Indomethacin

Indomethacin is a prescription NSAID used to reduce pain, swelling and stiffness in certain types of arthritis, acute gout attacks and shoulder inflammation. This guide covers indomethacin uses, how it works, dosage, side effects, precautions, drug interactions, use in pregnancy and breastfeeding and its approximate price in India.

At a Glance

What is Indomethacin?

Indomethacin is a prescription non-steroidal anti-inflammatory drug (NSAID) used to reduce inflammation, pain and stiffness in certain arthritis conditions, acute gout attacks and shoulder inflammation. It relieves symptoms but does not change the underlying disease. It has significant gastrointestinal, cardiovascular and kidney-related risks, so it is prescribed for specific inflammatory conditions and should be used under a doctor’s supervision.

How Indomethacin Works

Indomethacin blocks COX enzymes, which make prostaglandins, the chemicals that promote inflammation, pain and swelling. With fewer prostaglandins, inflammation and pain are reduced. The same effect on prostaglandins also explains several side effects, such as stomach irritation and effects on the kidneys.

When Indomethacin Is Used

According to US prescribing information for indomethacin capsules, it is indicated for

• Rheumatoid arthritis, ankylosing spondylitis and osteoarthritis: Moderate to severe disease, including acute flares of long-standing rheumatoid arthritis.
• Acute painful shoulder (bursitis and/or tendinitis): For short-term control of inflammation in the shoulder.
• Acute gouty arthritis: To relieve inflammation and pain during an acute gout attack.

It is not intended as a routine everyday painkiller or fever medicine. A separate intravenous indomethacin product is used in hospital to close a patent ductus arteriosus (a heart vessel that stays open) in certain premature infants. That product is not interchangeable with indomethacin capsules.

Indomethacin Dosage and How to Take It

The dose depends on the condition, the product (immediate-release or extended-release) and how you respond. The examples below come from US prescribing information for indomethacin capsules and are general information only. Your doctor decides the dose.

• Rheumatoid arthritis, ankylosing spondylitis, osteoarthritis (immediate-release capsules): The usual starting dose is 25 mg two or three times a day. If it is well tolerated, the daily dose may be increased by 25 mg or 50 mg at weekly intervals under medical supervision, as needed, until a satisfactory response or a total of 150 to 200 mg a day is reached. The total daily dose should not exceed 200 mg.
• Acute painful shoulder (bursitis and/or tendinitis): 75 to 150 mg a day in 3 or 4 divided doses. The drug should be stopped after the signs and symptoms of inflammation have been controlled for several days.
• Acute gouty arthritis: 50 mg three times a day until the pain is tolerable, and then the dose is reduced rapidly and stopped, as directed by the doctor. Acute gout is treated with the immediate-release regimen, not with extended-release capsules.
• Extended-release (ER/SR) capsules: Dosing depends on the specific ER product label. For example, one US extended-release 75 mg product is given once or twice daily and may be substituted for the immediate-release schedule in some conditions, but not for acute gout. ER/SR products are not interchangeable with immediate-release dosing unless the specific product label says so, and the maximum daily dose depends on the product, so do not switch products or schedules on your own.
• Children: Indomethacin ordinarily should not be prescribed for children 14 years of age and younger, unless a specialist decides that toxicity or lack of effect with other medicines justifies the risk. A child’s dose must be set by the specialist.
• How to take it: Take it exactly as prescribed. To reduce stomach upset, it is usually taken with food or immediately after meals, with a full glass of water, and sometimes with an antacid if your doctor or product label advises it. Taking it with food does not remove the risk of stomach bleeding. Swallow extended-release capsules whole, and do not crush or chew them.

Use the lowest effective dose for the shortest appropriate time, and do not increase the dose on your own.

Side Effects of Indomethacin

Common effects may include:

• Stomach upset, nausea, indigestion, heartburn and stomach pain
• Headache and dizziness
• Ringing in the ears (tinnitus)
• Swelling from fluid retention

Serious effects need prompt medical attention:

• Stomach and intestinal bleeding, ulcers or perforation: black or bloody stools, vomiting blood or severe stomach pain. These can occur without warning and are more likely with long-term use, higher doses and older age.
• Heart attack and stroke: chest pain, trouble breathing, weakness on one side of the body or slurred speech
• Kidney injury: passing much less urine, swelling or sudden weight gain
• Severe allergic reactions: swelling of the face or throat, breathing difficulty or widespread rash
• Serious skin reactions: blistering or peeling rash, or skin sores with fever
• Liver problems: yellowing of the skin or eyes, or dark urine
• Blood abnormalities: unusual bruising or bleeding, severe tiredness or anemia
• Mood and nervous system effects: confusion or depression, especially in older people

