Based on NIH | Is it safe to take naproxen on an empty stomach if I smoke, or does smoking increase the risk of stomach irritation, ulcers, or bleeding?

Taking naproxen on an empty stomach is generally not recommended especially if you smoke because smoking is one of several factors that can increase the risk of stomach irritation, ulcers, and gastrointestinal (GI) bleeding from NSAIDs like naproxen. Using naproxen with food, milk, or an antacid can help reduce stomach upset, and avoiding smoking and alcohol can lower the risk of serious GI side effects. ^{[1] [2]}

Why smoking matters with naproxen

• Higher GI risk with NSAIDs: Naproxen (a nonsteroidal anti‑inflammatory drug, NSAID) can injure the stomach and intestines, leading to ulcers and bleeding, sometimes without warning. ^{[3] [4]}
• Smoking increases risk: Smoking is specifically listed as a factor that increases the chance of ulcers and bleeding while using NSAIDs. ^{[3] [4]}
• Other risk multipliers: Older age, prior ulcers or GI bleeding, taking blood thinners (anticoagulants), steroids, or certain antidepressants (SSRIs/SNRIs), drinking alcohol, higher doses, and longer use also raise risk. ^{[3] [4]}

Empty stomach vs. with food

• Empty stomach may worsen irritation: While naproxen can be absorbed on an empty stomach, labeling warns of severe stomach bleeding risks and advises steps to reduce irritation; taking with food or milk is commonly recommended to lessen stomach upset. This is particularly important if you smoke, because baseline risk is already higher. ^{[1] [2]}
• Do not exceed directions: Using more than directed or for longer than directed further increases GI risk. ^{[2] [5]}

How big is the risk?

• Established association: Long‑term NSAID use can cause GI ulcers and potentially life‑threatening complications. Risk rises with smoking, alcohol, older age, previous ulcer, steroids, and higher doses. ^{[6] [7]}
• Epidemiologic signal: Use of non‑aspirin NSAIDs has been linked with increased gastric ulcer risk in population studies; bleeding risk is higher with aspirin and increases with age, and signals with NSAIDs are also observed. ^[8]

Practical safety tips

• Take with food or milk: This can help reduce stomach irritation from naproxen. Consider taking after a meal rather than on an empty stomach. ^{[1] [2]}
• Avoid combining risks: Try not to drink alcohol while taking naproxen, and avoid taking multiple NSAIDs together. If you smoke, cutting back or quitting can meaningfully lower your GI risk while on NSAIDs. ^{[1] [2]}
• Use the lowest effective dose for the shortest possible time: This helps limit GI and cardiovascular risks. ^{[2] [5]}
• Know when to seek help: Stop the medicine and seek care if you develop symptoms like stomach pain that doesn’t go away, black/tarry stools, or vomiting blood/coffee‑ground material. These can be signs of bleeding. ^{[1] [2]}

Who may need extra protection

• Higher‑risk users (e.g., smokers, adults ≥60, history of ulcers, on steroids, anticoagulants, or SSRIs/SNRIs) may benefit from medical review before using naproxen. A clinician may suggest a protective stomach medicine such as a proton pump inhibitor (PPI), an H2‑blocker, or misoprostol if NSAIDs are needed. ^{[6] [9] [7]}

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Quick reference: Key risk factors for NSAID‑related GI harm

Risk factor	Effect on GI risk	Notes
Smoking	Increases risk of ulcers/bleeding	Consider avoiding taking naproxen on an empty stomach; reduce or quit smoking if possible. [3] [4]
Alcohol use	Increases risk of stomach bleeding	Avoid alcohol while using naproxen. [1] [2]
Age ≥60	Higher bleeding risk	Use lowest effective dose, shortest duration. [2] [5]
Prior ulcer or GI bleed	Strongly increases risk	Consider gastroprotection if NSAID is necessary. [3] [9]
Anticoagulants, steroids, SSRIs/SNRIs	Increases bleeding risk	Ask a clinician about safer alternatives or protection. [3] [4]
High dose/long duration	Increases risk	Adhere strictly to label dosing. [3] [2]

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Bottom line

• If you smoke, taking naproxen on an empty stomach may further irritate your stomach and adds to an already higher risk of ulcers and bleeding from NSAIDs. ^{[3] [4]}
• It’s safer to take naproxen with food or milk, avoid alcohol, stick to the lowest effective dose for the shortest time, and consider talking to a clinician about protective options if you have additional risk factors. ^{[1] [2] [9]}