Naproxen vs. Hydrocodone for Pain: Differences in Dosing, Side Effects, and More
Key takeaways:
Naproxen, a non-steroidal anti-inflammatory drug (NSAID), and hydrocodone, an opioid, work differently. But they’re both options for treating moderate-to-severe pain.
Naproxen is available over-the-counter and with a prescription, whereas hydrocodone is a controlled, prescription-only medication.
In many cases, non-opioid medications like naproxen are preferred over opioids due to potential risks of physical and mental dependence. However, both medications have potentially serious risks and side effects to be aware of.
Whether it’s from an injury, a surgery, or an occasional headache, pain can be unsettling. While other health conditions may have a clear answer for treatment, it’s not always so easy when it comes to pain.
There are many things to think about when choosing a pain treatment. It’s important to consider your level of pain, where it’s located, and whether the pain is acute or chronic. It’s also helpful to be aware of the risks and benefits of different types of pain medications. But it can be tricky to find a balance between finding a medication that works well enough and one that doesn’t hurt the rest of your body along the way.
Let’s look at two medications that can be used to treat moderate to severe pain — naproxen and hydrocodone.
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What is naproxen?
Naproxen (Aleve, Naprosyn) is a non-steroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation. It’s commonly used for body aches and headaches.
Naproxen is available as an over-the-counter (OTC) and prescription medication. It most commonly comes as an oral tablet or capsule.
As an OTC product, naproxen is taken as a 220 mg dose that can be used to treat mild to moderate pain. It’s also available with a prescription at higher doses. The higher doses are usually used to treat moderate to severe pain from conditions like menstrual cramps, rheumatoid arthritis, and gout.
Naproxen is also available as a liquid prescription medication and in certain combination products, such as Sudafed Sinus Pressure & Pain and Treximet. Other related medications are ibuprofen (Advil, Motrin) and celecoxib (Celebrex), which are in the same medication class as naproxen.
What is hydrocodone?
Hydrocodone is an oral opioid medication used to treat pain. It’s available by prescription only, like all opioids. It’s also categorized as a controlled substance, meaning it has a high risk for physical and mental dependence.
Hydrocodone is most frequently found in combination with acetaminophen (Tylenol). This duo is available as both brand-name and generic products, with common brand names being Norco, Vicodin, and Lortab.
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It’s less common, but hydrocodone is also available as a stand-alone extended-release (ER) product. It comes as a generic medication and under the brand name Hysingla ER.
Does naproxen work like hydrocodone?
No, they work differently.
Naproxen is an NSAID. It works by blocking the action of an enzyme (protein) called cyclooxygenase (COX). COX helps make prostaglandins in your body, which are natural substances that promote inflammation, pain, and fever.
Hydrocodone is an opioid — not an NSAID. It activates specific areas on your nerve cells called opioid receptors. This slows down pain signals in your body, which helps change and control feelings of pain. Opioids don’t reduce swelling or fever like naproxen and other NSAIDs do.
How are naproxen and hydrocodone dosed and given?
The recommended dosage of OTC naproxen is 1 tablet (220 mg) by mouth every 8 to 12 hours as needed, with a maximum amount of 660 mg (3 tablets) per day. As a prescription, naproxen can be dosed from 250 mg to 550 mg twice daily, with a maximum of 1,375 mg per day. However, know that naproxen’s dosing and safety recommendations vary based on age and other medication conditions, such as kidney problems.
Dosing for opioids like hydrocodone also varies from person to person. It’s based on factors like severity of pain, prior pain medication use and response, and personal risk factors. Still, a common dosage of the hydrocodone/acetaminophen combination product is 1 tablet (5 mg/325 mg) by mouth every 4 to 6 hours as needed for moderate to severe pain.
Hydrocodone ER is usually saved for severe, long-lasting pain. Since it’s an ER formulation, it lasts longer in the body than hydrocodone/acetaminophen. The starting dosage is usually 1 tablet (10 mg) by mouth every 12 hours, but it should be adjusted by a healthcare provider based on the response.
For both naproxen and hydrocodone, it's always recommended to use the lowest dose for the shortest possible amount of time.
How effective are NSAIDs, like naproxen, at treating moderate to severe pain?
NSAIDs, like naproxen, work well to reduce many forms of pain.
For instance, studies of people who just completed surgery showed that naproxen reduced moderate to severe pain by at least 50% over 4 to 6 hours. In another study of people with chronic back pain or arthritis-related pain, non-opioid medications (including NSAIDs) appeared to be better than opioids at lessening the intensity of pain. They also caused fewer side effects than the opioids did.
Keep in mind: Pain control varies for everyone. The best treatment for you will depend on your situation, the cause of your pain, and your medical history.
When should medications like hydrocodone be used instead of NSAIDs?
In most cases, it’s best to try a non-opioid alternative before trying an opioid. This can help prevent dangerous complications, such as opioid use disorder or overdose.
Still, opioid medications like hydrocodone may be used for more severe pain. This is often the case for people who are recovering from surgery, among other situations. There are also cases where opioids are a standard, go-to treatment choice. Two examples are cancer-related pain or a sickle cell crisis.
Common side effects of naproxen and hydrocodone
While many pain medications are available, the “perfect” pain medication doesn’t exist. All pain medications — including naproxen and hydrocodone — have risks and side effects to be aware of. Here are some common side effects of both medications:
Constipation
Nausea
Dizziness
Drowsiness
Serious risks and side effects to keep in mind
More serious side effects are also possible. NSAIDs like naproxen can cause or worsen stomach bleeding or ulcers, kidney function, and heart-related complications (like heart attack, stroke, heart failure). If you experience any of these rare but serious side effects, contact your healthcare provider right away:
Chest pain
Shortness of breath
Slurring of speech
Severe stomach pain or heartburn
Opioids like hydrocodone can cause physical and mental impairment. They can also lead to tolerance while also carrying a risk of overdose. Seek emergency medical care right away if you or a loved one experience any of the following symptoms while taking an opioid:
Slowed breathing or heart rate
Falling unconscious or being unable to respond
Pinpoint or tiny pupils
Bluish skin, especially on the lips and fingertips
Vomiting or gurgling noises
Can you take naproxen and hydrocodone together for pain?
In theory, yes. This is because they work differently. For instance, hydrocodone is sometimes found in combination with another NSAID, ibuprofen. But this combination is not commonly used. Hydrocodone is more often combined with acetaminophen for pain relief.
Before combining hydrocodone with an NSAID like naproxen, it’s best to talk to a healthcare provider. They can work with you to find a better solution for your pain if your current treatment isn’t working well enough.
The bottom line
Naproxen and hydrocodone are medications that can treat moderate-to-severe pain. Non-opioid medications, like naproxen, have been shown to treat certain types of pain as well as opioids. Generally, it’s best to try a non-opioid alternative before an opioid to avoid risks like dependence and overdose. But non-opioid medications, like naproxen, should also be used with caution due to their effects on the heart, kidneys, and stomach.
If you’re experiencing pain and thinking about starting medication, make sure to talk to your healthcare provider about the pros and cons of your different treatment options.
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References
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Bennett, M., et al. (2018). Pain and opioids in cancer care: Benefits, risks, and alternatives. ASCO Educational Book.
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Dowell, D., et al. (2016). CDC guideline for prescribing opioids for chronic pain. Journal of the American Medical Association.
Krebs, E. E., et al. (2018). Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain. Journal of the American Medical Association.
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