How does this medication work? What will it do for me?

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 have suggested this medication for conditions other than the ones listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

This medication is available as 25 mg and 50 mg capsules.

How should I use this medication?

When used on a regular basis, the usual recommended adult starting dose of indomethacin capsules is 25 mg to 50 mg 2 or 3 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 2 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 important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take indomethacin if you:

  • are or may be allergic to indomethacin or any ingredients of the medication
  • have had an allergic reaction to acetylsalicylic acid (ASA) or other anti-inflammatory medications
  • currently have or recently had inflammatory diseases of the stomach and intestines such as stomach or intestinal ulcer or ulcerative colitis
  • have bleeding in the brain or other bleeding disorders
  • have severe liver or kidney disease
  • have severe uncontrolled heart failure
  • have high blood levels of potassium
  • are currently taking other NSAIDs
  • are in the third trimester of pregnancy

Do not use indomethacin suppositories if you:

  • have any of the conditions listed above
  • have inflammation of the rectum or anus
  • have recently had rectal or anal bleeding

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

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 doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

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.

  • constipation
  • diarrhea
  • dizziness
  • drowsiness
  • headache
  • heartburn
  • nausea
  • vomiting
  • vertigo (feeling that you or your surroundings are spinning)

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

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

  • bladder pain
  • bleeding from cuts or scratches that last longer than usual
  • bleeding from rectum (with suppositories)
  • 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
  • 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
  • frequent urge to urinate
  • hallucinations
  • headache (severe), throbbing, or with stiff neck or back
  • hives, itching of skin, or any other skin problem (e.g., 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)
  • sudden, large increase or decrease in the amount of urine or loss of bladder control
  • swelling of face, feet, or lower legs
  • swelling of lips or tongue
  • swollen or painful glands (especially in the neck or throat area)
  • swelling or tenderness in upper abdominal or stomach 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 seek immediate medical attention if any of the following occur:

  • abdominal or stomach pain, cramping, or burning (severe)
  • chest pain
  • convulsions (seizures)
  • fainting
  • fast, irregular heartbeat or pulse
  • fast or irregular breathing
  • 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
  • symptoms of a serious allergic reaction (e.g., hives, swelling of the face or throat, or difficulty breathing)
  • symptoms of a bleeding problem, e.g.:
    • bloody or black, tarry stools
    • spitting up blood
    • unexplained nosebleeds
    • unusual bleeding or bruising
    • vomiting blood or material that looks like coffee grounds

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.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Drowsiness and reduced alertness: Headaches, sometimes combined with dizziness or lightheadedness, may occur during treatment with indomethacin. (These headaches usually occur early in the treatment.) Avoid operating motor vehicles and doing other activities that require alertness until you determine the effect this medication has on you.

Heart problems and strokes: Indomethacin may increase the risk of heart attacks, strokes, and high blood pressure, and may also make existing high blood pressure worse. As well, it can cause fluid buildup, especially in the feet and legs.

If you have or have had a heart condition (such as congestive heart failure), high blood pressure, high cholesterol, stroke, kidney disease, or if you have had recent surgery, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

High blood potassium: There is a risk of high blood potassium with NSAID treatment. People most at risk are seniors, people with conditions such as diabetes or kidney failure, and people who are taking beta-adrenergic blockers, angiotensin converting enzyme (ACE) inhibitors, or some diuretics (water pills). Ask your doctor whether you need to have your potassium levels checked while you are taking this medication.

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 for seniors. If you fit into one of these groups, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stomach ulcers: Stomach ulcers, perforation, and bleeding from the stomach have been known to occur during therapy with indomethacin. These problems can happen even to people who have never had stomach problems before. 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.

If you have ever had a stomach ulcer, bloody stools, diverticulosis or other conditions affecting the stomach or intestines (such as ulcerative colitis or Crohn's disease), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: Do not use this medication if you are in the third trimester of pregnancy. For the first and second trimesters, this medication should not be used unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking indomethacin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

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

What other drugs could interact with this medication?

There may be an interaction between indomethacin and any of the following:

  • ASA (acetylsalicylic acid)
  • alcohol
  • angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril)
  • beta-adrenergic blockers (e.g., metoprolol, atenolol)
  • corticosteroids (e.g., prednisone)
  • cyclosporine
  • digoxin
  • diuretics (water pills; e.g., spironolactone, triamterene)
  • heparin
  • lithium
  • methotrexate
  • oral hypoglycemics (antidiabetes medications; e.g., glyburide)
  • other NSAIDs (e.g., naproxen, diclofenac)
  • potassium supplements
  • probenecid
  • 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.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.