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Indomethacin

 

  • Common Brand Name(s): Indocin, Indocin SR
  • Common Generic Name(s): indomethacin
  • Pronunciation: in-doh-METH-uh-sin
  • Drug Classes: nonsteroidal anti-inflammatory drug (NSAID)
  • Availability: prescription only, generic available
  • How is it used? Capsule or liquid that is swallowed, suppository that is inserted into the rectum

 

What is Indomethacin?

 

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID), which is a medicine that is used to help treat osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, shoulder pain caused by bursitis or tendonitis, and gout. Indomethacin works to block specific substances in the body that cause pain, inflammation, and fever. Common side effects include headache, dizziness, upset stomach, and nausea. Indomethacin comes in several formulations such as oral capsule, extended-release oral capsule, oral liquid, and rectal suppository.

 

Indomethacin Uses

 

What is indomethacin used for?

Indomethacin is commonly used for the following conditions.

  • Rheumatoid arthritis, an autoimmune condition where your body attacks your joints
  • Ankylosing spondylitis, an autoimmune condition where your body attacks the joints in your spine
  • Osteoarthritis, a condition that causes inflammation in the joints when cartilage (a type of tissue) breaks down
  • Shoulder pain caused by bursitis or tendonitis
  • Gout, a type of arthritis that can cause swelling and pain in your joints 

Indomethacin may also be used for other conditions as determined by your healthcare provider.

How does indomethacin work (mechanism of action)?

Indomethacin works by blocking certain substances in the body that cause pain, inflammation, and fever.

How is indomethacin supplied (dosage forms)?

Brands and other names

  • Indocin
  • Indocin SR

Dosage forms and strengths

  • 25 mg oral capsules
  • 50 mg oral capsules
  • 75 mg extended-release oral capsules
  • 50 mg rectal suppository
  • 25 mg/5 mL oral suspension

How should I store indomethacin?

Oral Capsule. Indomethacin should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place, away from light and moisture.

Rectal Suppository. Indomethacin should be stored in the refrigerator between 36 F to 46 F (2 C to 8 C). 

Oral Liquid. Indomethacin should be stored below 86 F (30 C). Do not freeze.

 

Proper Use

 

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Taking too much of this medicine may increase the risk of side effects.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

When used for severe or continuing arthritis, this medicine must be taken regularly as ordered by your doctor in order for it to help you. This medicine usually begins to work within 1 week, but in severe cases up to two weeks or even longer may pass before you begin to feel better. Also, several weeks may pass before you feel the full effects of this medicine.

Swallow the capsule whole. Do not open, crush, break, or chew it.

Shake the oral suspension well before each use. Measure the medicine with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

It is best to take this medicine with food.

Check with your doctor first before changing dosage forms (eg, capsules, suspension). These forms are very different from each other.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage forms (capsules or suspension):

For acute gouty arthritis:

  • Adults—50 milligrams (mg) three times a day. Your doctor may decrease your dose as needed.
  • Children 15 years of age and older—Dose is based on body weight and must be determined by your doctor.
  • Children younger than 14 years of age—Use and dose must be determined by your doctor.

For acute painful shoulder (bursitis or tendinitis):

  • Adults—75 to 150 milligrams (mg) per day, divided into three or four equal doses, and taken for 1 to 2 weeks as determined by your doctor.
  • Children 15 years of age and older—Dose is based on body weight and must be determined by your doctor.
  • Children younger than 14 years of age—Use and dose must be determined by your doctor.

For mild to moderate acute pain:

  • Adults—20 milligrams (mg) three times a day, or 40 mg two or three times a day.
  • Children—Use and dose must be determined by your doctor.

For moderate to severe ankylosing spondylitis, osteoarthritis, or rheumatoid arthritis:

  • Adults—25 milligrams (mg) two or three times a day. Your doctor may increase your dose by 25 or 50 mg per day, as needed. However, the total dose is usually not more than 200 mg per day.
  • Children 15 years of age and older—Dose is based on body weight and must be determined by your doctor.
  • Children younger than 14 years of age—Use and dose must be determined by your doctor.

 

Side Effects

 

What are the most common side effects of indomethacin?

The most common side effects of indomethacin are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Headache (see below)
  • Dizziness
  • Upset stomach
  • Nausea

There may be other side effects of indomethacin that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of indomethacin?

While less common, the most serious side effects of indomethacin are described below, along with what to do if they happen.

