Important Information

  • FDA warning: Indomethacin has a Black Box Warning. This is the most serious warning from the Food & Drug Administration (FDA). Though the medication can still be sold and used, a black box warning alerts doctors and patients to potentially dangerous effects.
    • Heart risk. Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs may increase your risk of heart attack, heart failure, or stroke. This risk may be higher if you’re taking it long term, at high doses, or if you already have heart problems or risk factors for heart disease, such as high blood pressure.
    • Don’t take indomethacin for pain before, during, or after heart bypass surgery. This may increase your risk for a heart attack or stroke. Talk to your doctor if you take indomethacin and will have surgery soon.
    • Stomach problems. NSAIDs like indomethacin may increase your risk of serious side effects, including stomach bleeding or ulcers. These events may be fatal. They may happen at any time without symptoms. Seniors have a higher risk for serious stomach problems.
  • May cause kidney problems: Indomethacin may harm your kidneys if you take it for a long time. Call your doctor if you have symptoms of kidney damage, such as:
    • changes in your urine volume
    • swelling of your feet or ankles
    • shortness of breath
  • Dangerous skin reactions: Indomethacin can cause a skin reaction that can be fatal. Call your doctor if you have signs of a skin reaction, such as blistering, peeling, or swelling of your skin. You may also have a fever.
  • Pregnancy warning: Don’t use indomethacin if you’ve been pregnant for more than 29 weeks. Using it during this time can cause problems with the fetus’s heart.

Drug features

Indomethacin is a prescription drug. It’s available in these forms: oral immediate-release capsule, oral extended-release capsule, oral liquid, and rectal suppository.

Indomethacin is available in its generic form. Generic drugs often cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

This drug may be used as part of a combination therapy. That means you need to take it with other drugs.

Why it's used

Indomethacin is used to treat inflammation, pain, and fever. It’s most commonly used to treat:

  • moderate to severe rheumatoid arthritis
  • moderate to severe ankylosing spondylitis
  • moderate to severe osteoarthritis
  • acute painful shoulder (bursitis or tendinitis)
  • acute gouty arthritis (immediate-release only)

How it works

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking an enzyme in your body that leads to inflammation. Blocking the enzyme helps to reduce inflammation and pain.

MOST COMMON SIDE EFFECTS

The most common side effects that occur with indomethacin include:

  • nausea
  • vomiting
  • heartburn
  • diarrhea
  • stomach pain
  • constipation
  • headache
  • dizziness
  • tiredness
  • ringing in your ears

SERIOUS SIDE EFFECTS

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • heart attack. Symptoms may include:
    • chest pain
    • shortness of breath
    • discomfort in your upper body
  • stroke. Symptoms may include:
    • face drooping
    • arm weakness
    • difficulty speaking
  • high blood pressure. Symptoms may include:
    • a dull headache, dizzy spells, or nosebleeds
  • heart failure. Symptoms may include:
    • swelling of your ankles or feet
    • sudden weight gain
    • tiredness
  • kidney problems. Symptoms may include:
    • changes in your urine volume
    • swelling of your feet or ankles
    • shortness of breath
  • stomach or intestinal bleeding. Symptoms may include:
    • bright red- or black-colored stool
    • tar-like stool
    • red-colored vomit
  • low red blood cell (anemia) count. Symptoms may include:
    • shortness of breath
    • weakness
    • pale-colored skin
    • fast heartbeat
  • severe skin rash with blisters. You may also have a fever.
  • severe allergic reaction. Symptoms may include:
    • trouble breathing
    • swelling of your throat, tongue, or lips
  • liver problems. Symptoms may include:
    • yellowing of your skin or the whites of your eyes
    • nausea
    • fatigue
    • itching
    • flu-like symptoms such as muscle aches, chills, and tiredness
  • asthma attacks

Indomethacin can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol interaction

Combining this drug with alcohol may increase your risk of bleeding in your stomach or intestines. Talk to your doctor if you drink alcohol. You may need to limit how much alcohol you drink while taking this medication.

