indomethacin
Indomethacin (Indocin) is an NSAID that's used to treat different types of arthritis, including arthritis related to gout. It's also used to treat conditions that cause shoulder pain. This medication can be used in people 15 years of age and older; it hasn't been studied in younger children. The oral form of indomethacin (Indocin) is available as capsules (both immediate-release and extended-release) and a liquid. The dosage for immediate-release formulations is typically 2 to 4 times a day, and the dosage for extended-release capsules is once a day. Common side effects include headache, dizziness, and stomach upset.
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What is Indomethacin (Indocin)?
What is Indomethacin (Indocin) used for?
Moderate-to-severe rheumatoid arthritis, including flare-ups
Moderate-to-severe ankylosing spondylitis
Moderate-to-severe osteoarthritis
Shoulder pain caused by bursitis or tendonitis
Gouty arthritis - all forms except extended-release (ER) capsules
How Indomethacin (Indocin) works
Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug, or better known as an NSAID. It works by blocking proteins in the body called cyclooxygenase (COX) that cause inflammation, swelling, and pain. This helps lessen inflammation, swelling, and pain from your condition.
Drug Facts
What are the side effects of Indomethacin (Indocin)?
Common Side Effects
- Headache (12%)
- Nausea (up to 9%)
- Upset stomach (up to 9%)
- Dizziness (up to 9%)
Other Side Effects
- Diarrhea
- Constipation
- Stomach pain
- Sleepiness
- Ringing in the ears (tinnitus)
Serious Side Effects
- Stomach bleeding: feeling faint, vomiting blood, bloody or dark stools, severe stomach pain or discomfort
- Heart attack: chest pain or tightness; pain that radiates up to your shoulder, arm, neck, or jaw
- Heart failure: trouble breathing, swelling, fast heartbeat, sudden weight gain
- Stroke: sudden confusion, trouble breathing, weakness on one side of your body or face, slurred speech
- Worsening liver problems or liver failure: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark or brown urine
- Serious kidney problems: tiredness, dry and itchy skin, low appetite, urinating less than usual, foamy or bloody urine, muscle cramps
- Allergic reactions: hives, rash, blisters, swelling of the lips or tongue, trouble breathing
- Serious skin reactions: skin reddening, skin peeling, blisters, rash
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Abdominal or stomach cramping, burning, or tenderness
back or leg pains
bleeding gums
blistering, peeling, or loosening of the skin
bloody or black, tarry stools
blue lips and fingernails
blurred vision
breast enlargement and tenderness
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
burning upper abdominal or stomach pain
change in consciousness
change in hearing
chest pain, discomfort, or burning
clay colored stools
cloudy or bloody urine
confusion
continuing diarrhea
cough or hoarseness
coughing that sometimes produces a pink frothy sputum
cracks in the skin
dark urine
decreased appetite
decreased vision or any change in vision
difficult or labored breathing
difficulty with swallowing
dilated neck veins
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position
double vision
extreme fatigue
false sense of well-being
feeling of unreality
feeling of warmth
fever with or without chills
flushed, dry skin
fruit-like breath odor
general body swelling
greatly decreased frequency of urination or amount of urine
headache
heavier menstrual periods
increased hunger
increased sweating
increased thirst
increased urination
irregular breathing
irritation and swelling of the eye
jerky movements of the head, face, mouth, and neck
joint pain
large, flat, blue or purplish patches in the skin
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
loss of balance control
loss of bladder control
loss of consciousness
loss of hearing
loss of heat from the body
lower back or side pain
mask-like face
mood swings
muscle aches, pains, or weakness
muscle spasm or jerking of all extremities
nervousness
noisy, rattling breathing
nosebleeds
numbness or tingling in the hands, feet, or lips
pain in the ankles or knees
pain or discomfort in the upper stomach or throat
pain with swallowing
painful or difficult urination
painful, red lumps under the skin, mostly on the legs
pale skin
persistent bleeding or oozing from puncture sites, mouth, or nose
personality changes
pinpoint red or purple spots on the skin
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
red, swollen skin
redness of the face, neck, arms and occasionally, upper chest
seeing double
seeing, hearing, or feeling things that are not there
seizures
sense of detachment from self or body
severe constipation
severe mental changes
severe or continuing stomach pain
shuffling walk
skin rash, hives or welts, itching
slow, fast, irregular, pounding, or racing heartbeat or pulse
