Comparison Table: Naproxen vs Tolfenamic Acid
| Category | Naproxen | Tolfenamic Acid |
|---|---|---|
| 1. Drug Class | NSAID (non-selective COX inhibitor) | NSAID (fenamate class) |
| 2. Mechanism of Action | Inhibits COX-1 & COX-2 → reduces prostaglandins | Inhibits COX enzymes → reduces prostaglandins |
| 3. Primary Use | Pain, inflammation, arthritis | Migraine, musculoskeletal pain |
| 4. Onset of Action | 1 hour | 30–60 minutes |
| 5. Duration of Action | 8–12 hours | 4–6 hours |
| 6. Half-life | 12–17 hours | ~2–3 hours |
| 7. Formulations | Tablets, suspensions, gel, suppository | Tablets only |
| 8. Approval | Widely approved worldwide (FDA) | Not FDA-approved in USA (used in Asia & Europe) |
| 9. Availability | Over-the-counter & prescription | Prescription-only in most countries |
| 10. GI Tolerance | Moderate GI side effects | Higher GI irritation risk |
| 11. Renal Effects | Risk of renal impairment with long use | Less studied but potentially nephrotoxic |
| 12. Cardiovascular Risk | Possible ↑ risk (esp. with high dose) | Lower data, but assumed similar risk |
| 13. Anti-inflammatory Power | Strong for chronic use (e.g., arthritis) | Mild to moderate, short-term only |
| 14. Use in Migraine | Not first-line; may help mild migraine | Specifically effective in migraine |
| 15. Use in Menstrual Pain | Effective | Also effective; often preferred in dysmenorrhea |
| 16. Metabolism | Liver (CYP enzymes) | Liver |
| 17. Elimination | Renal (main route) | Hepatic & renal |
| 18. Pediatric Use | Safe in children (above 2 years) | Not recommended in children |
| 19. Pregnancy Category | C (1st/2nd tri), D (3rd trimester) | Not recommended; Category C |
| 20. Cost | Affordable, widely available | Less available, moderately priced |
✅ Indications
| Drug | Indications |
|---|---|
| Naproxen | Osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, tendonitis, bursitis, gout, dental pain, menstrual cramps, general pain |
| Tolfenamic Acid | Acute migraine, tension headache, musculoskeletal pain, postoperative pain, dysmenorrhea |
❌ Contraindications
| Drug | Contraindications |
|---|---|
| Naproxen | Peptic ulcer, GI bleeding, severe heart failure, renal failure, NSAID allergy, pregnancy (3rd trimester) |
| Tolfenamic Acid | Peptic ulcer, GI bleeding, asthma, renal or hepatic impairment, hypersensitivity to fenamates, pregnancy, breastfeeding |
💊 Dosage (Adults)
| Drug | Typical Dose |
|---|---|
| Naproxen | 250–500 mg every 12 hours (max: 1,000–1,500 mg/day) |
| Tolfenamic Acid | 200 mg initially, then 100 mg after 8 hours if needed (max: 400 mg/day) |
⚠️ Warning Signs (Stop Use & See Doctor If…)
| Drug | Warning Signs |
|---|---|
| Naproxen | Black stools, stomach pain, vomiting blood, chest pain, swelling, vision changes, yellowing skin, trouble breathing |
| Tolfenamic Acid | Severe stomach pain, vomiting blood, rash, shortness of breath, liver pain, jaundice, dizziness, vision disturbance |
🔍 Which One is Best and Safer?
| Aspect | Comparison |
|---|---|
| Efficacy | Naproxen is better for chronic pain and inflammation; Tolfenamic Acid is more migraine-specific |
| Safety | Naproxen has more data, is FDA-approved, and safer in regulated use; Tolfenamic Acid lacks long-term safety studies |
| Availability | Naproxen is more accessible globally |
| Preferred For | Long-term pain: Naproxen; Acute migraine: Tolfenamic Acid |
| Overall Safer | ✅ Naproxen, due to global approval, broader indications, and more research backing |