Medications that might interact with this drug

Blood pressure medications

  • angiotensin-converting enzyme (ACE) inhibitors
  • angiotensin II receptor blockers
  • water pills (diuretics), such as hydrochlorothiazide

These drugs may not work as well to control blood pressure when taken with indomethacin.

Aspirin

Combining these medications increases your risk of stomach problems, including ulcers and bleeding.

Bipolar disorder drug

  • lithium

Combining these drugs may cause lithium to take longer to be clear from your body. This increases the level of lithium in your body, which may cause nausea, tremors, and dizziness.

Disease modifying anti-rheumatic drug

  • methotrexate

Indomethacin may increase the amount of methotrexate in your body to toxic levels. This can raise your risk of infection, kidney damage, and low white blood cell counts.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Examples are:

  • ibuprofen
  • meloxicam
  • naproxen

Taking other NSAIDs with indomethacin may increase the risk of stomach problems.

Oral anticoagulants, blood thinners

  • warfarin
  • clopidogrel
  • ticlopidin
  • rivaroxaban

Taking these drugs with indomethacin may increase your risk of bleeding in your stomach or intestines.

Indomethacin warnings

  • People with heart conditions: Indomethacin may increase your risk of a heart attack or stroke. It may also cause higher blood pressure levels.
  • People with stomach problems: Indomethacin may increase your risk of swelling or bleeding in your stomach and intestines. It may also increase your risk for ulcers.
  • People with kidney problems: Your kidneys may not work as well when taking indomethacin. It may damage your kidneys or lower the blood flow to your kidneys.
  • People with asthma: Don’t use indomethacin if you have aspirin-sensitive asthma. It may cause a fatal allergic reaction.
  • Pregnant women: Indomethacin is a category C pregnancy drug. That means two things:
    1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
    2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.
    Tell your doctor if you’re pregnant or plan to become pregnant. Indomethacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Women who are breast-feeding: Indomethacin may pass through breast milk and cause serious side effects in a breastfeeding child. You and your doctor may need to decide whether you’ll take indomethacin or breastfeed.
  • For seniors: If you’re over 65 years of age, you may have more side effects, such as bleeding in the stomach or intestines. Also, your kidney function may be decreased. Your kidneys may not remove the drug from your body as well as they should, putting you at risk for serious side effects.
  • Allergies: Indomethacin can cause a severe allergic reaction. Symptoms may include:
    • trouble breathing
    • swelling of your throat or tongue
    • hives
    Don’t take this drug again if you’ve ever had an allergic reaction to aspirin or other NSAIDs. Taking it again could be fatal.

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Moderate to severe rheumatoid arthritis

Form: Oral immediate-release capsule
Strengths: 25 mg and 50 mg

Form: Oral extended-release capsule
Strengths: 75 mg

Adult dosage (ages 18 years and older)

  • Immediate-release capsule: Indomethacin is usually dosed 2 to 3 times per day and starts at a dose of 25 mg. Your doctor may increase your dose by 25 or 50 mg per day. The maximum dose is 200 mg per day.
  • Extended-release capsule: The dose is 75 mg once or twice per day. The maximum dose is 150 mg per day.

Child dosage (ages 0-17 years)

  • Immediate-release capsule: Indomethacin dosing for children is based on weight. Your doctor will determine the right dose for your child. A starting dose may be 1–2 mg/kg per day divided into 2–4 doses. The maximum dose is 3 mg/kg per day or 200 mg per day, whichever is less.
  • Extended-release capsule: A safe and effective extended-release capsule dosage hasn’t been established for this age group.

Moderate to severe ankylosing spondylitis

Form: Oral immediate-release capsule
Strengths: 25 mg and 50 mg

Form: Oral extended-release capsule
Strengths: 75 mg

Adult dosage (ages 18 years and older)

  • Immediate-release capsule: Indomethacin is usually dosed 2 to 3 times per day and starts at a dose of 25 mg. Your doctor may increase your dose by 25 or 50 mg per day. The maximum dose is 200 mg per day.
  • Extended-release capsule: The dose is 75 mg once or twice per day. The maximum dose is 150 mg per day.