slowed movements
slurred speech
small red or purple spots on the skin
sores, ulcers, or white spots on the lips or tongue or inside the mouth
stiffness of the arms and legs
sudden loss of consciousness
swelling of the breasts or breast soreness in both females and males
swelling of the face, fingers, feet, ankles, or lower legs
swollen or painful glands
tightness in the chest
trembling and shaking of the fingers and hands
troubled breathing at rest
troubled breathing with exertion
unexplained weight loss
unpleasant breath odor
unsteadiness or awkwardness
unusual bleeding or bruising
unusual tiredness or weakness
vaginal bleeding
vomiting of blood or material that looks like coffee grounds
weakness in the arms, hands, legs, or feet
yellow eyes or skin
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Confusion about identity, place, and time
severe headache
unusual drowsiness, dullness, or feeling of sluggishness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Mild headache
Less common
Continuing ringing or buzzing or other unexplained noise in the ears
difficulty having a bowel movement (stool)
discouragement
feeling sad or empty
general feeling of discomfort or illness
hearing loss
irritability
loss of interest or pleasure
sleepiness
trouble with concentrating
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Indomethacin (Indocin)
Pros
Can relieve pain and swelling
Available in fast-acting formulations and a longer-acting, extended-release capsule
Dose can be adjusted by your provider if needed
Liquid version is a good option for people who have trouble swallowing pills
Cons
Might not be the best option for long-term use because of safety risks
Most forms are taken 2 to 4 times a day
Not a good choice if you have kidney or liver problems
Can raise your risk of blood clots, heart attack, or stroke (similar to other NSAIDs)
Pharmacist tips for Indomethacin (Indocin)
Nausea and upset stomach are common side effects of indomethacin (Indocin). It's best to take this medication with food or milk to help prevent these side effects.
For extended-release indomethacin (Indocin) capsules: Swallow the capsule whole. Don't crush, cut, chew, or open them because this can damage the medication or affect how it works in your body.
For the indomethacin (Indocin) oral suspension: Be sure to use a medication dose cup, spoon, or oral syringe to measure out your dose. Ask your pharmacy if you need extras. Household teaspoons might not be accurate, and using them might cause you to take the wrong amount of medication.
Make sure to check with your provider and pharmacist before starting any new medications. Taking indomethacin (Indocin) with other NSAIDs, such as aspirin (including low-dose aspirin), can raise your risk for serious side effects.
Indomethacin (Indocin) raises the risk of stomach bleeding, so tell your provider right away if you have unexplained vomiting or stomach pain, dark-colored stools, or blood in your vomit or stool.
If you're allergic to aspirin, there's a chance that you could also be allergic to indomethacin (Indocin). Always discuss all your allergies with your provider before starting any new medications.
Talk to your provider about the risks and benefits of indomethacin (Indocin) if you're pregnant, thinking of becoming pregnant, or breastfeeding. This medication can cause harm to babies, and it might also make it harder to get pregnant. It's not known whether the medication is safe to use while breastfeeding.
Frequently asked questions about Indomethacin (Indocin)
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What are the risks and warnings for Indomethacin (Indocin)?
Indomethacin (Indocin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Stomach bleeding and ulcers
Risk factors: Older adults | History of stomach bleeding or ulcers | Bleeding problems | Liver problems | Taking other medications that raise your risk of bleeds | Drinking alcohol | Smoking | Taking indomethacin (Indocin) for a long time
Taking indomethacin (Indocin) raises your risk for serious stomach or gut problems, including bleeding and ulcers (sores). In some cases, these problems can be life-threatening. Serious stomach or gut problems can happen at any time and with or without symptoms while you're taking indomethacin (Indocin).
Your risk for stomach bleeds might be even higher if you're also taking other medications that can raise your risk for stomach bleeds, such as aspirin, other NSAIDs, oral corticosteroids, and blood thinners (anticoagulants). Discuss all of your conditions and medications with your providers before you start indomethacin (Indocin) so they can talk with you about your risk for stomach or gut bleeds. Get medical attention right away if you vomit blood, have bloody or dark stools, feel faint, or have severe stomach pain that doesn't go away while you're using indomethacin (Indocin).