Severe Allergic Reactions. Indomethacin may cause allergic reactions, including a specific type of allergic reaction called DRESS. DRESS stands for Drug Reaction with Eosinophilia and Systemic Symptoms. It is also sometimes called multi-organ hypersensitivity. This is a reaction that can affect multiple parts of the body including your liver, kidneys, and heart. Stop taking the medicine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Shortness of breath, trouble swallowing, or throat tightness
  • Swelling in your feet, ankles, or legs
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain
  • Dark-colored pee
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Heart Attack and Stroke. Indomethacin can increase your risk of a heart attack or stroke that can lead to death. This risk is increased in people with existing heart disease and with longer use of indomethacin and higher doses. Do not take indomethacin if you have had a recent heart attack without talking to your healthcare provider. This could increase your risk of having another heart attack. Get emergency help if you have any of the following symptoms of a heart attack or stroke.

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech

Stomach Bleeding. Indomethacin can increase your risk of bleeding, ulcers, and tears (perforation) in your gut. The risk is higher if you have a history of stomach ulcers, bleeding problems, take higher doses of indomethacin or take it for longer than directed, have poor health, are of older age, have liver disease, smoke, drink alcohol, or take certain other medicines. Stop taking indomethacin and get emergency help if you have any of the following symptoms.

  • Vomit blood
  • Black or tarry poop
  • Stomach pain that does not go away
  • Upset stomach
  • Feel faint

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking indomethacin. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Increased Blood Pressure (Hypertension). Indomethacin may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your healthcare provider if your blood pressure increases while taking this medicine.

If you measure your blood pressure and the top number (systolic) is 180 mm Hg or higher or the bottom number (diastolic) is 120 mm Hg or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your healthcare provider right away if you have any of the following symptoms of severely high blood pressure.

  • Sudden severe headache
  • Chest pain
  • Dizziness or confusion
  • Trouble breathing
  • Nausea or vomiting
  • Blurry or other changes to vision
  • Anxiety
  • Buzzing in the ears
  • Nosebleed
  • Feeling of skipped heartbeats

Fluid Retention (Edema) and Heart Failure. Indomethacin can cause fluid retention, also called edema which can lead to heart failure. Fluid retention can also cause serious issues in people with heart failure. Call your healthcare provider right away if you have any of the following symptoms. 

  • Chest pain
  • Irregular heartbeat
  • Shortness of breath
  • Stretched or shiny skin
  • Swollen body parts, such as the belly or ankles
  • Unusually fast weight gain
  • Unusual tiredness

Kidney Damage. Kidney damage can happen when taking indomethacin. Call your healthcare provider right away if you have any of the following symptoms of kidney damage.

  • Reduced need to pee
  • Swelling in your feet, ankles, or legs
  • Weakness or unusual tiredness
  • Difficulty catching your breath or chest pain/pressure
  • Confusion
  • Nausea
  • Seizures

High Potassium Levels (Hyperkalemia). Indomethacin can cause a high potassium level (hyperkalemia), which can be serious and may lead to death. Your healthcare provider may check your potassium levels, especially if you take certain other medicines. Call your healthcare provider right away if you have any of the following symptoms of a high potassium level. 

  • Muscle weakness or unusual tiredness
  • Slow heartbeat or feeling of skipped heartbeats 
  • Nausea or vomiting
  • Trouble breathing
  • Abnormal heart rhythm

Severe Skin Reactions. Indomethacin can cause severe skin reactions, called Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), that can lead to death if not treated. If you develop a rash, stop indomethacin and call your healthcare provider right away. Get emergency help if you have any of the following symptoms of SJS or TEN.

  • Painful red or purple skin that looks burned and peels off
  • Flat red rash or blisters on your skin, mouth, nose, and genitals
  • Red, painful, watery eyes

Anemia. Indomethacin may cause anemia, which is when you have low levels of red blood cells. Tell your healthcare provider if you have any of the following symptoms of anemia.

  • Unusual weakness or tiredness
  • Cold hands and feet
  • Fast or abnormal heartbeat
  • Pale or yellowish skin 
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Shortness of breath

Central Nervous System (CNS) Depression. Indomethacin may slow down your central nervous system (CNS), which controls many vital functions throughout the body. Call your healthcare provider right away if you have any of the following symptoms of CNS depression.

  • Confusion
  • Excessive sleepiness or trouble staying awake
  • Memory problems
  • Slow or shallow breathing
  • Slowed response or reaction time
  • Slurred speech

Headache. Indomethacin can cause headaches. Call your healthcare provider right away if you have headaches that do not go away or get worse. 

