Mixing Tramadol and Aleve: What You Should Know – Verywell Health

Mary Choy, PharmD, is board-certified in geriatric pharmacotherapy and is an active leader in professional pharmacy associations.
Tramadol and Aleve (naproxen) in combination can be used to treat acute pain that is severe enough to require opioid pain medicine. Tramadol is often prescribed when other pain relievers do not work well or are not tolerated.
When used together, tramadol and naproxen can offer better pain relief than one of the two drugs alone. Sometimes healthcare providers will prescribe the two medicines in lower doses to offer the best relief without taking too much of either drug. Learn more about tramadol and Aleve and whether it is safe to take them together.
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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—Ultram, Ultram ER, Ryzolt, and 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:
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:
More serious side effects of tramadol might include:
Make sure you get medical help for serious side effects. 
Significant side effects, including fast or irregular heartbeat, severe dizziness, fainting, or seizure, might be signs of a medical emergency, and you should get immediate medical help.
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.
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, drug overdose death involving synthetic opioids, including tramadol, rose 45% from 2016 to 2017.
Always take tramadol exactly as your healthcare provider has prescribed. Do not take more than prescribed or share this drug with other people.
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 arthritis 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.
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 (such as proton pump inhibitors to manage gastrointestinal [GI] side effects).
Some serious side effects of NSAIDs include:
Consult your healthcare provider if you experience serious 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.
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 the low-dose tramadol/NSAID combination could decrease the potential for adverse events while preventing acute low back 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/naproxen therapy with other medicines you take, including vitamins and supplements.
Tramadol and Aleve are both effective pain relievers for treating chronic and acute pain. But these medications with come 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.
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United States Drug Enforcement Administration. Drug scheduling
World Health Organization. Tramadol: Update Review Report.
Shmerling RH. Is tramadol a risky pain medication? Harvard Health.
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.
Centers for Disease Control and Prevention. Drug overdose deaths in the United States, 1999–2017.
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
National Institutes of Health. Label: Bayer Aleve- naproxen sodium tablet.
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Cleveland Clinic. Non-steroidal anti-inflammatory drugs (NSAIDs).
US Food and Drug Administration. FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes.
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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
Nava A. 7 ways to treat chronic back pain without surgery. Johns Hopkins Medicine.

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