Indomethacin belongs to the class of medications known as nonsteroidal anti-inflammatories (NSAIDs). It works by reducing pain, swelling, and inflammation. Indomethacin is used for the relief of mild to moderately severe pain accompanied by inflammation. It can be used for people with conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and gout.

Your doctor may choose to use this medication for conditions other than the ones listed here. If you're unsure why you are taking this medication, contact your doctor.

When used on a regular basis, the recommended adult starting dose of indomethacin capsules is 25 mg two or three times a day. Your doctor will gradually increase the dose until the best results are achieved with the least amount of side effects. The maximum recommended daily dose of indomethacin is 200 mg. Indomethacin should always be taken with food or antacids to reduce stomach upset.

The recommended dose of indomethacin suppositories is 100 mg to 200 mg daily. Doses higher than 100 mg must be given in two divided doses.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is very important that this medication be taken on a regular schedule exactly as prescribed by your doctor. If you miss a dose of this medication take it as soon as you remember it. If it is almost time for your next dose, skip the missed dose and carry on with your regular schedule. Do not double-up on doses.

Indomethacin should not be taken by anyone who:

currently has or recently had inflammatory diseases of the stomach and intestines such as stomach or intestinal ulcer or ulcerative colitis

is currently taking other NSAIDs

is or may be allergic to indomethacin or any of the ingredients of the medication

has had an allergic reaction to ASA or other anti-inflammatory medications

Suppositories should not be used by anyone who:

has any inflammatory lesions of the rectum or anus

has recently had rectal or anal bleeding

Indomethacin is not safe for use by children.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your health professional. They may be able to help you to deal with some of the effects.

The following side effects may go away as your body becomes used to the medicine; check with your doctor if the following side effects continue or become bothersome. A common side effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is stomach upset. This can be minimized by taking the medication immediately after a meal, or with food or milk.

More common

abdominal or stomach cramps, pain, or discomfort (mild to moderate)

diarrhea

dizziness, drowsiness, or lightheadedness

headache (mild to moderate)

heartburn, indigestion, nausea, or vomiting

Less common or rare

bitter taste or other change in taste sensation

bloated feeling, gas, or constipation

decreased appetite or loss of appetite

fast or pounding heartbeat

flushing or hot flashes

general feeling of discomfort or illness

increased sensitivity of eyes to light

increased sweating

irritation, dryness, or soreness of mouth

nervousness, anxiety, irritability, trembling, or twitching

rectal irritation (with suppositories)

trouble sleeping

unexplained weight loss

unusual tiredness or weakness without any other symptoms

Check with your doctor as soon as possible if any of the following side effects occur:

More common

bleeding from rectum (with suppositories)

skin rash

Less common or rare

bladder pain

bleeding from cuts or scratches that lasts longer than usual

bleeding or crusting sores on lips

bloody or cloudy urine or any problem with urination, such as difficult, burning, or painful urination

change in urine colour or odour

frequent urge to urinate

sudden, large increase or decrease in the amount of urine or loss of bladder control

blurred vision or any change in vision

burning feeling in throat, chest, or stomach

confusion, forgetfulness, mental depression, or other mood or mental changes

cough or hoarseness

decreased hearing, any other change in hearing, or ringing or buzzing in ears

difficulty swallowing

eye pain, irritation, dryness, redness, or swelling

hallucinations

headache (severe), throbbing, or with stiff neck or back

hives, itching of skin, or any other skin problem (such as blisters, redness or other colour change, tenderness, burning, peeling, loosening or splitting of fingernails)

muscle cramps, pain or weakness

numbness, tingling, pain, or weakness in hands or feet

pain in lower back or side (severe)

swelling or tenderness in upper abdominal or stomach area

swelling of face, feet, or lower legs

swelling of lips or tongue

swollen or painful glands (especially in the neck or throat area)

thirst (continuing)

trouble speaking

unexplained runny nose or sneezing

unexplained, unexpected, or unusually heavy vaginal bleeding

unusual tiredness or weakness

weight gain (rapid)

yellow eyes or skin

Stop taking this medication and contact your doctor immediately if any of the following side effects occur:

