Indomethacin

• Type of Drug: Nonsteroidal anti-inflammatory drug (NSAID).
• Prescribed for: Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, menstrual pain, tendinitis, bursitis, painful shoulder, gout (except Indocin SR), sunburn prevention and treatment (as a cream or lotion), and migraine and cluster headache prevention (except Indocin SR). Indomethacin can be used to prevent premature labor, but this can affect the development of the baby’s heart and should be avoided. The drug is also used in place of surgery to treat a rare condition in premature infants called patent ductus arteriosus, where the baby’s heart is not fully formed. Topical Indomethacin has been used as eyedrops to treat a severe and unusual inflammation of part of the retina.

Indomethacin General Information

Indomethacin is one of 16 nonsteroidal anti-inflammatory drugs (NSAIDs), which are used to relieve pain and inflammation. We do not know exactly how NISAIDs work, but part of their action may be due to an ability to inhibit the body’s production of a hormone called prostaglandin and to inhibit the action of other body chemicals, including cyclo-oxygenase, lipoxygenase, leukotrienes, lysosomal enzymes, and a host of other factors. Indomethacin is absorbed into the bloodstream fairly quickly. Pain relief comes about 30 minutes after taking the first dose .and lasts, for 4 to 6 hours, but the drug’s anti-inflammatory effect takes a week to become apparent, and may take 2 weeks to reach its maximum effect. Indomethacin is broken down in the liver and eliminated through the kidneys.

Indomethacin Cautions and Warnings

People who are allergic to Indomethacin (or any other NSAID) and those with a history of asthma attacks brought on by another NSAID, by Iodides, or by Aspirin should not take Indomethacin.

Indomethacin can cause gastrointestinal (GI) bleeding, ulcers, and stomach perforation, which can occur at any time, with or without warning, in people who take chronic Indomethacin treatment. People with a history of active GI bleeding should be cautious about taking any NSAID. Minor stomach upset, distress, or gas is common during the first few days of treatment with Indomethacin. People who develop bleeding or ulcers and continue treatment may develop more serious drug toxicity.

• Indomethacin can affect platelets and blood clotting at high doses, and should be avoided by people with clotting problems and by those taking Warfarin.
• People with heart problems who use Indomethacin may experience swelling in their arms, legs, or feet.
  Indomethacin should not be used by people who have had ulcers or other stomach lesions.
• Indomethacin may worsen depression or other psychiatric disorders, epilepsy, and parkinsonism.
• Indomethacin should never be used as “first therapy” for any disorder (with the possible exception of ankylosing spondylitis), because of the severe side effects often associated with this medicine.
• Indomethacin can cause severe toxic effects to the kidney. Report any unusual side effects to your doctor, who may need to periodically test your kidney function.
• Indomethacin can make you unusually sensitive to the effects of the sun (photosensitivity).

Possible Side Effects

• Most common: diarrhea, nausea, vomiting, constipation, stomach gas, stomach upset or irritation, and loss of appetite.
• Less common: stomach ulcers, GI bleeding, hepatitis, gallbladder attacks, painful urination, poor kidney function, kidney inflammation, blood and protein in the urine, dizziness, fainting, nervousness, depression, hallucinations, confusion, disorientation, tingling in the hands or feet, light-headedness, itching, increased sweating, dry nose and mouth, heart palpitations, chest pain, difficulty breathing, and muscle cramps.
• Rare: severe allergic reactions, including closing of the throat, fever and chills, changes in liver function, jaundice (yellowing of the skin or eyes), and kidney failure. People who experience such effects must be promptly treated in a hospital emergency room or doctor’s office.

NSAIDs have caused severe skin reactions; if this happens to you, see your doctor immediately.

Indomethacin Drug Interactions

• Indomethacin can increase the effects of oral anticoagulant (blood-thinning) drugs, such as Warfarin. You may take this combination, but your doctor may have to reduce your anticoagulant dose.
• The combination of Indomethacin and a thiazide diuretic affects the amount of diuretic in your blood. Indomethacin may reduce the effect of the diuretic.
• Diflunisal increases the amount of Indomethacin in your blood; the combination of Indomethacin and Diflunisal has resulted in a fatal GI hemorrhage.
• Indomethacin may reduce the blood-pressure-lowering effect of beta blockers, angiotensin-converting-enzyme (ACE) inhibitor drugs, and loop diuretics.
• Taking Indomethacin with Cyclosporine may increase the toxic kidney effects of both drugs. Methotrexate toxicity may be increased in people also taking Indomethacin.
• Indomethacin may increase Digoxin levels in the blood.
• Taking Indomethacin with Phenylpropanolamine (found in many over-the-counter drug products) may cause an increase in blood pressure.
• The combination of Indomethacin and Dipyridamole may increase your water retention.
• Indomethacin may increase blood levels of Phenytoin, leading to increased Phenytoin side effects. Blood-Lithium levels may be increased in people taking Indomethacin.
• Indomethacin blood levels may be affected by Cimetidine because of that drug’s effect on the liver.
• Probenecid may interfere with Indomethacin’s elimination from the body, increasing the chances for Indomethacin toxic reactions.
• Aspirin and other salicylates may decrease the amount of Indomethacin in your blood These medicines should never be taken at the same time.

Food Interactions

Take Indomethacin with food or a magnesium/aluminum antacid if it upsets your stomach.

Usual Dose

Adult and Adolescent (age 14 and older): 50 to 200 mg per day, individualized to your needs.
Child (age 14 and under): Not recommended.

Indomethacin Overdosage

People have died from NSAID overdoses. The most common signs of overdosage are drowsiness, nausea, vomiting, diarrhea, abdominal pain, rapid breathing, rapid heartbeat, increased sweating, ringing or buzzing in the ears, confusion, disorientation, stupor, and coma.
Take the victim to a hospital emergency room at once. ALWAYS bring the medicine bottle with you.

Special Information

Indomethacin can make you drowsy and/or tired: Be careful when driving or operating hazardous equipment. Do not take any nonprescription products containing Acetaminophen or Aspirin while taking this drug; also, avoid alcoholic beverages.

Take each dose with a full glass of water, and don’t lie down for 15 to 30 minutes after you take the medicine.
Contact your doctor if you develop skin rash or itching, visual disturbances, weight gain, breathing difficulty, fluid retention, hallucinations, black or tarry stools, persistent headache, or any unusual or intolerable side effects.

If you forget to take a dose of Indomethacin, take it as soon as you remember. If you take several Indomethacin doses a day and it is within 4 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take it once a day and it is within 8 hours of your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.

Indomethacin Special Populations

Pregnancy/Breast-feeding
Indomethacin may cross into the fetal blood circulation. Although it has not been found to cause birth defects, Indomethacin should not be used during the second half of pregnancy, because it may affect the developing fetal heart. Women who are or who might become pregnant should not take Indomethacin without their doctor’s approval. When the drug is considered essential by your doctor, its potential benefits must be carefully weighed against its risks.

Indomethacin may pass into breast milk but has caused few problems among breast-fed infants, except for seizures in a baby whose mother was taking it. However, there is also a possibility that a nursing mother taking Indomethacin could affect her baby’s heart or cardiovascular system. If you must take Indomethacin, bottle-feed your baby.

Seniors
Older adults may be more susceptible to Indomethacin side effects, especially ulcer disease.