Comparison Table: Naproxen vs Indomethacin
| Category | Naproxen | Indomethacin |
|---|---|---|
| 1. Drug Class | NSAID (Nonsteroidal Anti-inflammatory Drug) | NSAID (Nonsteroidal Anti-inflammatory Drug) |
| 2. Mechanism of Action | Inhibits COX-1 and COX-2 enzymes → reduces prostaglandins | Inhibits COX-1 and COX-2 enzymes → reduces prostaglandins |
| 3. Onset of Action | Slower (1–2 hours) | Faster (30–60 minutes) |
| 4. Duration of Action | Long-acting (8–12 hours) | Shorter duration (4–6 hours) |
| 5. Formulations | Tablet, capsule, suspension | Capsule, suppository, injection |
| 6. Dosing Frequency | Usually 2 times/day | 2–4 times/day |
| 7. Common Adult Dose | 250–500 mg twice daily | 25–50 mg 2–4 times daily |
| 8. Pediatric Use | Approved for children over 2 years | Generally not recommended for children |
| 9. Indications | Arthritis, menstrual cramps, gout, tendonitis, pain | Gout, ankylosing spondylitis, osteoarthritis, RA, PDA closure |
| 10. Preferred for Gout? | Useful for mild-moderate gout | First-line for acute gout attack |
| 11. GI Side Effects | Moderate risk of ulcers and bleeding | High risk of ulcers, gastritis |
| 12. CNS Side Effects | Rare headaches | Common: headache, dizziness, confusion |
| 13. Renal Risk | Moderate risk of kidney injury | Higher risk of nephrotoxicity |
| 14. Cardiovascular Risk | Lower than indomethacin | Higher cardiovascular risk (BP, stroke) |
| 15. Pregnancy Safety | Avoid in 3rd trimester | Avoid, especially in late pregnancy |
| 16. Breastfeeding | Generally safe | Caution advised |
| 17. Drug Interactions | Interacts with blood thinners, lithium, diuretics | More frequent and severe interactions |
| 18. Contraindications | Active GI bleed, NSAID allergy, severe renal disease | Same, plus caution in psychiatric or seizure disorders |
| 19. Warning Signs | Black stool, chest pain, shortness of breath | Same, plus confusion, mental changes |
| 20. Long-Term Use Safety | Better tolerated long-term | Not ideal for long-term due to CNS/GI risk |
✅ Which One Is Better or Safer?
| Context | Best Choice |
|---|---|
| General pain or arthritis | Naproxen (better tolerated) |
| Acute gout attack | Indomethacin (more potent, faster relief) |
| Long-term therapy | Naproxen (safer for prolonged use) |
| Patients with high blood pressure or heart disease | Naproxen (lower CV risk) |
| Elderly patients or those with CNS sensitivity | Naproxen (fewer mental side effects) |
⚠️ Key Warnings for Both Drugs
Do not use either drug in the third trimester of pregnancy.
Avoid in patients with active ulcers or GI bleeding.
Use caution in patients with kidney disease, heart failure, or hypertension.
Seek immediate help for bloody stools, chest pain, weakness on one side, or mental confusion.