Heart attack and stroke
Risk factors: History of heart problems | At risk for heart problems | Taking high doses of indomethacin (Indocin) | Taking indomethacin (Indocin) for a long time | Recent or planned heart surgery
Indomethacin (Indocin) can raise your risk of having blood clots, heart attack, and stroke. If you have heart problems, talk to your healthcare provider before starting this medication. To lower your risk, take indomethacin (Indocin) at the lowest dose and for the shortest time possible. Don't take indomethacin (Indocin) if you've recently had or will be having heart surgery. Call 911 if you have chest pain, shortness of breath, weakness on one side of your body, or trouble speaking or walking.
High blood pressure and heart failure
Risk factors: History of heart problems | History of high blood pressure
Indomethacin (Indocin) can raise your blood pressure. The medication can also put you at risk for heart failure and hospitalization from complications. This is because indomethacin (Indocin) can cause your body to hold onto extra fluid. Before starting indomethacin (Indocin), tell your providers if you have a history of heart problems (especially heart failure) or if you're taking blood pressure medications so they can make sure it's safe for you.
Be sure to check your blood pressure while you're taking indomethacin (Indocin) and tell your provider if you notice any changes. Also contact your provider if you have chest pain with physical activity, swelling, trouble breathing, irregular heartbeat, or sudden weight gain while you're taking indomethacin (Indocin). These can be signs of fluid buildup or heart failure.
Liver problems
Risk factors: History of liver problems
Rarely, indomethacin (Indocin) can cause serious liver problems that can lead to liver failure. Get medical help right away if you notice swelling of your stomach; stomach pain; yellowing of your skin or the whites of your eyes; stool changes (black, tarry, or bloody stools); nausea; vomiting; confusion; or dark or brown urine. These can be signs of liver damage.
Kidney damage and high potassium levels
Risk factors: Older adults | Kidney or liver problems | Heart failure | Taking certain high blood pressure medications, such as water pills, ACE inhibitors, or ARBs | Loss of body fluid through conditions such as severe vomiting, bleeding, or diarrhea | Using indomethacin (Indocin) for a long time
Indomethacin (Indocin) can damage your kidneys by slowing down blood flow to the kidneys. The risk is higher if you're taking certain blood pressure medications (like ACE inhibitors, ARBs, or water pills). Your risk might also be higher if you have certain conditions (like kidney or liver problems and heart failure). This medication isn't recommended if you have very severe kidney problems, so discuss the risks and benefits of taking it with your provider. Tell your provider if you notice a change in how often you urinate after you start indomethacin (Indocin) since this can be a sign of kidney damage. Kidney damage is usually reversible once you stop taking indomethacin (Indocin).
In addition, kidney damage from indomethacin (Indocin) can also lead to high potassium levels. Sometimes, this medication can cause high potassium levels even in people with healthy kidneys. Call your provider right away if you experience signs of high potassium levels, such as nausea, muscle weakness, or tingling sensations in your muscles because it can lead to dangerous health problems.
Severe allergic reactions
Risk factors: Aspirin allergy | NSAID allergy
It's possible to have a severe allergic reaction to indomethacin (Indocin). These can include life-threatening reactions like anaphylaxis (closing of the throat). Before starting indomethacin (Indocin), let your provider know if you have an allergy to aspirin or other NSAIDs. Seek medical attention right away if you notice hives, rash, red skin, swelling of the lips or tongue, or trouble breathing after you use indomethacin (Indocin).
Rarely, indomethacin (Indocin) can cause serious skin reactions. Stop using the medication and get medical help as soon as possible if you notice skin changes such as rash, blisters, skin reddening, or skin peeling.
Severe asthma attack
Risk factors: Asthma | Stuffy nose with or without nasal polyps | Allergic reaction to aspirin or other NSAIDs
Indomethacin (Indocin) can cause your airways to tighten, which might lead to severe asthma attacks. Because of this risk, be careful using this medication if you have asthma. You should avoid taking indomethacin (Indocin) if you have asthma or asthma attacks after taking aspirin or other NSAID in the past because severe asthma attacks might be more likely to happen when you use indomethacin (Indocin). Get medical help right away if your throat tightens and you can't breathe.
