7 Common OTC Painkillers That Could Be Hurting Your Gut Microbiome

5. Naproxen (Aleve): Prolonged Action, Possible Microbial Disruption

Naproxen, commonly found under the brand name Aleve, is another staple for easing long-lasting aches—think arthritis, back pain, or menstrual cramps. Its ability to tame pain for hours makes it a favorite for those who need sustained comfort. However, prolonged or frequent use may have consequences for the gut. Like other NSAIDs, naproxen can irritate the stomach lining and, new evidence suggests, alter the mix of bacteria in the gut. While much of the research is grouped with ibuprofen’s effects, early findings point to a similar risk for disturbing the microbiome. If Aleve is part of your regular routine, try to take “gut breaks” when you can, stick to the recommended dose, and incorporate gut-friendly foods or habits. A simple log of when and how you take these medications can also provide helpful patterns for you and your doctor to review together.

6. Tramadol: Prescription-Strength Relief Now OTC in Some Regions

Tramadol belongs to a different class than most OTC painkillers, but is sometimes available without a prescription in limited formulations. Frequently given for more serious or chronic pain, especially after injuries or surgeries, tramadol was highlighted in recent microbiome research for its role in driving bacterial mutation and resistance. The gut seems to respond to tramadol by changing both the number and types of bacteria present, which may make antibiotics less effective down the line. While tramadol remains prescription-only in the US for most uses, it’s important to recognize its presence in combination products or in other countries’ OTC aisles. If you have been prescribed tramadol, consider reviewing your entire medication list with your provider—especially if you’re taking several painkillers routinely. Gut health is just one reason among many to approach all medicines with self-compassion and steady support.