Trade/other name(s): Indocin, Indocin SR, Indotech
Why would this drug be used?
Indomethacin may be used to treat mild to moderate pain from cancer, surgery, or other causes. For severe pain, it is more helpful when used along with other pain-relieving drugs. It is also used to reduce fever and inflammation, as well as for other purposes.
How does this drug work?
Indomethacin's action is not fully understood, but it helps block the body from making prostaglandins. It is a non-opioid pain medicine (analgesic) that belongs to the general class of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). It prevents pain receptors from passing pain messages to the brain. Indomethacin reduces inflammation. It also reduces fever by helping enlarge blood vessels near the skin so that the body loses heat. Because the drug has serious side effects it is not often used for this purpose.
Before taking this medicine
Tell your doctor…
- If you are allergic to anything, including medicines, dyes, additives, or foods.
- About any reactions you have had when taking aspirin or other non-steroidal anti-inflammatory medicines in the past. If you have had problems with any of these medicines, you are more likely to have problems taking indomethacin.
- If you have any medical conditions such as asthma, nasal polyps, allergies, high blood pressure, kidney disease, liver disease (including hepatitis), stroke, high cholesterol, diabetes, or heart disease. These conditions increase the risk of serious side effects from indomethacin, and you may need a different medicine. If you take the drug, you may need to be watched more closely during treatment.
- If you have congestive heart failure or fluid retention (swelling, usually of the legs and feet). Indomethacin may worsen this problem.
- If you are taking blood pressure medicines. Indomethacin may cause some blood pressure medicines to stop working properly. In some cases, the combination of medicines may damage the kidneys.
- If you have ever had stomach or intestinal ulcers, especially if you had bleeding. Indomethacin can worsen these problems or make them come back.
- If you smoke, drink alcohol, or take steroid medicines. These can increase your risk of intestinal bleeding.
- If you have proctitis (rectal irritation) or ulcerative colitis. Indomethacin may cause or worsen these conditions, especially if given by suppository.
- If you have hemophilia or any other bleeding problem, or if you are taking blood thinners such as warfarin or heparin. Indomethacin can increase your risk of bleeding from the stomach or intestine.
- If you have had depression, mental illness, Parkinson disease, or epilepsy. Indomethacin can aggravate these problems.
- If you are pregnant or trying to get pregnant. Taking indomethacin, especially later in pregnancy, can delay delivery and cause heart problems in the baby.
- If you are breast-feeding. Very small amounts of indomethacin are excreted in breast milk. Talk to your doctor about any effects it might have on the baby.
- About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.
Interactions with other drugs
If you take indomethacin while you are taking lithium, your lithium level may go up. This can increase your risk of toxic effects from lithium. You may need more frequent monitoring of lithium levels while on indomethacin.
Taking indomethacin while using "blood thinners" (such as warfarin and heparin) can increase your risk of serious bleeding.
Aspirin and other non-steroidal anti-inflammatory medicines should not be used with indomethacin. Diflunisal especially has been reported to cause kidney failure and severe bleeding when taken with indomethacin.
Alcohol may increase your risk of stomach irritation or bleeding, as may aspirin. Steroids that are taken by mouth, such as prednisone, prednisolone, hydrocortisone, betamethasone, budesonide, triamcinolone, can also increase this risk.
Triamterene (Dyrenium) should not be taken with indomethacin, since it may seriously harm the kidneys. Other diuretics ("water pills") can also cause problems with the kidneys as well as the potassium level in the blood.
Many of the medicines used for high blood pressure may not work as well during treatment with indomethacin:
- diuretics ("water pills")
- angiotensin antagonists (such as candesartan, losartan, valsartan, and others)
- beta blockers (such as atenolol, timolol, metoprolol, propranolol, and others)
- ACE inhibitors (such as captopril, lisinopril, enalapril, benazepril, and others)
You will need more frequent blood pressure checks and possibly a change of medicines.
Methotrexate may have more toxic effects if indomethacin is taken during the same time.
Cyclosporine may cause worse side effects if you are taking indomethacin.
Your blood level of digoxin (for the heart) may go up while taking indomethacin. Be sure your doctor knows that you are on digoxin so that your blood levels can be watched more closely.
Probenecid may increase the blood level of indomethacin and raise the risk of toxic effects. Your doctor may lower your indomethacin dose if you are on both drugs.
Check with your doctor, nurse, or pharmacist about whether other medicines, vitamins, herbs, and supplements can cause problems with this medicine.
Interactions with foods
No serious interactions with food are known at this time. Check with your doctor, nurse, or pharmacist about whether foods may be a problem.
Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.
How is this drug taken or given?
