Other Names/Brands

Confortid, Dialon, Reumatin, Indocin, Indocin SR, Indocin IV, and Tivorbex

Mechanism of Action

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that works by inhibiting the cyclooxygenase (COX) enzyme, which plays a role in prostaglandin production.

Prostaglandins are substances that trigger pain, inflammation, and fever. By decreasing prostaglandin production, indomethacin helps relieve pain, reduce swelling, and decrease the body's inflammatory response.

Indications

Indomethacin is indicated for the relief of pain and inflammation in various musculoskeletal conditions, such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gout attacks. It can also be used for postoperative pain or other inflammatory conditions requiring a strong anti-inflammatory effect.

Contraindications

Indomethacin is contraindicated in individuals with a history of allergy to indomethacin or other non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin.

This medication should also not be used in patients with gastric ulcers, gastrointestinal bleeding, or severe liver or kidney disorders.

Indomethacin is also contraindicated in patients with severe heart failure, NSAID-induced asthma, and pregnant women because it can interfere with fetal development.

Side Effects

Side effects of indomethacin can include gastrointestinal complaints such as nausea, abdominal pain, heartburn, and in some cases, ulcers or stomach bleeding. This medication can also cause headaches, dizziness, drowsiness, or confusion in some users. Indomethacin can affect kidney function and increase blood pressure, and in rare cases, it can cause allergic reactions.

Preparations

Indomethacin is available in several dosage forms to suit the patient's condition and needs. Common forms are capsules and tablets for oral use.

Indomethacin is also available as a rectal suppository, which can be used when patients cannot take the medication orally.

In some countries, topical preparations such as gels are also available for local application to areas of pain or inflammation.

Dosage

Indomethacin dosage varies depending on the patient's condition, age, and response to therapy. This medication is given in multiple doses per day, with the total daily dose limited to reduce the risk of side effects, particularly those affecting the gastrointestinal tract and kidneys.

For acute inflammatory conditions such as gout attacks, the initial dose is higher and then reduced as symptoms improve. For chronic conditions such as arthritis, the dose is started at a low level and gradually adjusted.

Indomethacin has the potential for significant side effects, so the dosage should follow the doctor's recommendation.

Safety of Drugs

Indomethacin has a safety category that requires careful consideration, especially in pregnant women and patients with certain health conditions.

In the first and second trimesters of pregnancy, this drug is generally classified as pregnancy category C, meaning its use should only be considered if the benefits outweigh the risks. In the third trimester, indomethacin is classified as pregnancy category D because it can interfere with fetal development, particularly the risk of premature closure of the ductus arteriosus.

This drug should be used with caution in patients with kidney or liver disorders, high blood pressure, or a history of stomach problems, as it may increase the risk of side effects.

Drug Interactions

Indomethacin has a wide range of potential drug interactions due to its mechanism of action as a non-steroidal anti-inflammatory drug (NSAID). This drug can increase the risk of bleeding when used with anticoagulants or antiplatelets and can decrease the effectiveness of antihypertensive medications such as ACE inhibitors, ARBs, and diuretics.

Indomethacin can also increase the risk of kidney damage when combined with nephrotoxic drugs and may increase blood levels of certain medications, such as lithium or methotrexate.

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