Child dosage (ages 0-17 years)

  • Immediate-release capsule: Indomethacin dosing for children is based on weight. Your doctor will determine the right dose for your child. A starting dose may be 1–2 mg/kg per day divided into 2–4 doses. The maximum dose is 3 mg/kg per day or 200 mg per day, whichever is less.
  • Extended-release capsule: A safe and effective extended-release capsule dosage hasn’t been established for this age group.

Moderate to severe osteoarthritis

Form: Oral immediate-release capsule
Strengths: 25 mg and 50 mg

Form: Oral extended-release capsule
Strengths: 75 mg

Adult dosage (ages 18 years and older)

  • Immediate-release capsule: Indomethacin is usually dosed 2 to 3 times per day and starts at a dose of 25 mg. Your doctor may increase your dose by 25 or 50 mg per day. The maximum dose is 200 mg per day.
  • Extended-release capsule: The dose is 75 mg once or twice per day. The maximum dose is 150 mg per day.

Child dosage (ages 0-17 years)

  • Immediate-release capsule: Indomethacin dosing for children is based on weight. Your doctor will determine the right dose for your child. A starting dose may be 1–2 mg/kg per day divided into 2–4 doses. The maximum dose is 3 mg/kg per day or 200 mg per day, whichever is less.
  • Extended-release capsule: A safe and effective extended-release capsule dosage hasn’t been established for this age group.

Acute painful shoulder (bursitis or tendinitis)

Form: Oral immediate-release capsule
Strengths: 25 mg and 50 mg

Form: Oral extended-release capsule
Strengths: 75 mg

Adult dosage (ages 18 years and older)

  • Immediate-release capsule: The dose is 75–150 mg in 3 or 4 divided doses per day for 7–14 days.
  • Extended-release capsule: The dose is 75 mg once or twice per day. The maximum dose is 150 mg per day.

Child dosage (ages 0-17 years)

  • Immediate-release capsule: Indomethacin dosing for children is based on weight. Your doctor will determine the right dose for your child. A starting dose may be 1–2 mg/kg per day divided into 2–4 doses. The maximum dose is 3 mg/kg per day or 200 mg per day, whichever is less.
  • Extended-release capsule: A safe and effective extended-release capsule dosage hasn’t been established for this age group.

Acute gouty arthritis

Form: Oral immediate-release capsule
Strengths: 25 mg and 50 mg

Adult dosage (ages 18 years and older)
The dose is usually 50 mg 3 times per day until your pain improves.

Child dosage (ages 0-17 years)
Indomethacin dosing for children is based on weight. Your doctor will determine the right dose for your child. A starting dose may be 1–2 mg/kg per day divided into 2–4 doses. The maximum dose is 3 mg/kg per day or 200 mg per day, whichever is less.

Important considerations for taking indomethacin

  • Take with food to reduce risk of upset stomach
  • Don’t crush, chew, or cut extended-release capsules. They need to be released in your body slowly
  • Store at room temperature: 68–77°F (20–25°C) Don’t freeze indomethacin. Keep this drug away from light and high temperatures. Keep your drugs away from areas where they could get wet, such as bathrooms. Store these drugs away from moisture and damp locations.
  • This prescription is refillable
  • When traveling with your medication:
    • Always carry it with you or in your carry-on bag.
    • Don’t worry about airport X-ray machines. They can’t hurt this medication.
    • You may need to show your pharmacy’s preprinted label to identify the medication. Keep the original prescription-labeled bottle with you when traveling.
  • Your doctor will check you regularly for signs of stomach or intestinal bleeding. Your doctor will also do blood work to make sure that your liver and kidneys are working properly. If you’re taking any drugs that may interact with indomethacin, your doctor may also monitor the levels of those drugs.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.