What to Know About Indomethacin

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve joint pain, swelling, and stiffness in various arthritis conditions. It works by blocking the body’s production of natural substances that cause inflammation, swelling, and pain.

Forms of indomethacin include an oral capsule, oral liquid, or a rectal suppository. It is marketed under the brand names Indocin and Tivorbex, and also as a generic drug.

Uses

Indomethacin can help to reduce inflammation, pain, and fever. Indomethacin can be given alone to treat an acute (temporary) condition or as a part of combination therapy for a chronic condition. Healthcare providers will prescribe indomethacin to treat:

• Moderate to severe rheumatoid arthritis (RA), osteoarthritis (OA), or ankylosing spondylitis (AS)
• Acute painful shoulder from conditions like bursitis or tendonitis
• Acute gouty arthritis

In chronic conditions such as RA, OA, or AS, you would take indomethacin as part of your treatment plan to manage or reduce flare-ups (periods of high disease activity) or when you experience periods of high inflammation.

Before Taking

Before starting indomethacin, your healthcare provider will weigh the risks of this drug against the benefits of using it. They will want to know about any allergies you have to any medications, foods, dyes, preservatives, or animal products.

According to the Food and Drug Administration (FDA), certain groups of people should not take indomethacin. It should not be given to children younger than age 14 because the safety and effectiveness of the drug have not been established in this group.

Older adults might be more sensitive to the effects of the medicine and are more likely to experience more unwanted side effects, including stomach issues and kidney problems. There hasn’t been enough evidence to determine if indomethacin is safe to use if you are breastfeeding.

Some medications should not be used with indomethacin. People who take antidepressants should check with their healthcare providers if it’s safe to take indomethacin.

You should also check with your healthcare provider if it is safe to take indomethacin with the following medicines:

• Cyclosporine
• Lithium
• Methotrexate
• Probenecid
• Heart or blood pressure medications, including diuretics
• Blood thinners
• Other NSAIDs, including celecoxib, diclofenac, and meloxicam

This list is not a complete one. Other drugs could interact with indomethacin, including over-the-counter medicines, vitamins, and herbs.

People with certain conditions should let their healthcare providers know about these before starting indomethacin. These include:

• Heart disease
• High blood pressure
• Bleeding disorders
• Stomach ulcers or bleeding
• Asthma
• Liver or kidney problems

You should also let your healthcare provider know if you smoke, as smoking might increase the side effects of indomethacin or affect the way the drug works. Smoking can also increase the risk for gastrointestinal side effects and complications.

Other NSAIDs

Other NSAIDs include:

• Celebrex (celecoxib)
• Clinoril (sulindac)
• Feldene (piroxicam)
• Motrin, Advil, Mediprin, Nuprin (ibuprofen)
• Orudis, Oruvail, Actron (ketoprofen)
• Lodine (etodolac)
• Mobic (meloxicam)
• Naprosyn, Aleve, Naprelan, Anaprox (naproxen)
• Relafen (nabumetone)
• Voltaren (diclofenac sodium)

Dosage     

Oral indomethacin comes in immediate-release capsules and extended-release capsules. The immediate-release capsules come in 25 milligrams (mg) and 50 mg strengths, while the extended-release capsules are available in a 75 mg strength. 

It is taken by mouth, usually two or three times a day, with a full glass of water. If you experience upset stomach while taking indomethacin, take it with food or milk.

Indomethacin can also be taken as a suppository to be used rectally. Make sure you follow all the directions on the prescription label or as your healthcare provider has instructed.

If you are taking indomethacin because you have persistent night pain or morning stiffness, discuss dosage and timing with your healthcare provider, as they may recommend giving a larger portion of the daily dose at bedtime (not to exceed 100 mg).

To reduce the risk of gastrointestinal problems or other side effects, your healthcare provider will prescribe this medication at the lowest effective dose for the shortest time possible. Don’t increase your dose without talking to your healthcare provider first.

If you miss a dose, take it as soon as you can. If it is time to take the next dose, take that dose only. Do not take double doses to try to make up for a missed dose.

Side Effects

The most common side effects of indomethacin are diarrhea, dizziness, headache, and heartburn. These usually go away once your body gets used to the medicine. However, you should contact your healthcare provider if they continue or are severe.

You should let your healthcare provider know if you experience more serious side effects. These might include:

• An allergic reaction
• Difficulty breathing or wheezing
• Severe skin symptoms
• Signs of internal bleeding: Bloody, black, or tarry stools; red or dark-brown urine; spitting up blood or brown material; red spots on the skin; unusual bruising; bleeding from the eyes, nose, or gums
• Signs of a blood clot: Vision changes; chest pain; severe headache; problems speaking; sudden numbness or weakness of the face, arm, or leg; trouble with walking
• Unexplained weight gain
• Unexplained swelling
• Feeling weak or extremely tired
• Yellowing of the eyes or skin

Warnings and Interactions

Indomethacin (and other NSAIDs) may increase the risk for heart attack or stroke. This could happen any time while taking the medication, but it is more likely the longer you are on the drug. This risk is higher if you have heart disease, are older, or have risk factors for heart disease, including smoking, family history, high blood pressure, or diabetes.

While rare, indomethacin can cause stomach or intestinal bleeding. This can occur at any time while taking this drug. Older adults seem to have a higher risk.

If you take too much indomethacin, you could experience an overdose. If you think you are experiencing an overdose, contact a poison control center or go to an emergency room right away.

Signs of an NSAID overdose might include ringing in the ears, blurred vision, a severe headache, breathing difficulties, stomach pain, low blood pressure, weakness, confusion, extreme agitation, or anxiety.

Talk to your healthcare provider if you have concerns about using indomethacin or think you may have severe side effects or a reaction to the drug. Your healthcare provider can discuss the risk and benefits of treating with indomethacin and help you to decide if it’s right for you.