Can you take Excedrin and naproxen (Aleve) together?

Why

Most people think of Excedrin as "the headache one" and don't register that it is an aspirin product. The DailyMed label for Excedrin Extra Strength lists, in each caplet: "Acetaminophen 250 mg", "Aspirin 250 mg (NSAID)" and "Caffeine 65 mg". Aspirin is a nonsteroidal anti-inflammatory drug, the same class as naproxen. Aleve is "Naproxen sodium 220 mg (naproxen 200 mg) (NSAID)" per caplet. Taking both stacks two drugs that block the same COX enzymes — the mechanism that thins the protective prostaglandin layer of the stomach lining and reduces renal blood flow — so you double the gastrointestinal-bleed and kidney risk without doubling the analgesia; naproxen also carries an FDA warning that aspirin does not ("NSAIDs, except aspirin, increase the risk of heart attack, heart failure, and stroke. These can be fatal. The risk is higher if you use more than directed or for longer than directed."). Each label warns about the other. Excedrin's "Stomach bleeding warning" says the chance of severe stomach bleeding is higher if you "take other drugs containing prescription or nonprescription NSAIDs (aspirin, ibuprofen, naproxen, or others)"; the Aleve Drug Facts carry the same bullet. The prescription naproxen label is blunt about the futility: "Controlled clinical studies showed that the concomitant use of NSAIDs and analgesic doses of aspirin does not produce any greater therapeutic effect than the use of NSAIDs alone. In a clinical study, the concomitant use of an NSAID and aspirin was associated with a significantly increased incidence of GI adverse reactions as compared to use of the NSAID alone." So the trade is real added bleed risk for no added benefit. There is a second overlap: acetaminophen. Which Excedrin you hold decides the ceiling, so read the Active ingredients panel on the box — that panel, not any list, is the authority. Most Excedrin variants (Extra Strength, Migraine, Menstrual Complete) contain aspirin 250 mg per caplet and collide with Aleve; only Excedrin Tension Headache ("Acetaminophen 500 mg" plus "Caffeine 65 mg") is aspirin-free, though its acetaminophen ceiling still applies. The per-product daily maximums differ and are not interchangeable: Excedrin Extra Strength is "not more than 8 caplets in 24 hours" (2,000 mg acetaminophen, 2,000 mg aspirin); Excedrin Migraine is capped far lower — "Do not take more than 2 caplets in 24 hours" (500 mg acetaminophen, 500 mg aspirin) and is labeled for adults only ("Under 18 years of age: ask a doctor"); Excedrin Tension Headache is "not more than 6 caplets in 24 hours" (3,000 mg acetaminophen). Acetaminophen from all sources must stay under the amount MedlinePlus states — "do not take more than 4000 mg of acetaminophen per day from all sources" — so any Tylenol, NyQuil, Midol or acetaminophen-containing prescription opioid counts against the same budget, and Excedrin's own label says "Do not use... with any other drug containing acetaminophen." Separately, if you take low-dose aspirin daily for your heart, that is a different question with a real interaction of its own: naproxen can blunt aspirin's antiplatelet effect. The FDA naproxen label reports "A pharmacodynamic (PD) study has demonstrated an interaction in which lower dose naproxen (220mg/day or 220mg twice daily) interfered with the antiplatelet effect of low-dose immediate-release aspirin, with the interaction most marked during the washout period of naproxen," and advises that "for patients taking low-dose aspirin for cardioprotection who require intermittent analgesics, consider use of an NSAID that does not interfere with the antiplatelet effect of aspirin, or non-NSAID analgesics where appropriate." The Aleve consumer label puts it plainly: ask a pharmacist first if you are "taking aspirin for heart attack or stroke, because naproxen may decrease this benefit of aspirin." Note that the 250 mg of aspirin per caplet in Excedrin (500 mg at the usual 2-caplet dose) is not a substitute for your cardiologist's low-dose aspirin regimen either — the naproxen label states, "Naproxen Tablets are not substitutes for low dose aspirin for cardiovascular protection."