Tramadol and Aleve: Can You Take Them Together?

When used together, they offer better pain relief

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Tramadol and Aleve (naproxen) can be used together to treat acute pain that is severe enough to require opioid pain medicine. It is safe to do so, and the combination can offer better pain relief than one of the two drugs alone.

Tramadol is often prescribed when other pain relievers do not work well or are not tolerated. Sometimes healthcare providers will prescribe the two medicines in lower doses to offer the best relief without taking too much of either drug.

This article will help you to learn more about tramadol and naproxen, side effects that may occur, how the drug interaction between them works, and why they may be taken together for pain.

Pain Relief

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What Is Tramadol?

Tramadol is an oral drug that can treat ongoing moderate to severe pain. It acts like other opioid analgesics. It works in the brain by changing how the body feels pain and responds to it. Tramadol is available as a generic drug and under several brand names, including:

  • Ultram
  • Ultram ER
  • ConZip

Tramadol is a controlled substance, a drug or other substance that is tightly controlled by the government because it has the potential for abuse or addiction. It is available only as a prescription treatment, where your healthcare provider will need to supervise your use of the drug.

Tramadol comes in many different formulations. which include:

  • Capsules: both immediate and extended-release
  • Tablets: both immediate and extended-release
  • Chewable tablets
  • Suppositories
  • Effervescent tablets and powders
  • Sterile solutions to be given intravenously (through a vein)
  • Solutions that can be given by injection into the spine
  • Oral liquids
  • Tablets combined with acetaminophen, aspirin, or other pain-relieving agents

Tramadol may be prescribed alone or in combination with other drugs. For example, Ultracet is formulated with tramadol and acetaminophen. Tramadol also is available in generic forms.

Side effects of tramadol are mild and will decrease after you have been using the medicine for a while.

Mild side effects of tramadol might include:

  • Nausea or vomiting
  • Constipation
  • Lightheadedness or dizziness
  • Headache
  • Drowsiness
  • Itching

More serious side effects of tramadol might include:

  • Interrupted breathing during sleep (sleep apnea)
  • Mental or mood changes
  • Severe stomach pain
  • Difficulty urinating
  • Adrenal gland dysfunction: Signs include loss of appetite, unusual tiredness, and weight loss

An allergic reaction to tramadol is rare. Call your healthcare provider if you experience signs of an allergic reaction, including rash, itching, swelling of the face, throat, or tongue, severe dizziness, or trouble breathing.

Tramadol and Naproxen Side Effects

Tramadol and Aleve are safe to take together. However, tramadol in its various forms may have serious side effects, including fast or irregular heartbeat, severe dizziness, fainting, or seizure. These may indicate a medical emergency, and you should get immediate medical help.

Opioid Warnings

The risk of addiction to opioid drugs is high. Fortunately, tramadol has a lower risk of addiction. Regardless, it still carries the potential for abuse and is associated with a risk of overdose and death.

A survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that misuse was seen in 8.1% of tramadol users.

People who abuse tramadol are at risk of overdose and possibly death. According to the Centers for Disease Control and Prevention, more than half (51.5%) of drug overdose deaths in the United States involved synthetic opioids, including tramadol, in 2019.

Always take tramadol exactly as your healthcare provider has prescribed. Do not take more than prescribed or share this drug with other people.

What Is Aleve? 

Aleve is a brand name for naproxen. Naproxen belongs to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), drugs commonly used to manage mild to moderate pain, inflammation, and fever.

NSAIDs work by blocking cyclooxygenase, enzymes that promote prostaglandins. Prostaglandins promote inflammation, pain, and fever. Taking an NSAID like naproxen can reduce these symptoms. 

Aleve is used to treat pain from a variety of conditions, including headaches, muscle aches, dental pain, and menstrual cramping. It can also manage joint pain, swelling, stiffness, and inflammation associated with conditions like osteoarthritis (OA) and rheumatoid arthritis (RA). 

The usual adult dose of Aleve ranges from 220 milligrams (mg) to 1,000 mg every eight to 12 hours. The recommended dosage for RA, OA, or ankylosing spondylitis (AS) is 500 mg to 100 mg every 12 hours. Naproxen should be taken with food to reduce stomach upset.

NSAID Warnings

NSAIDs carry a risk of side effects, and older adults and people with chronic conditions might have an increased risk. Most people can tolerate NSAIDs. The side effects experienced are usually mild and can be countered by reducing the dosage or taking another drug to counter them.