Rare

abdominal or stomach pain, cramping, or burning (severe)

bloody or black, tarry stools

chest pain

convulsions (seizures)

fever with or without chills

nausea, heartburn, or indigestion (severe and continuing)

pinpoint-sized red spots on skin

sores, ulcers, or white spots on lips or in mouth

spitting up of blood

unexplained nosebleeds

unusual bleeding or bruising

vomiting of blood or material that looks like coffee grounds

Stop taking this medication and get emergency help immediately if any of the following side effects occur:

Rare

fainting

fast or irregular breathing

fast, irregular heartbeat or pulse

hive-like swellings (large) on face, eyelids, mouth, lips, or tongue

puffiness or swelling of the eyelids or around the eyes

shortness of breath, troubled breathing, wheezing, or tightness in chest

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Fluid and electrolyte balance: Fluid retention and edema have been reported with use of this medication. Indomethacin should be used with caution by anyone who:

has certain heart conditions (e.g., congestive heart failure)

has high blood pressure

has kidney disease or reduced kidney function

is recovering from a surgical operation under general anesthesia

has any other condition that might lead to fluid retention

There is a risk of high blood potassium with NSAID treatment. People most at risk are seniors: those having conditions such as diabetes or kidney failure; and those taking beta-adrenergic blockers, angiotensin converting enzyme (ACE) inhibitors, or some diuretics (water pills).

Gastrointestinal: Stomach ulcers, perforation, and bleeding from the stomach have been known to occur during therapy with indomethacin. These complications can occur at any time, and are sometimes severe enough to require immediate medical attention. The risk of ulcers and bleeding increase for people taking higher doses of NSAIDs for longer periods of time.

Indomethacin should be taken under close medical supervision by people prone to irritation of the stomach and intestines, particularly those who have had a stomach ulcer, bloody stools, or diverticulosis or other inflammatory disease of the stomach or intestines (such as ulcerative colitis or Crohn's disease). In these cases, your doctor must weigh the benefits of treatment against the possible risks.

Stop taking the medication and contact your doctor immediately if you experience symptoms or signs suggestive of stomach ulcers or bleeding in the stomach (black, tarry stools). These reactions can occur at any time during treatment without warning.

Kidney function: Long-term use of indomethacin may lead to a higher risk of reduced kidney function. This is most common for those who already have kidney disease, liver disease, or heart failure; for those who take diuretics (water pills); and seniors.

Occupational hazards: Headaches, sometimes accompanied by dizziness or lightheadedness, may occur during treatment with indomethacin. (These headaches usually occur early in the treatment.) Although the severity of these effects rarely requires the therapy to be stopped, indomethacin should be discontinued if the headaches persist despite dose reduction. Avoid operating motor vehicles and doing other potentially hazardous activities until you determine the effect this medication has on you.

Pregnancy: This medication is not recommended for use during pregnancy as its safety has not been established.

Breast-feeding: This medication should not be used by nursing mothers.

Children: Indomethacin is strongly not recommended for children. The safety, effectiveness, and dosages of the medication for this age group have not been established.

Seniors: Seniors appear to have a higher risk of side effects. They should use the lowest effective dosage under close medical supervision.

The following medications may affect the way that indomethacin works or increase the risk of side effects:

ASA

alcohol

angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril)

beta-adrenergic blockers (e.g., metoprolol, atenolol)

corticosteroids (e.g., prednisone)

diuretics (water pills; e.g., spironolactone, triamterene)

heparin

other NSAIDs (e.g.; naproxen, diclofenac)

potassium supplements

probenecid

warfarin

Indomethacin may affect the way that the following medications work:

cyclosporine

digoxin

diuretics (water pills; e.g., furosemide, hydrochlorothiazide)

heparin

lithium

methotrexate

oral hypoglycemics (anti-diabetes medications; e.g., glyburide)

warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,

change one of the medications to another,

change how you are taking one or both of the medications, or

leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.