Worsening of nervous system and mental health problems
Risk factors: History of mental health problems | Epilepsy | Parkinson's disease
Indomethacin (Indocin) can cause certain nervous system conditions and mental health problems to get worse. People with conditions like epilepsy or Parkinson's disease might notice more symptoms while they're taking indomethacin (Indocin). And people with mental health problems, such as depression, might notice their condition getting worse. Let your provider know right away if you notice any changes to your mental health, have seizures, or experience more symptoms of your nervous system condition while you're taking indomethacin (Indocin).
Harm to unborn babies
Indomethacin (Indocin) can cause harm to your unborn baby or cause complications during delivery if it's taken during the second half of pregnancy. Before using indomethacin (Indocin), talk to your provider about the risks and benefits of using the medication if you're pregnant or thinking of becoming pregnant. Ask whether there are safer alternatives.
Indomethacin (Indocin) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 25mg/5ml | 474 ml | $4337.57 | $9.15 |
Typical dosing for Indomethacin (Indocin)
Immediate-release capsules and oral suspension
Osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis: The typical starting dose is 25 mg by mouth 2 or 3 times a day. If needed, your provider might raise your dose up to 200 mg per day.
Gouty arthritis: The typical dose is 50 mg by mouth 3 times a day. Once your pain is tolerable, your provider will lower your dose until you can stop taking it altogether.
Shoulder pain: The typical dose is 75 mg to 150 mg by mouth per day, split into 3 or 4 smaller doses and taken throughout the day. Usually, you'll take the medication for 7 to 14 days.
Osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis: The typical dose is 75 mg by mouth once a day.
Shoulder pain: The typical dose is 75 mg by mouth once or twice a day. usually, you'll take the medication for 7 to 14 days.
More on Indomethacin (Indocin) dosage forms
Interactions between Indomethacin (Indocin) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abciximab
- Acenocoumarol
- Amiloride
- Amineptine
- Amitriptyline
- Amitriptylinoxide
- Amoxapine
- Anagrelide
- Apixaban
- Ardeparin
- Argatroban
- Aspirin
- Bemiparin
- Bendroflumethiazide
- Benzthiazide
- Betamethasone
- Betrixaban
- Bivalirudin
- Budesonide
- Bumetanide
- Cangrelor
- Certoparin
- Chlorothiazide
- Chlorthalidone
- Cilostazol
- Citalopram
- Clomipramine
- Clopamide
- Clopidogrel
- Cortisone
- Cyclopenthiazide
- Cyclosporine
- Dabigatran Etexilate
- Dalteparin
- Danaparoid
- Deflazacort
- Desipramine
- Desirudin
- Desmopressin
- Desvenlafaxine
- Dexamethasone
- Diazoxide
- Dibenzepin
- Diflunisal
- Digoxin
- Dipyridamole
- Dothiepin
- Doxepin
- Duloxetine
- Edoxaban
- Enoxaparin
- Eplerenone
- Epoprostenol
- Eptifibatide
- Escitalopram
- Ethacrynic Acid
- Feverfew
- Fluocortolone
- Fluoxetine
- Fluvoxamine
- Fondaparinux
- Furosemide
- Ginkgo
- Glucagon
- Gossypol
- Heparin
- Hydrochlorothiazide
- Hydrocortisone
- Hydroflumethiazide
- Ibuprofen
- Iloprost
- Imipramine
- Indapamide
- Inotersen
- Ketoprofen
- Lepirudin
- Levomilnacipran
- Lithium
- Lofepramine
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Macimorelin
- Magnesium Salicylate
- Meadowsweet
- Meclofenamate
- Mefenamic Acid
- Melitracen
- Meloxicam
- Mesalamine
- Methotrexate
- Methyclothiazide
- Methylprednisolone
- Metolazone
- Milnacipran
- Morniflumate
- Nabumetone
