GENERIC NAME: Indomethacin

COMMON BRANDS: Indocin, Tivorbex, Indocin SR

Indomethacin is an oral prescription, belongs to a class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs) with anti-inflammatory, analgesic and antipyretic activity. It acts by decreasing the amount of prostaglandins (cyclooxygenase COX-1 and COX-2) produced in your body. Prostaglandins are responsible for pain and inflammation.

Indomethacin oral capsule is available in both brand-name version and generic-name version. The oral capsule is sold under the common brand names “Indocin”. The generic drugs usually cost less than the brand name version.

It’s also available as an oral suspension, rectal suppository and intravenous solution (given by healthcare professionals only).

What is Indomethacin used for?

This drug is used to reduces pain, swelling, and joint stiffness caused by the following conditions:

Rheumatoid arthritis: It is a condition that causes pain, swelling, and stiffness of the joint.

Osteoarthritis: It is a common chronic joint condition that causes pain, stiffness, and other symptoms.

Bursitis: It is a painful condition that affects the small, fluid-filled sacs called bursae that cushion the bones, tendons and muscles near joints.

Spondylitis: It primarily affects the neck and backbone. It causes severe inflammation of the joints of vertebrae that might lead to chronic pain and disability.

How to use Indomethacin?

Read the medication guide carefully given by your pharmacist before you start taking this medicine and whenever you get a refill. If you have any problem or you do not understand any part, discuss with your doctor or pharmacist.

Take this medication orally, usually once in a day with a full glass of water or as advised by your doctor. Do not lie down wait for at least 10 minutes after taking this drug. To avoid gastrointestinal problems (like stomach upset) take this drug with food.

Do not change your dose or take it more frequently than directed by your doctor. Pain medication works best if they are used with the first signs of pain. If you wait until your pain worsens, the medicine may not work well.

Swallow the tablet whole; do not chew it or let it melt/dissolve in your mouth. If you are taking liquid form (oral suspension) shake well just before taking a dose. Measure liquid medicine with the dosing syringe, or with a special dose-measuring spoon or cup.

The dose of the drug in children is based upon their body weight.

The dose depends on the medical condition and treatment response. In adults, take this medication no more than 200mg per day. In children, dosage depends on weight. The maximum dose for children is 4mg/kg/day or 150 to 200mg a day, whichever is less.

It may require up to 4 weeks to get the full benefit of this drug. Use this medication regularly to get the most benefit from it. To avoid missing of dose take this drug at the same time each day.

What are the side effects of Indomethacin?

The common side effects observed with the use of this drug are abdominal pain, diarrhoea, stomach problems, nausea, vomiting, dizziness, headache, itching or rash. If any of these effects remain or get worse, notify your doctor immediately.

This drug rarely causes severe, possibly fatal liver damage and can even lead to liver failure. The symptoms of liver damage are persistent nausea, vomiting, weakness, severe stomach/abdominal pain, dark urine, yellow discolouration of the sclera in the eyes or skin. If you notice any of these effects, stop taking indomethacin and consult your doctor or pharmacist right away.

Get emergency medical assistance if you notice symptoms of GIT bleeding or ulcers such as stomach pain or abdominal pain, black/sticky stools and bloody vomit.

This drug may increase your blood pressure. Consult your doctor if you observe symptoms of extremely high blood pressure like a headache, dizzy spells and nosebleed.

Seek medical assistance promptly, if you notice any severe side effects, like easy bruising/bleeding, hearing problems (like ringing in the ears), mental/mood changes, signs of kidney problems (like change in the amount of urine), stiff neck, vision changes, symptoms of heart failure (like swelling ankles/feet, unusual tiredness).

This document does not include all possible side effects. If you see other side effects not listed above, reach out to your doctor or pharmacist.

What are the precautions while using Indomethacin?

Inform your doctor/pharmacist before taking indomethacin, if you are allergic to it; or if you have other allergies (including aspirin and other NSAIDs like meloxicam, diclofenac, naproxen etc.). This drug may also contain some inactive ingredients that can cause allergic reactions or other problems. Talk to your doctor/pharmacist for more information.

Inform your doctor/pharmacist about all the products you are using including prescription, non-prescription, vitamins, nutritional supplements, and herbal products.

