Indocin (indomethacin) is a potent nonsteroidal anti-inflammatory drug (NSAID) prescribed for the management of moderate to severe inflammatory conditions and pain. As a cornerstone therapy in rheumatology and related specialties, it works by inhibiting prostaglandin synthesis, effectively reducing inflammation, pain, and fever. Its clinical utility spans a range of disorders, including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis. This medication is reserved for cases where less potent NSAIDs have proven inadequate, offering a robust option for patients requiring significant anti-inflammatory and analgesic effects. Proper usage under medical supervision ensures optimal therapeutic outcomes while minimizing risks.

Features

• Active Ingredient: Indomethacin
• Available Forms: Capsules (25 mg, 50 mg), Extended-Release Capsules (75 mg), Oral Suspension (25 mg/5 mL), Suppositories (50 mg)
• Mechanism of Action: Non-selective cyclooxygenase (COX-1 and COX-2) inhibitor
• Onset of Action: Rapid absorption; peak plasma concentrations within 2 hours (immediate-release)
• Half-Life: Approximately 4.5 hours (immediate-release); 5-6 hours (extended-release)
• Prescription Status: Rx-only in most jurisdictions

Benefits

• Provides potent anti-inflammatory action, reducing joint swelling, tenderness, and morning stiffness in arthritic conditions.
• Offers effective analgesia for moderate to severe pain, including that associated with acute gout flares and post-surgical discomfort.
• Helps lower fever in cases where standard antipyretics are insufficient or contraindicated.
• Can improve mobility and functional capacity in patients with chronic inflammatory joint diseases.
• May be used for closure of patent ductus arteriosus in premature infants (under strict hospital protocol).
• Available in multiple formulations (oral, rectal) to accommodate patient-specific needs and tolerability.

Common use

Indocin is predominantly indicated for the relief of signs and symptoms associated with rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. It is also highly effective in managing acute painful shoulder (bursitis/tendinitis) and acute gouty arthritis. In pediatric cardiology, intravenous indomethacin (a different formulation) is used to medically close a hemodynamically significant patent ductus arteriosus in premature infants. Its use is generally reserved for situations where the condition is sufficiently severe to warrant the risk of NSAID-related side effects and where less potent agents have failed.

Dosage and direction

Dosage must be individualized based on the condition being treated, formulation used, and patient response. For adults with arthritis: usual starting dose is 25 mg two or three times daily; may be increased by 25 or 50 mg daily at weekly intervals until satisfactory response is achieved (max 150-200 mg/day). For acute gout: 50 mg three times daily until pain is tolerable, then rapidly taper. For acute bursitis/tendinitis: 75-150 mg daily in 3-4 divided doses for 7-14 days. Extended-release capsules (75 mg) are designed for once or twice daily dosing. Should be taken with food, milk, or antacids to minimize gastric upset. The lowest effective dose for the shortest duration should be used.

Precautions

Use with caution in patients with a history of gastrointestinal disease (bleeding, ulcers), cardiovascular risk factors, hypertension, heart failure, renal impairment, hepatic dysfunction, asthma, or dehydration. Monitor renal function and blood pressure periodically during long-term therapy. Avoid alcohol consumption during treatment, as it increases risk of GI bleeding. Patients should be advised to report any signs of gastrointestinal ulceration or bleeding, skin rash, weight gain, edema, or black tarry stools. Use during pregnancy, especially third trimester, should be avoided due to risk of premature closure of ductus arteriosus.

Contraindications

Hypersensitivity to indomethacin, aspirin, or other NSAIDs; history of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs; peri-operative pain in setting of coronary artery bypass graft (CABG) surgery; third trimester of pregnancy; significant renal impairment; active gastrointestinal bleeding or ulceration.

Possible side effect

Common: nausea, dyspepsia, diarrhea, dizziness, headache. Serious: gastrointestinal bleeding, ulceration, or perforation; hypertension, heart failure, myocardial infarction; renal impairment, acute kidney injury; hepatotoxicity; severe skin reactions; anaphylaxis; exacerbation of asthma in aspirin-sensitive patients. Patients should seek immediate medical attention for symptoms like chest pain, shortness of breath, weakness on one side of the body, slurred speech, swelling, or unusual weight gain.

Drug interaction

May increase toxicity of lithium, methotrexate, cyclosporine. Concomitant use with other NSAIDs, corticosteroids, or anticoagulants (e.g., warfarin) increases risk of GI bleeding. May reduce antihypertensive effect of ACE inhibitors, angiotensin II receptor blockers, beta-blockers, diuretics. May increase serum levels of digoxin. Aspirin co-administration not recommended. Caution with SSRIs/SNRIs due to increased bleeding risk.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. Maintaining consistent dosing is important for stable therapeutic effect, but occasional missed doses are not typically dangerous; consistency helps manage symptoms effectively.

Overdose

Symptoms may include nausea, vomiting, intense headache, dizziness, drowsiness, blurred vision, tinnitus, respiratory depression, coma, seizures, acute renal failure. There is no specific antidote. Management is supportive and symptomatic, including gastric lavage or activated charcoal (if recent ingestion), monitoring and supporting vital functions, and correcting electrolyte imbalances. Hemodialysis is not effective due to high protein binding.

Storage

Store at room temperature (20-25°C or 68-77°F), away from light, moisture, and heat. Keep in original container, tightly closed. Do not store in bathroom. Keep all medications out of reach of children and pets. Do not flush medications down toilet or pour into drain unless instructed to do so.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. Indocin is a prescription medication and should be used only under the supervision of a healthcare professional.

Reviews

Clinical studies and patient reports consistently highlight Indocin’s efficacy in managing inflammatory pain, particularly in acute gout and rheumatoid arthritis. Many patients experience significant improvement in pain scores and joint function. However, reviews also frequently note gastrointestinal side effects, underscoring the importance of taking it with food and using the lowest effective dose. Physicians often regard it as a powerful option when first-line NSAIDs are ineffective, but stress the need for careful patient selection and monitoring.