Some serious side effects of NSAIDs include:

  • Stomach problems: These might include stomach irritation, abdominal pain, heartburn, gas, diarrhea, constipation, nausea, vomiting, GI bleeding, and ulcers. You can lessen some of these by taking NSAIDs with food, milk, or a proton pump inhibitor or other medication. You should avoid consuming alcohol with NSAIDs to reduce your risk of GI bleeding.
  • Heart attack and stroke: Most NSAIDs can increase the risk of stroke and heart attack. NSAIDs come with a black box warning for this elevated risk. The warning indicates the risk can occur as early as after a few weeks of use, with long-term use, and more likely with higher doses. The risk is present with or without other risk factors for heart disease or stroke.
  • High blood pressure: All NSAIDs can increase blood pressure in people with and without high blood pressure. This side effect can occur even with the use of blood pressure medicines.
  • Kidney problems: The most common kidney problem associated with NSAID use is fluid retention, mainly swollen ankles and feet. According to the National Kidney Foundation, NSAIDs carry an increased risk of sudden kidney failure or damage. The foundation recommends that people who already have reduced kidney function avoid NSAIDs.
  • Allergic reactions: NSAID allergic reactions are rare. Symptoms of an allergic reaction include swollen lips, tongue, or eyes, shortness of breath, wheezing, problems with swallowing, rash, or hives.
  • Bruising or bleeding: NSAIDs affect the blood’s clotting abilities. This may cause easy bruising and cuts that take longer to stop bleeding. People who use blood thinners should talk to their healthcare providers before taking NSAIDs.
  • Other side effects: Some people might experience dizziness, balance problems, or trouble concentrating.

Consult your healthcare provider if you experience serious tramadol and Aleve side effects, or side effects that persist. If you experience more severe or dangerous side effects (such as signs of a stroke or heart attack), get emergency help.

Safety of Using Aleve With Tramadol

Using tramadol with an NSAID may increase side effects, which might be more common in older adults and people with chronic health conditions. However, research has shown it is safe to take tramadol with most NSAIDs for people ages 16 and over.

A study reported in 2016 aimed to determine whether combination therapy of low-dose tramadol and an NSAID can prevent the transition from acute low back to chronic back pain. It confirmed that low-dose tramadol/NSAID combinations could decrease the potential for adverse events while preventing such pain from becoming chronic.

Acute back pain is back pain that develops suddenly, usually as the result of a known injury. It often resolves within days but can last up to six weeks. Chronic back pain is back pain that develops slowly over time, or it may become progressively worse over time. Pain that lasts three or more months is considered chronic.

Always consult your healthcare provider before you change your medication regimen. Discuss whether it is safe to take combination tramadol and Aleve with other medicines you take, including vitamins and supplements.

A Word From Verywell

Tramadol and Aleve are both effective pain relievers for treating chronic and acute pain. But these medications come with many risks, including severe side effects, the potential for overdose and death, and, as might be the case with tramadol, the potential for abuse.

Make sure you take tramadol and naproxen exactly as your healthcare provider has prescribed and for the time they have recommended.

Frequently Asked Questions

  • What is stronger, tramadol or naproxen?

    Tramadol is stronger than naproxen. Tramadol is a synthetic opiate, which is a very strong painkiller. While weaker in comparison, naproxen is considered strong amongst drugs in its class (NSAIDs). It may cause more side effects than Tylenol (acetaminophen) when used to treat conditions like chronic lower back pain.

  • What's the best pain reliever to take with tramadol?

    There are several FDA-approved combinations, including tramadol with Aleve, tramadol with acetaminophen, and tramadol with Seglentis (celecoxib). Your healthcare provider can determine which may be right for you.

  • Do tramadol and Aleve interact with other drugs?

    They can. The FDA cautions their use with a number of other drugs, such as Tegretol (carbamazepine), prescribed to control seizures. Tramadol and naproxen should also not be used while consuming alcohol.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Food & Drug Administration. Tramadol Information.

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  5. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.

  6. Centers for Disease Control and Prevention. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019.

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  11. National Kidney Foundation. Pain medicines (analgesics).

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  13. Johns Hopkins Medicine. 7 ways to treat chronic back pain without surgery.

  14. Peck J, Urits I, Peoples S, Foster L, Malla A, Berger AA, et al. A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain. Pain Ther. 2021 Jun;10(1):69-80. doi:10.1007/s40122-020-00209-w.

  15. Food & Drug Administration. Seglentis.

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By Lana Barhum
Lana Barhum has been a freelance medical writer since 2009. She shares advice on living well with chronic disease.