Table of ContentsView AllTable of ContentsWhat Is Tramadol?What Is Naproxen?Side EffectsPotential RisksInteractionsBenefits of Dual Therapy
Table of ContentsView All
View All
Table of Contents
What Is Tramadol?
What Is Naproxen?
Side Effects
Potential Risks
Interactions
Benefits of Dual Therapy
When used together, tramadol and naproxen may provide excellent pain relief without the risk of side effects that tramadol is well known for.
This article explains how tramadol and naproxen work, including possible side effects and interactions. It also explains the potential benefits of dual therapy.
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Tramadol belongs to a class of drugs called opioids which are prescribed to treat severe pain. It is also classified as aserotonin-norepinephrine reuptake inhibitor (SNRI), a type of antidepressant with pain-relieving properties.
Tramadol is indicated for the treatment of bothacute(sudden, severe) andchronic(persistent pain). It is often prescribed to treat postoperative pain when an over-the-counter (OTC) drug likeTylenol (acetaminophen)fails to provide relief.
Tramadol vs. Oxycodone: What Are the Differences?
Naproxen belongs to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs) that provide temporary relief of mild to moderate pain,inflammation, and fever.
Naproxen is available as a generic and sold under brand names like Aleve, Aflaxen, Anaprox, Naprosyn, Naprelan, and others. It is sold over the counter in tablet, capsule, liquid, and gel cap formulations.
Naproxen has many uses, including the treatment of:
Side Effects of Tramadol and Naproxen
As with all drugs, tramadol and naproxen can cause side effects. These side effects need to be taken into consideration when considering dual therapy.
Of the two, tramadol is the stronger drug classified as acontrolled substancedue to its high potential for abuse or addiction.Up to 40% of users experience side effects, some of which may be intolerable.
Naproxen tends to cause fewer side effects, although some people are more sensitive to the drug. The risk of side effects is greater if naproxen is overused.
Side EffectsTramadolConstipationHeadacheDizzinessFatigueDrowsinessLoss of appetiteNausea and vomitingSweatingMuscle weaknessDry mouthIndigestionAbdominal painNaproxenConstipationGasExcessive thirstHeadacheDizzinessLightheadednessDrowsinessDifficulty sleepingTingling sensationsNasal congestionRinging in the earsReduced hearing
TramadolConstipationHeadacheDizzinessFatigueDrowsinessLoss of appetiteNausea and vomitingSweatingMuscle weaknessDry mouthIndigestionAbdominal pain
Constipation
Headache
Dizziness
Fatigue
Drowsiness
Loss of appetite
Nausea and vomiting
Sweating
Muscle weakness
Dry mouth
Indigestion
Abdominal pain
NaproxenConstipationGasExcessive thirstHeadacheDizzinessLightheadednessDrowsinessDifficulty sleepingTingling sensationsNasal congestionRinging in the earsReduced hearing
Gas
Excessive thirst
Lightheadedness
Difficulty sleeping
Tingling sensations
Nasal congestion
Ringing in the ears
Reduced hearing
Tramadol and naproxen are generally safe for use if taken as prescribed. Most side effects will subside as your body adapts to treatment, and some people may experience no side effects at all. Even so, both drugs pose significant risks if used in excess.
Tramadol
Tramadol is of special concern due to the risk of addiction and withdrawal. For this reason, tramadol is typically used for no more than a few days or weeks.If longer-term treatment is needed, the dose will be gradually tapered (rather than abruptly stopped) when the drug is no longer needed.
Tramadol withdrawal symptoms include:
An overdose of tramadol can be even more severe, leading to slowed breathing, muscle spasms, irregular heartbeats, disorientation, shivering, diarrhea, agitation, and, in extreme cases, seizures, coma, and death.
Naproxen
One of the other functions of prostaglandins is to regulate blood clotting.By suppressing prostaglandins, naproxen can increase the risk of bleeding, particularly if taken at higher doses or over a long period.
This can lead to potentially serious symptoms like:
If overused, naproxen can lead to rectal bleeding,bloody or tarry stools, andvomiting of blood—all of which are signs of a medical emergency. The prolonged use of naproxen at higher doses can also increase the risk of heart attacks and stroke.
