage over time. The risk of irreversible liver damage or even death from acute liver failure is higher for people who drink alcohol while taking acetaminophen.

One 2022 clinical research study found that regular daily intake of 4 g acetaminophen increased systolic blood pressure in individuals with hypertension by about 5 mm Hg compared with a placebo.

To minimize the risk of adverse side effects, strictly follow the dosing instructions on the drug’s label (and avoid or cut alcohol consumption if you’re a drinker). If you’re also using other pain medication, such as NSAIDs, keep your daily acetaminophen dose within the recommended limit.

Please seek the advice of a medical professional before making health care decisions.

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