Key takeaways:
Naproxen (Aleve, Naprosyn), a nonsteroidal anti-inflammatory drug (NSAID), and hydrocodone (Hysingla ER), an opioid, work differently. But they’re both options for pain relief.
Naproxen is available over the counter or with a prescription. Hydrocodone is a controlled, prescription-only medication.
In many cases, nonopioid medications such as naproxen are preferred over opioids due to potential risks of physical and mental dependence. However, both medications have potentially serious side effects to be aware of.
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Whether it’s from an injury, surgery, or chronic migraines, 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 strike 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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Overview: Comparing naproxen vs. hydrocodone
Naproxen (Aleve, Naprosyn) and hydrocodone (Hysingla ER) are both used to treat pain. But they’re very different medications.
Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). It’s commonly used for body aches and headaches.
Hydrocodone is an oral opioid. It’s available by prescription only, like all opioids. It’s also categorized as a controlled substance, meaning it has a risk for physical and mental dependence.
The chart below contrasts the similarities and differences between naproxen and hydrocodone.
| Naproxen | Hydrocodone | |
|---|---|---|
| Brand names | Aleve, Naprosyn, Naprelan, Anaprox DS | Hysingla ER |
| Combination medications | Can be part of multisymptom cold and flu products
Examples include:
|
Often prescribed in combination with other medications
Examples include:
*Only available as a generic product |
| Typical uses | Minor aches and pains, including:
|
Moderate to severe pain, including pain caused by major surgeries |
| Controlled substance | No | Yes |
| Dosage forms | Immediate-release tablet, extended-release tablet, oral solution | Immediate-release tablet, extended-release tablet, oral solution |
| Dosage frequency |
|
|
| Duration of use | Usually used short term but may be used long term in certain situations | Usually used short term but may be used long term in certain situations |
| Common side effects |
|
|
Below, we dive deeper into five key things to know when considering naproxen versus hydrocodone.
1. Naproxen is an NSAID, while hydrocodone is an opioid
Naproxen and hydrocodone belong to different classes of medications. They each work in their own way to reduce pain.
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. Blocking COX in this manner helps reduce pain and swelling.
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.
2. Naproxen and hydrocodone have multiple dosage forms
Naproxen is available as both an over-the-counter (OTC) and prescription medication. It most commonly comes as an oral tablet or capsule. But you can also find it as a liquid prescription medication and in certain combination products, such as Sudafed Sinus Pressure & Pain and Treximet. Other related NSAIDs are ibuprofen (Advil, Motrin) and celecoxib (Celebrex).
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Hydrocodone is most often combined with acetaminophen, the active ingredient in Tylenol. This combination was previously sold under brand names such as Norco, Vicodin, and Lortab, but all brand-name versions have been discontinued. Today, only generic hydrocodone / acetaminophen products are available.
Hydrocodone can also be combined with other medications, such as ibuprofen. It’s available on its own as an extended-release (ER) product, too. This form is sold as a generic and under the brand name Hysingla ER.
3. Naproxen and hydrocodone have different dosage instructions
The recommended dosage of OTC naproxen is 1 tablet (220 mg) by mouth every 8 to 12 hours as needed, with a maximum dosage of 660 mg (3 tablets) per day.
As a prescription, naproxen can be taken as a dosage of 250 mg to 550 mg twice daily, with a maximum of 1,375 mg per day. But keep in mind that naproxen’s dosages and safety recommendations vary based on age and other medical conditions, such as kidney problems.
Dosages for opioids such as hydrocodone also vary from person to person. They’re based on factors such as pain severity, prior pain medication use, and personal risk factors. The amount of acetaminophen you can safely have can also make a difference. Still, a common dosage of hydrocodone / acetaminophen 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 (20 mg) by mouth once a day, but it should be adjusted by a healthcare professional based on the response.
For both naproxen and hydrocodone, it's always recommended to take the lowest effective dose for the shortest possible amount of time.
4. The best choice varies for more severe pain
NSAIDs such as naproxen work best for relatively mild forms of pain, such as headaches or muscle aches. But in some cases, they’re also beneficial for more intense discomfort.