Before taking Indomethacin, discuss with your doctor or pharmacist about your medical history especially of asthma, severe kidney disease, recent heart bypass surgery (CABG), active bleeding/sores in stomach/intestines (ulcer, gastrointestinal bleeding), blood disorders (like anemia), high blood pressure, diabetes, liver disease, nasal polyps, obesity, tobacco use, stroke, swelling of the ankles/feet/hands.

Indomethacin may cause stomach or intestinal bleeding, which can be fatal, older adults are more susceptible to this condition. Regular use of this drug with alcohol and tobacco may increase your chances for stomach bleeding. Restrict the use of alcohol and stop smoking. Consult your doctor/pharmacist for further information.

NSAIDs like Indomethacin sometimes can cause kidney problem which is more likely to occur if you have kidney disease or have heart failure, in severe dehydration, or an older adult. To avoid kidney problems take plenty of water. Notify your doctor instantly if you have a change in the amount of urine.

If you are using this medication, you may be more sensitive to sun exposure. Limit your time under sun exposure. Avoid tanning booths and sunlamps. Use sun protection (such as sunscreen) and wear protective clothing when you are going outdoors. Inform your doctor as soon as possible if you get sunburns or if you have blisters or redness on your skin.

Children can be more susceptible to the side effects of this drug, especially side effects like serious liver problems. Caution must be taken, when this drug is used in children. Discuss the risks and benefits of treatment with your doctor.

Older adults are susceptible to the side effects of this drug especially to stomach bleeding and kidney problems. Therefore, caution is required while using this drug in older adults.

During pregnancy, use this medication only when benefits outweigh the risk and only if prescribed by your doctor. This drug is not recommended during pregnancy as it may harm to the fetus and interference with normal delivery/labour.

This drug may cross into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breastfeeding.

What are the drug interactions of Indomethacin?

Indomethacin may interact with other medications, herbs, or vitamins you may be using. A drug interaction is when a substance changes the way a drug works which can be harmful or block the drug from working well.

Do not start, stop, or alter the dose of the drug without consulting your doctor because your doctor may be monitoring you for all possible drug interactions.

Some products that may interact with indomethacin are aliskiren, ACE inhibitors (like captopril, lisinopril), angiotensin II receptor blockers (like losartan, valsartan), cidofovir, corticosteroids (like prednisone), or diuretics (like furosemide), ketorolac.

Indomethacin may increase the levels of certain mental health drug like lithium in your body. Symptoms of lithium toxicity include slurred speech and tremors.

Taking “blood thinners” such as dabigatran/enoxaparin/warfarin and anti-platelet drugs such as clopidogrel with Indomethacin increases the risk of severe stomach bleeding.

Take advice from your doctor/pharmacist before using any over-the-counter medicine for cold, allergy, or pain. Many over-the-counter medications contain aspirin or other NSAIDs similar to Indomethacin (such as mefenamic acid, naproxen, diclofenac, etc.). Taking these products together with Indomethacin can increase the concentration of Indomethacin in your body which may result in severe side effects. Read the medication label carefully to check if the medicine contains aspirin or any other NSAIDs. However, you should continue using aspirin if you are already using it for the prevention of heart attack or stroke but only on doctor’s advice.

Indomethacin like some other NSAIDs may interfere with specific laboratory tests, giving a false test result. Make sure that laboratory personnel and all your doctors know you use this drug.

WARNINGS:

Heart risk:

NSAID’s like indomethacin may increase the risk of heart problems, such as blood clot, stroke, heart attack or heart failure which can be fatal. The risk may increase if you already have heart disease or have taken Indomethacin for an extended period or at high doses.

Coronary artery bypass graft (CABG) warning:

This drug is contraindicated for the treatment of pain before coronary artery bypass graft (CABG) surgery (heart surgery is done to increase blood flow to the heart). Taking this drug before surgery may increase the risk of heart attack and stroke.

Gastrointestinal:

This drug may increase your risk of stomach problems, like bleeding, or peptic ulcers which can be fatal. These conditions can occur at any time and without any warning signs. If you are above 65 years, you may have a higher chance of developing severe stomach issues.