When to Seek Emergency CareAn allergic reaction to tramadol and naproxen is rare.Even so, rare cases of a potentially life-threatening, whole-body allergy calledanaphylaxishave been reported.Call 911 if you experience the following after taking tramadol or naproxen:Sudden rash or hivesShortness of breathWheezingIrregular or rapid heartbeatsSudden severe diarrheaSwelling of the face, neck, or tongueA feeling of impending doom
When to Seek Emergency Care
An allergic reaction to tramadol and naproxen is rare.Even so, rare cases of a potentially life-threatening, whole-body allergy calledanaphylaxishave been reported.Call 911 if you experience the following after taking tramadol or naproxen:Sudden rash or hivesShortness of breathWheezingIrregular or rapid heartbeatsSudden severe diarrheaSwelling of the face, neck, or tongueA feeling of impending doom
An allergic reaction to tramadol and naproxen is rare.Even so, rare cases of a potentially life-threatening, whole-body allergy calledanaphylaxishave been reported.
Call 911 if you experience the following after taking tramadol or naproxen:
Comparing Tramadol vs. Hydrocodone
Drugs Interactions
Tramadol and naproxen are safe to use together and do not interact with each other. They can interact with other drugs, however, and may need to be avoided if you take any of the following medications:
TramadolMonoamine oxidase inhibitor (MAOI) antidepressantsTegretol (carbemapezine)Zofran (ondansetron)RifampicinWellbutrin (bupropion)Prozac (fluoxetine)Paxil (paroxetine)St. John’s wortNaproxenOther NSAIDS like aspirin, ibuprofen, diclofenac, and celecoxibWarfarinPlavix (clopidogrel)Eliquis (apixaban)Diuretics (“water pills”)LithiumMethotrexate
TramadolMonoamine oxidase inhibitor (MAOI) antidepressantsTegretol (carbemapezine)Zofran (ondansetron)RifampicinWellbutrin (bupropion)Prozac (fluoxetine)Paxil (paroxetine)St. John’s wort
Monoamine oxidase inhibitor (MAOI) antidepressants
Tegretol (carbemapezine)
Zofran (ondansetron)
Rifampicin
Wellbutrin (bupropion)
Prozac (fluoxetine)
Paxil (paroxetine)
St. John’s wort
NaproxenOther NSAIDS like aspirin, ibuprofen, diclofenac, and celecoxibWarfarinPlavix (clopidogrel)Eliquis (apixaban)Diuretics (“water pills”)LithiumMethotrexate
Other NSAIDS like aspirin, ibuprofen, diclofenac, and celecoxib
Warfarin
Plavix (clopidogrel)
Eliquis (apixaban)
Diuretics (“water pills”)
Lithium
Methotrexate
Other interactions are possible. To avoid interactions, advise your healthcare provider if you take any medications, whether prescription, OTC, nutritional, herbal, or recreational.
When using opioids like tramadol, the primary aim is to reduce pain with the lowest possible dose taken for the shortest period of time. This not only lowers the risk of side effects but also reduces the chance of dependence.
If tramadol is prescribed to treat severe pain, using naproxen alongside may allow you to reduce the dose from 300 milligrams per day (the maximum daily dose) to 100 milligrams or less.
More importantly, only 10% of people prescribed tramadol experience significant side effects. This is a big drop from the 40% of people who commonly experience side effects with tramadol.
Currently, there is no standard protocol for the co-administration of tramadol and naproxen. Even so, some experts recommend tramadol doses of no more than 50 milligrams per day to reduce the risk of side effects.
Speak with your healthcare provider to make an informed choice. Do not increase or decrease the dose without first speaking to your provider.