- Nadroparin
- Naproxen
- Nefazodone
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Nortriptyline
- Olsalazine
- Opipramol
- Oxaprozin
- Oxyphenbutazone
- Paramethasone
- Parecoxib
- Parnaparin
- Paroxetine
- Pemetrexed
- Pentosan Polysulfate Sodium
- Pentoxifylline
- Phenindione
- Phenprocoumon
- Phenylbutazone
- Phenyl Salicylate
- Piketoprofen
- Piroxicam
- Polythiazide
- Potassium
- Prasugrel
- Prednisolone
- Prednisone
- Probenecid
- Proglumetacin
- Propyphenazone
- Proquazone
- Protein C
- Protriptyline
- Reboxetine
- Reviparin
- Rivaroxaban
- Rofecoxib
- Salicylamide
- Salicylic Acid
- Salsalate
- Sertraline
- Sibutramine
- Sodium Salicylate
- Spironolactone
- Sulfasalazine
- Sulindac
- Tacrolimus
- Tenofovir Disoproxil Fumarate
- Tenoxicam
- Tianeptine
- Tiaprofenic Acid
- Ticagrelor
- Ticlopidine
- Tinzaparin
- Tirofiban
- Tolfenamic Acid
- Tolmetin
- Torsemide
- Trazodone
- Treprostinil
- Triamterene
- Trichlormethiazide
- Trimipramine
- Trolamine Salicylate
- Valdecoxib
- Vasopressin
- Venlafaxine
- Vilazodone
- Vorapaxar
- Vortioxetine
- Warfarin
- Xipamide
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acebutolol
- Alacepril
- Atenolol
- Azilsartan
- Azilsartan Medoxomil
- Benazepril
- Betaxolol
- Bisoprolol
- Candesartan Cilexetil
- Captopril
- Carteolol
- Carvedilol
- Celiprolol
- Enalapril
- Enalaprilat
- Eprosartan
- Esmolol
- Fosinopril
- Gentamicin
- Irbesartan
- Labetalol
- Levobunolol
- Lisinopril
- Losartan
- Metipranolol
- Metoprolol
- Moexipril
- Nadolol
- Nebivolol
- Olmesartan Medoxomil
- Oxprenolol
- Penbutolol
- Perindopril Erbumine
- Pindolol
- Practolol
- Propranolol
- Quinapril
- Ramipril
- Sotalol
- Spirapril
- Telmisartan
- Timolol
- Trandolapril
- Valsartan
How much does Indomethacin (Indocin) cost?
Indomethacin (Indocin) contraindications
History of asthma, hives, or other allergic reactions after taking aspirin or another NSAID
Using indomethacin (Indocin) after coronary artery bypass graft surgery (CABG)
What are alternatives to Indomethacin (Indocin)?
Moderate-to-severe rheumatoid arthritis, including flare-ups
Moderate-to-severe ankylosing spondylitis
Moderate-to-severe osteoarthritis
Shoulder pain caused by bursitis or tendonitis
Gouty arthritis - all forms except extended-release (ER) capsules
Osteoarthritis (OA)
Rheumatoid arthritis (RA)
Sudden pain
Menstrual cramps
Ankylosing spondylitis (AS) (arthritis of the spine)
Polyarticular juvenile idiopathic arthritis (arthritis in children)
Tendonitis and bursitis
Pain
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References
Best studies we foundAmneal Pharmaceuticals LLC. (2021). Indomethacin- indomethacin capsule, extended release [package insert]. DailyMed.
Camber Pharmaceuticals, Inc. (2019). Indomethacin - indomethacin capsule [package insert]. DailyMed.
Chartwell RX, LLC. (2023). Indomethacin capsule [package insert]. DailyMed.
Montford, J. R., et al. (2017). How dangerous is hyperkalemia? Journal of the American Society of Nephrology.
National Heart, Lung, and Blood Institute. (2022). What is coronary artery bypass grafting?
Sostres, C., et al. (2013). Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage. Arthritis Research and Therapy.
U.S. Food and Drug Administration. (2022). FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid.
Zyla Life Sciences US LLC. (2021). Indocin- indomethacin suppository [package insert]. DailyMed.
Zyla Life Sciences US LLC. (2021). Indocin- indomethacin suspension [package insert]. DailyMed.
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