Eye Problems. Indomethacin may cause eye problems. Call your healthcare provider if you have any changes in your vision.

 

Warnings & Precautions

 

Who should not use indomethacin?

Allergies to Ingredients. People who are allergic to any of the following should not take indomethacin.

  • Indomethacin
  • Indocin
  • Aspirin or any other medicine known as a non-steroidal anti-inflammatory (NSAID)
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific indomethacin products they stock.

Heart Surgery. Do not take indomethacin right before or after a heart surgery called coronary artery bypass graft (CABG). Taking indomethacin during this time can increase your risk of heart attack or stroke.

Rectal Swelling or Bleeding (Suppository). Indomethacin suppositories should not be used if you have recent bleeding from your rectum or a condition called proctitis or a history of this condition. The rectum is the lower part of your intestine that leads to your anus. 

What should I know about indomethacin before using it?

Indomethacin can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how indomethacin affects you.

People who are 65 and older can be at greater risk for some side effects from indomethacin. Talk to your healthcare provider about your risks if you are in this age group.

Use an accurate measuring device to measure your indomethacin oral liquid dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.

Do not take indomethacin unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share indomethacin with other people, even if they have the same condition as you. It may harm them.

Keep indomethacin out of the reach of children.

Since indomethacin suppository should be kept in a refrigerator, take special precautions to keep it away from children who also use the refrigerator.

What should I tell my healthcare provider before using indomethacin?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if indomethacin is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

Other Medicines and Supplements. Indomethacin may interact with other medicines and supplements. Before taking indomethacin, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Smoking. Tell your healthcare provider if you smoke. Smoking while taking indomethacin can increase the risk of stomach bleeding. 

Pregnancy. Do not take indomethacin 20 weeks or later in pregnancy without talking to your healthcare provider. Taking indomethacin during this time may cause harm to an unborn baby and complications during delivery. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take indomethacin while you are pregnant or trying to get pregnant.

Breastfeeding. Indomethacin passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take indomethacin while breastfeeding.

 

Interactions

 

Does indomethacin interact with foods or drinks?

There are no known interactions between indomethacin and foods or drinks.

It is unknown if drinking alcohol will affect indomethacin, but both indomethacin and alcohol can increase your risk of bleeding. It is best to limit the amount of alcohol you drink.

Does indomethacin interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking indomethacin.

  • A blood thinner, such as warfarin, which is a medicine used to treat or prevent blood clots
  • An antiplatelet medicine, such as clopidogrel (Plavix), ticagrelor (Brilinta), aspirin/dipyridamole, or cilostazol, which is a medicine used to prevent blood clots
  • Aspirin, which is in many prescription and OTC products, including those for pain, swelling, and fever
  • A selective serotonin reuptake inhibitor (SSRI), such as fluoxetine, paroxetine, or sertraline, which is a medicine commonly used for anxiety and depression
  • A serotonin and norepinephrine reuptake inhibitor (SNRI), which is a medicine commonly used for anxiety and depression
  • An angiotensin-converting enzyme (ACE) inhibitor, such as enalapril or lisinopril, which is a medicine for high blood pressure, heart failure, and certain kidney problems
  • An angiotensin II receptor blocker (ARB), such as losartan or valsartan, which is a medicine for high blood pressure, heart failure, and other heart conditions
  • A beta-blocker, such as metoprolol (Lopressor, Toprol XL, and others), atenolol (Tenormin), or propranolol (Inderal LA, Innopran XL), which is a medicine that may be used for certain heart conditions or to reduce blood pressure
  • A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
  • Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
  • Lithium, which is a medicine for certain mental health conditions
  • Methotrexate (Trexall and others), which is a medicine commonly used for rheumatoid arthritis or certain types of cancer
  • Cyclosporine (Gengraf, Neoral, Sandimmune, and others), which is a medicine that suppresses your immune system
  • A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, sulindac, and others, which is in many prescription and OTC products for pain, swelling, and fever
  • A salicylate, such as diflunisal or salsalate, which is a medicine used for osteoarthritis or rheumatoid arthritis
  • Pemetrexed (Alimta, Pemfexy), which is a medicine to treat certain cancers
  • Probenecid, which is a medicine commonly used for gout

This may not be a complete list of medicines that can interact with indomethacin. Always check with your healthcare provider.

 

Overdose/Missed Dose

 

What should I do if I accidentally use too much indomethacin?

