What are the adverse effects of concurrent naproxen (nonsteroidal anti-inflammatory drug, NSAID) and alcohol use?

From the Guidelines

Combining naproxen with alcohol is not recommended due to increased risk of serious side effects, including gastrointestinal bleeding, stomach ulcers, and digestive tract irritation, as supported by studies such as 1 and 1. When taken together, these substances can significantly increase the risk of gastrointestinal complications, as alcohol enhances naproxen's ability to erode the protective lining of the stomach and intestines, potentially leading to severe bleeding that may require hospitalization. Some key points to consider include:

• The risk of gastrointestinal complications is increased in patients with a history of previous gastrointestinal events, concomitant use of anticoagulation therapy, and concomitant use of corticosteroids, as noted in 1.
• The use of proton pump inhibitors can decrease the risk of bleeding ulcers in high-risk NSAID or aspirin users, as seen in 1.
• Naproxen may have a dose-response relationship to adverse GI events, and concurrent use of other substances like alcohol can increase this risk, as discussed in 1 and 1.
• People with certain conditions like liver disease, kidney disease, or a history of stomach ulcers face even higher risks when combining naproxen and alcohol, and should consult their healthcare provider for personalized advice, as suggested by 1 and 1. It's essential to consult your healthcare provider about your specific situation, especially if you have underlying health conditions, to determine the best course of action and minimize potential risks, as recommended in 1 and 1.

From the FDA Drug Label

Other factors that increase the risk for GI bleeding in patients treated with NSAIDs include ... use of alcohol The use of alcohol with naproxen may increase the risk of gastrointestinal (GI) bleeding.

• Key factors that increase this risk include:
  • Concomitant use of oral corticosteroids or anticoagulants
  • Longer duration of NSAID therapy
  • Smoking
  • Older age
  • Poor general health status
  • Use of alcohol 2

From the Research

Side Effects of Naproxen with Alcohol Use

• The use of naproxen with alcohol can increase the risk of gastrointestinal (GI) bleeding, as noted in a study published in 2001 3.
• Naproxen is an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) that carries the risk of GI bleeding, and this risk may be higher in alcoholic patients.
• There is limited evidence to suggest that naproxen use with alcohol can cause liver injury, but it is a rare entity that should be considered in patients presenting with cholestasis shortly after naproxen use, as reported in a case study published in 2011 4.
• Another case study published in 2023 reported naproxen-induced liver injury in a 13-year-old girl taking therapeutic doses of the drug, highlighting the importance of monitoring liver function in patients taking naproxen 5.
• To minimize the risk of adverse interactions, it is recommended to use one drug at a time and clearly communicate its generic name, as well as advise patients to stay within the recommended dosing limits, regardless of which OTC analgesic is used 3.