Long-term effects of OTC pain pills

Dear Alice,

I suffer from all kinds of body pain on a daily basis and have been taking three to four naproxen sodium pills (Aleve) a day for about two years now. Is this safe? Are there any long-term effects? I have searched the internet and your site and have not found information on prolonged use of these drugs. Thanks for your help.

Dear Reader,

Kudos to you for considering the safety of your pain management strategy. While treating chronic pain with over-the-counter (OTC) pain relievers may seem like just a quick fix, your concern is warranted. Using non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium, for an extended period of time may result in some serious consequences to your health, above and beyond the body pain you're already experiencing. Read on for more about safety recommendations and potential risks associated with naproxen sodium use.

Naproxen sodium is approved by the U.S. Food and Drug Administration (FDA) and deemed safe for use as indicated or prescribed. That being said, it's typically meant for short-term relief and there's a limit to the amount or dosage that is considered safe to use, which depends on the condition being treated. Over-the-counter naproxen sodium is typically used for the relief of minor aches, pains, and fever. The recommended daily dose for the OTC version is no more than one 220 milligram (mg) pill every eight to twelve hours and isn’t meant to be taken for longer than ten consecutive days. Naproxen sodium also comes in prescription strength and is administered under the supervision of a health care provider (to monitor for any side effects). Though this pain reliever can treat chronic conditions such as arthritis, it’s rarely prescribed for more than six months at a time. Furthermore, a dosage for long-term use must be determined and clearly given by a health care provider, and the patient must undergo routine screenings in order to check for asymptomatic side effects such as gastrointestinal (GI) bleeding (more on this later).

Reader, depending on the dosage of the naproxen sodium pills you're taking, there may be some risks in taking three or four pills per day for such a long period of time. It’s best to consult with a medical professional while taking this medication. Heeding the recommendations for the use of naproxen sodium is vital in light of the potentially serious health consequences that can result. Prolonged use of NSAIDs (including naproxen sodium) is associated with various harmful side effects, including kidney problems, and cardiovascular risks. Additionally, GI bleeding can occur when naproxen sodium is taken at high doses over long periods of time. Some signs and symptoms of GI bleeding are bloody, tarry, or black stools or blood in vomit. The following factors may increase risk of GI bleeding while taking naproxen sodium:

  • Drinking alcohol
  • Taking other pain relievers or cold medications
  • Taking prescription blood thinner medications
  • A past history of GI bleeding
  • Being elderly (GI bleeding events that are fatal and happen without warning occur in those with advanced age)

Kidney problems, including kidney failure and renal toxicity are also possible. The following factors may increase risk for renal problems while taking naproxen sodium:

  • Taking diuretics or angiotensin-converting enzyme (ACE) inhibitors
  • Impaired liver functioning
  • Heart failure
  • Being elderly

In addition, NSAIDs may lead to an increased risk of serious cardiovascular events, including heart attack, stroke, and heart failure. This risk can occur within a few weeks of taking them, but tend to increase with duration of use and in larger doses. Folks with pre-existing cardiovascular disease (CVD) and those at risk of developing CVD are more likely to experience these harmful side effects. However, research indicates that NSAIDs can increase the risk of heart attack or stroke in patients with or without CVD or risk factors for heart disease. It's also crucial to note that these events can be fatal and happen without warning. Something else to keep in mind is that it’s not advised to consume other substances such as alcohol or aspirin alongside this medication as these may decrease the effectiveness of naproxen sodium or cause harmful side effects.

Instead of continuing to use pain medication to cope with your chronic pain, you might also consider some alternative methods to help ease your discomfort. There are many  complementary health approaches to alleviating pain, such as acupuncture, meditation, massage therapy, spinal manipulation, tai chi, and yoga.

Chronic physical pain can result from a wide variety of conditions, from depression to physical injury. Because you've been dealing with it for a number of years, it may be time to address the root cause of your pain. Do you have any inkling as to where it comes from? When did you first notice the pain? Are there other strategies besides medication that help relieve the pain (such as eating or avoiding certain foods, being physically active, or practicing relaxation techniques)? As you think about the origin and nature of your pain, your best bet might be to explore it further with the help of a health care provider. The answers to these questions may be helpful as you meet with them. They can help you determine the cause of your pain and identify the most appropriate treatment regimen — one that provides maximum relief while minimizing any potential negative impacts to your health. And, if your pain ever becomes severe, it's wise to seek out medical attention as soon as possible. 

Wishing you relief,

Last updated Feb 04, 2022
Originally published Feb 01, 2008

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