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
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Do not use either drug in the third trimester of pregnancy.
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Avoid in patients with active ulcers or GI bleeding.
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Use caution in patients with kidney disease, heart failure, or hypertension.
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Seek immediate help for bloody stools, chest pain, weakness on one side, or mental confusion.