For instance, studies of people who just had 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, nonopioid medications (including NSAIDs) appeared to be better than opioids at lessening the intensity of their pain. They also caused fewer side effects than the opioids did.
When should opioids be used instead of NSAIDs?
In most cases, it’s best to try a nonopioid alternative before trying an opioid. This can help prevent dangerous complications, such as opioid use disorder or overdose.
Still, opioid medications such as hydrocodone may be prescribed 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 for the treatment of cancer-related pain or a sickle cell crisis.
Keep in mind: Pain management varies for everyone. The best treatment for you will depend on your situation, the cause of your pain, and your medical history.
5. Some naproxen and hydrocodone side effects overlap, while others are unique
The perfect pain medication doesn’t exist. All pain medications — including naproxen and hydrocodone — have risks and side effects to be aware of. Common side effects of both naproxen and hydrocodone include:
Constipation
Nausea
Dizziness
More serious side effects are also possible, typically with long-term use. NSAIDs such as naproxen can cause or worsen stomach bleeding or ulcers, kidney function, and heart-related complications (such as heart attack, stroke, or heart failure). If you experience any of these rare but serious NSAID side effects, contact your healthcare team right away:
Chest pain
Shortness of breath
Slurred speech
Severe stomach pain or heartburn
Opioids such as hydrocodone can cause physical and mental impairment. They can also lead to tolerance while carrying a risk of overdose. These are key factors that separate opioids from NSAIDs. Seek emergency medical care right away if you or a loved one experiences 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 making gurgling noises
These aren’t comprehensive lists of naproxen and hydrocodone side effects. A healthcare professional can help explain all of the potential risks of either medication.
Frequently asked questions
In theory, yes. This is because they work differently. Hydrocodone is even 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 such as naproxen, it’s best to talk to a healthcare professional. They can work with you to find a better solution for your pain if your current treatment isn’t working well enough.
Naproxen and oxycodone belong to different medication classes, so their strength can’t be directly compared. Naproxen is an NSAID that reduces inflammation and relieves pain. Oxycodone is an opioid that works on the nervous system to block pain signals.
Compared with hydrocodone, though, oxycodone is slightly more potent.
It’s best to avoid this unless a healthcare professional tells you to. Prescription-strength naproxen is typically taken as 250 mg to 550 mg twice daily, with a maximum daily dose of 1,375 mg. Higher doses increase the risk of side effects and should only be used under medical guidance.
Over-the-counter (OTC) naproxen has more conservative dosages. The usual dosage is one 220 mg tablet every 8 to 12 hours as needed, and you shouldn’t take more than 660 mg (3 tablets) per day.
In theory, yes. This is because they work differently. Hydrocodone is even 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 such as naproxen, it’s best to talk to a healthcare professional. They can work with you to find a better solution for your pain if your current treatment isn’t working well enough.
Naproxen and oxycodone belong to different medication classes, so their strength can’t be directly compared. Naproxen is an NSAID that reduces inflammation and relieves pain. Oxycodone is an opioid that works on the nervous system to block pain signals.
Compared with hydrocodone, though, oxycodone is slightly more potent.
It’s best to avoid this unless a healthcare professional tells you to. Prescription-strength naproxen is typically taken as 250 mg to 550 mg twice daily, with a maximum daily dose of 1,375 mg. Higher doses increase the risk of side effects and should only be used under medical guidance.
Over-the-counter (OTC) naproxen has more conservative dosages. The usual dosage is one 220 mg tablet every 8 to 12 hours as needed, and you shouldn’t take more than 660 mg (3 tablets) per day.
The bottom line
Naproxen (Aleve, Naprosyn) and hydrocodone (Hysingla ER) are two pain-relieving medications. Nonopioid medications, such as naproxen, have been shown to treat certain types of pain as well as opioids. Generally, it’s best to try a nonopioid alternative before an opioid to avoid the risks of dependence and overdose. But nonopioid medications, such as naproxen, should also be taken 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 professional about the pros and cons of your different treatment options.
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References
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