Indomethacin Precautions and Monitoring

• Do not use if you have had an allergic reaction (such as asthma, hives or other allergic-type reactions) to indomethacin, aspirin or another NSAID, or for pain around heart bypass surgery (CABG).
• Ask a doctor before use if you are 60 or older, or have had stomach ulcers or bleeding problems, heart disease, high blood pressure, a stroke, heart failure or fluid retention, liver disease, asthma, or if you take blood thinners, antiplatelet medicines, corticosteroids or other NSAIDs. These conditions raise risk but do not always rule out treatment, so your doctor decides.
• Kidney safety: Indomethacin can worsen kidney function. The risk is higher in people with kidney disease or reduced kidney function, dehydration or low blood volume, heart failure, older age, or who take ACE inhibitors, ARBs or diuretics. Your doctor may monitor kidney function if you are at risk. Drink fluids as advised, and tell your doctor if you become dehydrated or have much less urine than usual.
• Fertility and ovulation: NSAIDs, including indomethacin, may temporarily delay or interfere with ovulation. This effect is reversible, and fertility generally returns after stopping the medicine. If you are trying to conceive or having difficulty conceiving, discuss NSAID use with your healthcare professional.
• Alcohol: Alcohol can add to stomach irritation and the risk of bleeding when combined with NSAIDs. Avoid alcohol, or discuss alcohol use with a healthcare professional, especially if you have a stomach ulcer or bleeding history, are older, or take blood thinners or steroids.
• Monitoring: With longer treatment, doctors may check blood pressure, kidney function, liver tests and blood counts, depending on your risks.
• Driving: Indomethacin can cause dizziness or drowsiness in some people, so take care if you drive or operate machinery.
• Do not take other NSAIDs (such as ibuprofen, diclofenac or naproxen) or salicylates together with indomethacin unless your doctor advises it.

Indomethacin Drug Interactions

Interactions are not all absolute, and your doctor will decide whether a combination is appropriate and how closely to monitor you.

• Aspirin and other NSAIDs: Taking them together is not recommended because it raises the risk of stomach bleeding and other side effects, with little added benefit.
• Warfarin and other blood thinners: Raise the risk of bleeding.
• ACE inhibitors and ARBs: NSAIDs can reduce their blood-pressure-lowering effect and add to the risk of kidney problems.
• Diuretics: NSAIDs can reduce their effect and add to kidney risk, particularly with dehydration.
• Lithium and methotrexate: NSAIDs can raise their blood levels, so doctors monitor for toxicity.

Tell your doctor and pharmacist about all prescription medicines, over-the-counter medicines and supplements you take. This list is not complete.

Indomethacin in Pregnancy and Breastfeeding

Pregnancy: NSAIDs, including indomethacin, can harm an unborn baby. The US FDA advises

• From about 20 weeks of pregnancy, NSAIDs should generally be avoided unless a healthcare professional specifically advises otherwise, because they can cause kidney problems in the baby and low amniotic fluid (oligohydramnios).
• Between about 20 and 30 weeks, if an NSAID is considered necessary, it should be used at the lowest effective dose for the shortest possible time. If treatment goes beyond 48 hours, clinicians may consider ultrasound monitoring of the amniotic fluid.
• At about 30 weeks and later, NSAIDs should generally be avoided because they can cause premature closure of a key blood vessel in the baby (the ductus arteriosus).
• Before 20 weeks, NSAID use is not automatically safe, so use indomethacin only when medically appropriate and advised by a healthcare professional.

Breastfeeding: Indomethacin passes into breast milk. Some current product labeling states that indomethacin is not recommended for nursing mothers, while other labels advise weighing the importance of the medicine to the mother against possible risk to the infant. Do not stop breastfeeding on your own. Talk to a healthcare professional about the most appropriate treatment for you.

Indomethacin Brands, Strengths and Approximate Price in India

Examples of indomethacin brands marketed in India include Indocap and Indocid, based on pharmacy listings. This is not an exhaustive list, and availability can change. Listings show 25 mg capsules and 75 mg sustained-release (SR) capsules. SR capsules are different from immediate-release capsules and are not interchangeable without medical advice.

These are listing-based figures from online pharmacy sites, not guaranteed current MRPs. Prices are approximate and vary by brand, strength, pack size, pharmacy, location, availability and date.

How HealthPil Can Help

Medicines should be started, adjusted, or stopped only under the guidance of a qualified healthcare professional. If you have arthritis, gout or inflammation-related pain, you can consult a doctor through HealthPil, including rheumatologists and pain management specialists who can help you find a suitable treatment plan.