Indomethacin (Indocin) is a medication used to treat moderate to severe pain, swelling and stiffness from arthritis.
Indomethacin belongs to a class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs).
These drugs treat swelling, pain and fever, blocking the production of substances in the body called prostaglandins, which regulate inflammation and other bodily processes.
Indomethacin is approved for treatment of:
- Moderate or severe osteoarthritis (arthrosis due to wear and tearing)
- Rheumatoid arthritis (inflammatory arthritis)
- Ankylosing spondylitis (inflammatory arthritis of the spine)
Doctors can also use Indomethacin to treat bursitis (inflammation of the shoulder joint), gout or arthritic arthritis (a form of arthritis caused by the appearance of uric acid crystals inside the joints) and inflammation of the tendons (a tissue that attaches muscles to the bones).
The Food and Drug Administration (FDA) approved Indomethacin in 1965 for the pharmaceutical company Iceutica Operations under the Indocin brand.
Today, several drug manufacturers make general versions of the drug. It is also sold under other trademarks, including Indo-Lemmon and Tivorbex.
Indomethacin and other NSAIDs can cause a heart attack and stroke.
They can occur without warning and can be fatal. This risk may increase if you take Indomethacin for a long period of time.
You may also have an increased risk if you have a history of heart disease or high blood pressure. Taking indomethacin can cause high blood pressure or worsen it, and high blood pressure is a risk factor for developing a stroke and heart attack.
Indomethacin and other NSAIDs can cause ulcers, perforations and sudden bleeding in your stomach or intestines.
This can happen at any time during treatment. You may have an increased risk of GI bleeding if you are an elderly person, drink a lot of alcohol, smoke, feel bad, or take any medications that dilute blood.
You may also be at a higher risk if you have a history of ulcers or bleeding GI.
About 1 percent of people taking indomethacin every day for three to six months experience GI bleeding.
You should not take indomethacin if you have asthma, polyps of the nose and an allergy to aspirin.
This triple combination, known as the triad of ASA, the triad of aspirin, or the triad of Sumter, can lead to anaphylaxis, a potentially fatal allergic reaction.
Talk with your doctor about warnings related to stroke, heart attack, GI bleeding and anaphylaxis.
Tell your doctor about any history of heart disease, stroke, ulceration, or GI bleeding, including any family history of heart disease or stroke.
Use Indomethacin with caution if you have high blood pressure, heart failure or swelling (fluid retention), or if you have ever had a peptic ulcer.
You should not take Indomethacin within two weeks after you have performed a heart bypass operation, called bypassing the coronary artery. Adopting indomethacin may increase the risk of developing a stroke or heart attack after this operation.
Before you start taking Indomethacin, also tell your doctor if you have any of these diseases:
- Kidney disease
- Liver disease
- Diseases of the eye
- Parkinson’s disease
- Abnormal bleeding
- Lung disease or asthma
Indomethacin and pregnancy
Indomethacin is not safe in the later stages of pregnancy, because it can cause heart defects and other problems in the developing fetus.
Before taking Indomethacin, tell your doctor if you are pregnant or plan to become pregnant. And if you become pregnant with taking indomethacin, tell your doctor immediately.
Indomethacin is also unsafe to take during breastfeeding, because it can enter the breast milk.
Children 14 years and younger should not take indomethacin.
Possible side effects include:
- Nausea and vomiting
- Stomach upset
Serious side effects can also occur.
If you have any of these side effects, stop taking Indomethacin and immediately consult a doctor. For serious side effects, get emergency help or call 911:
- Thoracic pain
- Hypovia or difficulty breathing
- Weakness on one side of the body
- Slurred speech
- Abdominal pain
- Vomiting with blood or something like coffee grounds
- Bloody diarrhea or tarry stools
- Unusual bleeding or bruising
- Skin rash or bloating
- Skin rash with fever
- Fatigue, nausea, yellowing of the skin or eyes, dark urine and flu symptoms
- Swelling of the face, throat, tongue or body
- Difficulty swallowing or talking
- Blurred vision
If you have any side effects from Indomethacin, tell your doctor.
People over 65 years are more likely to side effects of indomethacin, including bleeding GI. If you are more than 65 years old, ask your doctor if there are safer alternatives.
Some drugs may interfere with Indomethacin, and Indomethacin may affect other drugs that you take.
It is very important to inform your doctor about all the medicines that you take, including any other prescription drugs, over-the-counter medications, illegal or recreational, herbal remedies or supplements.
Types of drugs that are known to interact with indomethacin include:
- Over-the-counter NSAIDs, including Advil, Aleve and Motrin
- Prescription NSAIDs such as Diflunizal (Dolobid) and Naproxen (Naprosin)
- Angiotensin converting enzyme (ACE) inhibitors of high blood pressure, such as Benazepril (Lotensin), Captopen (Capoten), and Enalapril (Vasotec)
- Beta-blockers for high blood pressure, including Atenolol (Tenormin), Labetalol (Normodyne) and Metoprolol (Lopressor, Toprol XL)
- Angiotensin receptor blockers (ARB) of high blood pressure, such as Candesartan (Atacand), Eprosartan (Teveten), and Irbesartan (Avapro)
- Oral corticosteroids, such as Dexamethasone (Decadron, Dexon), Methylprednisolone (Medrol) and Prednisone (Deltasone)
- Drugs used to treat rheumatoid arthritis, including Methotrexate (Rheumatrex)
- Diuretics such as Triamteren (Dyrenium, in Dyazide)
- Blood solvents such as Warfarin (Coumadin)
- Dioxin heart therapy (Lanoxin)
- Treatment with gout antigen (Benemid)
Indomethacin can cause drowsiness and headache, so do not drive or do other things that require close attention until you learn how Indomethacin affects you.
You should not drink alcohol while taking this medication, because it can worsen side effects from indomethacin.
A typical dose of Indomethacin for rheumatoid arthritis, osteoarthritis or ankylosing spondylitis is 75 milligrams (mg) two or three times a day, but your doctor will try to find the lowest dose that works for you.
Indomethacin is included in regular capsules, sustained-release capsules, liquid form and suppositories.
Do not open or crush extended-release capsules and mix thoroughly. Take Indomethacin with food or after eating.
Treatment of shoulder pain can last for one or two weeks, but gout treatment should stop once pain is gone.
In 2014, the FDA approved a dose of Indomethacin 20 mg and 40 mg capsules sold under the trademark Tivorbex.
This version of the drug consists of smaller particles of indomethacin, which dissolve faster.
Overdose can cause nausea, vomiting, severe headache, dizziness, confusion and fatigue.
Severe symptoms can include numbness, tingling, and an attack.
If you think you have reached an overdose, call the Toxicology Center at 1-800-222-1222 or call 911.
The missed dose of indomethacin
Take indomethacin exactly as your doctor says. Do not take more or less.
If you miss a dose of Indomethacin, take it as soon as you remember.
But if it’s time for the next dose, skip it and continue the regular dosing schedule.
Do not double your dose to make up for the missed one.