If you or someone else has used too much indomethacin, get medical help right away, call 911, or contact a Poison Control center at 1-800-222-1222.

What should I do if I miss a dose of indomethacin?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.

 

FAQ's

 

What is indomethacin used for?

A healthcare provider might prescribe indomethacin to you to manage symptoms, including:

  • Pain.
  • Inflammation (swelling).
  • Stiffness.
  • Tenderness.

Providers commonly prescribe indomethacin to treat different types of arthritis, including:

  • Osteoarthritis.
  • Rheumatoid arthritis.
  • Ankylosing spondylitis (arthritis that affects joints in your spine and causes lower back pain).
  • Gout.

Your provider might prescribe indomethacin to manage symptoms of other issues, including:

  • Bursitis — especially shoulder bursitis.
  • Tendinitis.
  • Patent ductus arteriosus (PDA) — a heart condition some babies have when they’re born.
  • Plantar fasciitis.
  • Preterm labor.
  • Chronic (frequent) headaches.

Does indomethacin make you sleepy?

Yes, indomethacin can cause drowsiness and make you feel sleepy. Talk to a healthcare provider if indomethacin makes you feel extremely tired. Don’t stop taking it unless your provider says to.

Talk to your healthcare provider if you experience drowsiness along with other side effects like headaches, confusion or disorientation (not knowing where you are or what’s going on around you). It’s rare, but these can be signs of indomethacin toxicity (overdose).

How long does indomethacin stay in your system?

How long indomethacin stays in your system depends on how much you’re taking (the dosage). It usually stays in your body anywhere from two to 16 hours.

Indomethacin leaves your body in your pee and poop as your body processes it and breaks it down.

Can I take ibuprofen with indomethacin?

No, you shouldn’t take ibuprofen while you’re taking indomethacin.

Ibuprofen is another type of NSAID (nonsteroidal anti-inflammatory drug). Taking it while you’re taking indomethacin can greatly increase your risk of experiencing serious side effects like ulcers and internal bleeding.

 

One Final Note..

 

Indomethacin is a prescription NSAID — a medication that reduces inflammation and relieves pain. Your provider might prescribe it for a temporary issue like bursitis, or you may need it as part of a longer-term way to manage arthritis symptoms.

No matter why you’re taking it, never mix indomethacin with other NSAIDs or over-the-counter medications. Talk to your provider about all the medicines and supplements you’re taking before you start indomethacin. They’ll tell you what’s safe and what you should avoid.

 

Important Warning:

 

People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as indomethacin may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time. Do not take an NSAID such as indomethacin if you have recently had a heart attack, unless directed to do so by your doctor. Tell your doctor if you or anyone in your family has or has ever had heart disease, a heart attack, or a stroke, if you smoke, and if you have or have ever had high cholesterol, high blood pressure, or diabetes. Get emergency medical help right away if you experience any of the following symptoms: chest pain, shortness of breath, weakness in one part or side of the body, or slurred speech.

If you will be undergoing a coronary artery bypass graft (CABG; a type of heart surgery), you should not take indomethacin right before or right after the surgery.

NSAIDs such as indomethacin may cause ulcers, bleeding, or holes in the stomach or intestine. These problems may develop at any time during treatment, may happen without warning symptoms, and may cause death. The risk may be higher for people who take NSAIDs for a long time, are older in age, have poor health, or drink large amounts of alcohol while taking indomethacin. Tell your doctor if you take any of the following medications: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); aspirin; other NSAIDs such as diflunisal (Dolobid), ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn); oral steroids such as dexamethasone, methylprednisolone (Medrol), and prednisone (Rayos); selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluoxetine (Prozac, Sarafem, Selfemra, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); or serotonin norepinephrine reuptake inhibitors (SNRIs) such as desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), and venlafaxine (Effexor XR). Also tell your doctor if you have or have ever had ulcers or bleeding in your stomach or intestines, or other bleeding disorders. If you experience any of the following symptoms, stop taking indomethacin and call your doctor: stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools.

Keep all appointments with your doctor and the laboratory. Your doctor will monitor your symptoms carefully and will probably order certain tests to check your body's response to indomethacin. Be sure to tell your doctor how you are feeling so that your doctor can prescribe the right amount of medication to treat your condition with the lowest risk of serious side effects.

Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with indomethacin and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website (https://www.fda.gov/Drugs) or the manufacturer's website to obtain the Medication Guide.

 

 

 

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Most recent revision July 12, 2025 08:38:07 AM

 

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