Indomethacin can be taken by mouth or as a rectal suppository. Indomethacin comes as a capsule, extended-release capsule, or liquid. Do not open or crush the extended release capsule. Shake the liquid before pouring the dose. Take the medicine 3 to 4 times a day as directed with food, milk, or antacid to reduce the risk of upset stomach.
To take the rectal suppository, open the package and dip the tip in water. If you are right-handed, lie down on your left side, bring your knees up near your chest, and insert the suppository in your rectum about an inch. Stay in this position for about 15 minutes, then get up and wash your hands well.
Take this drug exactly as directed by your doctor. If you do not understand the instructions, ask your doctor or nurse to explain them to you.
Keep the medicine in a tightly closed container away from heat and moisture and out of the reach of children and pets.
Avoid aspirin or other non-steroidal anti-inflammatory drugs while taking indomethacin. They may increase the risk of overdose, stomach irritation, and aplastic anemia (damage to the bone marrow which results in very low blood counts.) It is easy to get aspirin or ibuprofen without knowing it, because they are often added to other medicines. Read the ingredient list on any remedies for headache, sinus, cold or flu before taking them, or check with your pharmacist.
If you have ever had trouble breathing, rash, itching, or swelling in the mouth, face, or throat after taking aspirin or other anti-inflammatory drugs, do not take indomethacin.
If your blood counts are low due to chemotherapy or radiation, check with your doctor or nurse before taking indomethacin. It may increase your chance of bleeding.
Avoid indomethacin if you have a stomach or duodenal ulcer. Indomethacin can cause severe bleeding or holes in the intestine. This risk is higher in elderly people.
Call your doctor or nurse right away if you have bleeding from the stomach such as vomiting blood or a coffee-ground material, blood in your stool, or black, tarry stools. Stop taking indomethacin until after you talk with your doctor or nurse.
Call your doctor or nurse right away if you have changes in vision or neurologic side effects occur (numbness and tingling, confusion, nightmares, or depression). Stop taking indomethacin until you talk to your doctor or nurse.
If you notice any type of rash, especially if you also have a fever, stop the indomethacin and call your doctor right away.
Indomethacin can cause fluid retention and worsen heart failure. If you have unexplained weight gain or swelling, stop the indomethacin and call your doctor.
Indomethacin must be stopped a few days before any type of surgery. Make sure you tell your doctor or dentist at least a week before surgery if you are taking indomethacin to be sure of your instructions.
Rarely, indomethacin can cause damage to the liver. If you notice nausea, tiredness, itching, tenderness below the right side of your rib cage, flu-like symptoms, or yellowing of the skin or eyes, stop the medicine and call your doctor or nurse right away.
Indomethacin can increase your risk of heart attack and stroke. If you develop shortness of breath, chest pain, weakness in one part or on one side of the body, slurred speech, get help right away.
If you have an allergic reaction with symptoms like trouble breathing, itchy welts on the skin, or swelling of your mouth, face, or throat, get emergency help.
Smoking or drinking alcohol increases your risk of bleeding from the stomach or intestine while taking this drug.
Most cancer pain can be controlled. Keep your doctor or nurse informed about how well your pain medicines are working and any side effects you are having. Your cancer team may need to adjust your medicines several times before they find the medicines that work best for you.
If your doctor prescribes another medicine for pain, ask your doctor or nurse whether you should continue taking indomethacin along with the new medicine. Severe pain usually requires more than one type of medicine to control it.
If you have chronic cancer pain, take your pain medicines on a regular schedule to keep it from worsening. If you wait until the pain is bad, it takes more medicine to get it under control. If pain gets bad between doses, talk to your cancer team about changing your medicine or adding an extra one for "breakthrough" pain.
Possible side effects
You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.
- ringing or buzzing in ears (tinnitus)
- trouble sleeping
- tiredness (fatigue)
- heartburn, indigestion, stomach pain
- numbness and tingling in hands and/or feet*
- loss of appetite
- ulcers or holes in the stomach or intestine*
- bleeding from the stomach or intestine*
- kidney problems with blood or protein in urine
- fast heart rate
- high blood pressure*
- swelling of the arms and legs*
- rash, sometimes with blistering and fever*
- low white blood cell count with increased risk of infection
- low platelet count with increased risk of bleeding
- low red blood cell count with tiredness (fatigue)
- allergic reaction*
- congestive heart failure*
- heart attack*
- blurred vision*
- hearing loss
- liver damage (may improve when drug is stopped)
*See "Precautions" section for more detailed information.
Yes – first approved before 1984 (FDA cannot verify dates of drugs approved before 1984).
Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.
Last Revised: 11/05/2009