Summary
Tramadol, a prescription opioid pain reliever, and Aleve (naproxen), an over-the-counter nonsteroidal anti-inflammatory drug, can be taken together to treat severe pain. Doing so may allow you to lower the tramadol dose, reducing the risk of side effects and opioid dependence.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Label: tramadol hydrochloride tablet, coated.U.S. Food and Drug Administration.Naproxen: prescribing information and medication guide.Gunaydin C, Bilge SS.Effects of nonsteroidal anti-inflammatory drugs at the molecular level.Eurasian J Med. 2018;50(2):116-121. doi:10.5152/eurasianjmed.2018.0010U.S. Drug Enforcement Administration.Drug scheduling.Inage K, Orita S, Yamauchi K, et al.Low-dose tramadol and non-steroidal anti-inflammatory drug combination therapy prevents the transition to chronic low back pain.Asian Spine J. 2016;10(4):685-9. doi:10.4184/asj.2016.10.4.685MedlinePlus.Naproxen.American Society of Health-System Pharmacists.Tramadol hydrochloride.U.S. Food and Drug Administration.FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. 2015.Chandanwale AS, Sundar S, Latchoumibady K, et al.Efficacy and safety profile of combination of tramadol-diclofenac versus tramadol-paracetamol in patients with acute musculoskeletal conditions, postoperative pain, and acute flare of osteoarthritis and rheumatoid arthritis: a Phase III, 5-day open-label study.J Pain Res.2014;7:455–463. doi:10.2147/JPR.S67817
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.DailyMed.Label: tramadol hydrochloride tablet, coated.U.S. Food and Drug Administration.Naproxen: prescribing information and medication guide.Gunaydin C, Bilge SS.Effects of nonsteroidal anti-inflammatory drugs at the molecular level.Eurasian J Med. 2018;50(2):116-121. doi:10.5152/eurasianjmed.2018.0010U.S. Drug Enforcement Administration.Drug scheduling.Inage K, Orita S, Yamauchi K, et al.Low-dose tramadol and non-steroidal anti-inflammatory drug combination therapy prevents the transition to chronic low back pain.Asian Spine J. 2016;10(4):685-9. doi:10.4184/asj.2016.10.4.685MedlinePlus.Naproxen.American Society of Health-System Pharmacists.Tramadol hydrochloride.U.S. Food and Drug Administration.FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. 2015.Chandanwale AS, Sundar S, Latchoumibady K, et al.Efficacy and safety profile of combination of tramadol-diclofenac versus tramadol-paracetamol in patients with acute musculoskeletal conditions, postoperative pain, and acute flare of osteoarthritis and rheumatoid arthritis: a Phase III, 5-day open-label study.J Pain Res.2014;7:455–463. doi:10.2147/JPR.S67817
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
DailyMed.Label: tramadol hydrochloride tablet, coated.U.S. Food and Drug Administration.Naproxen: prescribing information and medication guide.Gunaydin C, Bilge SS.Effects of nonsteroidal anti-inflammatory drugs at the molecular level.Eurasian J Med. 2018;50(2):116-121. doi:10.5152/eurasianjmed.2018.0010U.S. Drug Enforcement Administration.Drug scheduling.Inage K, Orita S, Yamauchi K, et al.Low-dose tramadol and non-steroidal anti-inflammatory drug combination therapy prevents the transition to chronic low back pain.Asian Spine J. 2016;10(4):685-9. doi:10.4184/asj.2016.10.4.685MedlinePlus.Naproxen.American Society of Health-System Pharmacists.Tramadol hydrochloride.U.S. Food and Drug Administration.FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. 2015.Chandanwale AS, Sundar S, Latchoumibady K, et al.Efficacy and safety profile of combination of tramadol-diclofenac versus tramadol-paracetamol in patients with acute musculoskeletal conditions, postoperative pain, and acute flare of osteoarthritis and rheumatoid arthritis: a Phase III, 5-day open-label study.J Pain Res.2014;7:455–463. doi:10.2147/JPR.S67817
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U.S. Food and Drug Administration.Naproxen: prescribing information and medication guide.
Gunaydin C, Bilge SS.Effects of nonsteroidal anti-inflammatory drugs at the molecular level.Eurasian J Med. 2018;50(2):116-121. doi:10.5152/eurasianjmed.2018.0010
U.S. Drug Enforcement Administration.Drug scheduling.
Inage K, Orita S, Yamauchi K, et al.Low-dose tramadol and non-steroidal anti-inflammatory drug combination therapy prevents the transition to chronic low back pain.Asian Spine J. 2016;10(4):685-9. doi:10.4184/asj.2016.10.4.685
MedlinePlus.Naproxen.
American Society of Health-System Pharmacists.Tramadol hydrochloride.
U.S. Food and Drug Administration.FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. 2015.
Chandanwale AS, Sundar S, Latchoumibady K, et al.Efficacy and safety profile of combination of tramadol-diclofenac versus tramadol-paracetamol in patients with acute musculoskeletal conditions, postoperative pain, and acute flare of osteoarthritis and rheumatoid arthritis: a Phase III, 5-day open-label study.J Pain Res.2014;7:455–463. doi:10.2147/JPR.S67817
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