What are the forms and strengths of Indomethacin?

Generic: Indomethacin
Form: Oral immediate-release capsule
Strengths: 25 mg and 50 mg

Form: Oral extended-release capsule
Strengths: 75 mg

What is the dosage of Indomethacin?

For Moderate to Severe Rheumatoid Arthritis:

Adult dosage (18 years and older):

Immediate-release capsule: Typical dosage is 2 to 3 times per day and starts at a dose of 25mg. The dose may be increased by 25 or 50mg per day. Maximum dose: 200mg per day.

Extended-release capsule: The dose is 75mg once or twice per day. The maximum dose is 150mg per day.

Children (0-17 years):

Dosage depends on weight in this age group.

Immediate-release capsule:

Starting dose: Take 1–2 mg/kg per day divided into 2–4 doses.
Maximum dose: Take 3mg/kg per day or 200 mg per day, whichever is less.

Extended-release capsule: A safety and efficacy of extended-release capsule dosage have not been established for this age group.

For Moderate to Severe Ankylosing Spondylitis:

Adult dosage (18 years and older):

Immediate-release capsule: Take 2 to 3 times per day and starts at a dose of 25mg. The dose may be increased by 25 or 50mg per day. The maximum dose is 200mg per day.

Extended-release capsule: Take 75 mg once or twice per day. The maximum dose is 150mg per day.

Children (0-17 years):

Dosage depends on weight in this age group.

Immediate-release capsule:

Typical starting dose: Take 1–2 mg/kg per day divided into 2–4 doses.
Maximum dose: Take 3 mg/kg per day or 200mg per day, whichever is less.

Extended-release capsule: A safety and efficacy of extended-release capsule dosage have not been established for this age group.

For Moderate to Severe Osteoarthritis:

Adult dosage (18 years and older):

Immediate-release capsule:

Typical dosage: Take 2 to 3 times per day and starts at a dose of 25mg. The dose may be increased to 25 or 50mg per day.
Maximum dose: 200 mg per day.

Extended-release capsule: Take 75 mg once or twice per day. The maximum dose is 150mg per day.

Children (0-17 years):

Dosage depends on weight in this age group.

Immediate-release capsule:

Typical starting dose: Take 1–2 mg/kg per day divided into 2–4 doses.
Maximum dose: Take 3 mg/kg per day or 200mg per day, whichever is less.

Extended-release capsule: Safety and efficacy of extended-release capsule dosage have not been established for this age group.

For Acute Painful Shoulder (bursitis or tendinitis):

Adult dosage (18 years and older):

Immediate-release capsule: Take 75–150mg in 3 or 4 divided doses per day for 7–14 days.

Extended-release capsule: Take 75mg once or twice per day. The maximum dose is 150mg per day.

Children (0-17 years):

Dosage depends on weight in this age group.

Immediate-release capsule:

Starting dose: Take 1–2mg/kg per day divided into 2–4 doses.
Maximum dose: 3mg/kg per day or 200mg per day, whichever is less.

Extended-release capsule: A safety and efficacy of extended-release capsule dosage have not been established for this age group.

For Acute Gouty Arthritis (immediate-release capsule only):

Adult dosage (18 years and older):

Typical dose: Take 50 mg 3 times per day until your pain improves.

Children (0-17 years):

Dosage depends on weight in this age group.

Starting dose: Take 1–2mg/kg per day divided into 2–4 doses.
Maximum dose: 3mg/kg per day or 200mg per day, whichever is less.

Most common questions asked about Indomethacin / Q&A’s:

What are the symptoms of Indomethacin overdose?

Indomethacin overdose symptoms may include nausea, vomiting, headache, dizziness, confusion, extreme tiredness, feeling of numbness, burning, pricking, or creeping on the skin and seizures. Seek a medical emergency as soon as possible if you experience any of these symptoms.

Disclaimer

TheMedPharma has made every effort to make sure that all the information is factually correct, comprehensive, and up-to-date. However, this website should not be considered as a substitute for the advice, knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or licensed health care professional before taking any medication. The drug information contained herein is subjected to changes if required. The lack of warnings or other information for a given drug does not mean that the drug or its combination is safe, effective or appropriate for use in all patients.