Indometacin should be used with caution in: patients who are allergic to other NSAIDS; elderly (as they are at increased risk for serious stomach/intestinal bleeding); liver (hepatic), kidney (renal) and heart (cardiac) problems, Crohn’s disease, ulcerative colitis; patients with a history of high blood pressure (hypertension).
It should not be used in: patients who are allergic to indometacin; patients with angioneurotic oedema (swelling of the skin of the face, normally around the mouth, and the mucosa of the mouth and/or throat, as well as the tongue due to an allergy); patients with aspirin-sensitive asthma (a history of worsening breathing with runny/stuffy nose after taking aspirin or other NSAIDs); patients taking other NSAIDs including cyclooxygenase 2 specific inhibitors; patients with active peptic ulcer, patients with a history of bleeding in the digestive system; patients with severe liver (hepatic), kidney (renal) and heart (cardiac) failure; patients who have recently undergone heart bypass surgery; patients with nasal polyps; last trimester of pregnancy; children (the safety has not been established); patients with rare hereditary problems of fructose or galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption or sucrase-isomaltase insufficiency.
Also see list of precautions and interactions.
Store in a dry place below 25°C. Protect from light.
What is it used for?
- Indometacin is used to treat a number of problems affecting the joints and muscles, as well as other conditions, such as acute gout and period pain.
- It is a member of a class of pain killing drugs called non-steroidal anti-inflammatory drugs (NSAIDs).
- It is used to relieve pain, reduce swelling and joint stiffness.
- In general this drug is used to treat patients who are suffering from the pain and/or swollen joints associated with many conditions.
- Benefits of being on this drug can include relieving pain and reducing the swelling and stiffness in joints allowing you to do more of your normal daily activities.
Listed below are the typical uses of indometacin:
- Treatment of inflammatory diseases of the joints or surrounding tissues such as rheumatoid arthritis, osteoarthritis, degenerative hip disease, bursitis, tendonitis, synovitis, tenosynovitis and capsulitis
- Treatment of deformity and stiffening of the backbone (ankylosing spondylitis)
- Treatment of muscular pain, low back pain and pain following bone or joint surgery
- Treatment of acute musculoskeletal disorders
- To reduce the inflammation, pain and oedema (swelling from excessive accumulation of watery fluid) following orthopaedic procedures
- Treatment of period pain
- Treatment of gout
On occasion your doctor may prescribe this medicine to treat a condition not on the above list. Such conditions are listed below:
- To relieve pain caused by inflammation of the lining surrounding the heart (pericardium).
HOW TO USE/TAKE
How often do I take it?
- This medication is available in capsule form and as a suppository.
- Take the capsule formulation by mouth, usually once or twice daily with or just after food to reduce the chance of upsetting your stomach. The suppository formulation should be inserted into your back passage (rectum) at night and repeated in the morning if necessary.
- Modified release preparations should be swallowed whole and must not be crushed or chewed.
- Use this medication regularly in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take a few weeks (with certain conditions such as arthritis) before the full benefit of this drug takes effect.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- Indometacin may make you feel drowsy, dizzy, tired or affect your vision, therefore make sure you are not affected before you drive or operate machinery. Consult your doctor or pharmacist for more details.
When can I stop?
- Always complete the full course as prescribed by your doctor.
INDOMETACIN SIDE EFFECTS
If any of these persist or you consider them severe then inform doctor or pharmacist.
Tell your doctor immediately if you develop any of the following symptoms: pass blood in your faeces; pass black tarry stools or vomit blood or dark particles that look like coffee grounds; stomach pain; swelling of the hands/feet; sudden/unexplained weight gain; vision changes; hearing changes (e.g. ringing in the ears); mental/mood changes (e.g. confusion, hallucinations); fast/pounding heartbeat; persistent/severe headache; fainting; muscle weakness; uncontrollable movements; difficult/painful swallowing.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash; itching/swelling (especially of the face/tongue/throat); dizziness; trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking indometacin, tell your doctor or pharmacist if you are allergic to it; or to other NSAIDs; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist in case of: aspirin-sensitive asthma (a history of worsening breathing with runny/stuffy nose after taking aspirin or other NSAIDs); recent heart bypass surgery; active peptic ulcer; a history of gastro-intestinal lesions; severe liver (hepatic), kidney (renal) and heart (cardiac) failure; severe heart failure; last trimester of pregnancy; patients with rare hereditary problems of fructose or galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption or sucrase-isomaltase insufficiency.
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following: kidney disease; liver disease; poorly controlled diabetes; stomach/intestine/oesophagus problems (e.g. bleeding, ulcers); heart disease (e.g. congestive heart failure, history of heart attack); blood disorders (e.g. anaemia); bleeding or clotting problems; high blood pressure; swelling (oedema, fluid retention); a severe loss of body water (dehydration); stroke; mental/mood conditions (e.g. depression, psychoses); seizures; Crohn’s disease, ulcerative colitis Parkinson's disease; high level of potassium in the blood; asthma; growths in the nose (nasal polyps).
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
The elderly: indometacin should be used with caution in the elderly as it may increase the risk of serious side effects.
Pregnancy and breastfeeding - please ensure you read the detailed information below
Indometacin is to be avoided in the last trimester of pregnancy and should not be used in the first two trimesters unless the potential benefit to the patients outweighs the potential risk to the foetus.
First trimester: not recommended
Second trimester: not recommended
Third trimester: avoid
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Indometacin is not safe to take if you are breastfeeding, as it can pass into the breast milk.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur: other NSAIDs (e.g. diflunisal, ketorolac); high doses of aspirin and related drugs (salicylates); a "water pill" (a diuretic) called triamterene.
If you are currently using any of these medications, tell your doctor or pharmacist before starting indometacin.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Aspirin or related medicines, such as such celecoxib or ibuprofen
- Other NSAIDs including diflunisal
- Quinolone antibiotics (such as ciprofloxacin)
- SSRI antidepressants (e.g. paroxetine)
- Sulphonylureas (used to treat diabetes)
- Medicines used to treat high blood pressure (such as atenolol, captopril, doxazosin, hydralazine, losartan, nifedipine, propranolol or quinipril)
- Anti-platelet medicines or other drugs to stop the blood clotting
- Lithium or haloperidol (psychiatric medicines)
- Anti-viral medicines (such as zidovudine or ritonavir)
- Cardiac glycosides (used to treat heart conditions e.g. digoxin)
- Ciclosporin or tacrolimus (immune system medicines)
- Corticosteroids (anti-inflammatories)
- Methotrexate (used to treat some cancers, severe psoriasis and severe rheumatoid arthritis)
- Desmopressin (hormone preparation used for night-time bed wetting)
- Thiazides, furosemide and triamterene (control fluid levels in the body)
- Mifepristone (used to induce abortion)
- Baclofen (muscle relaxant)
- Pentoxifylline (used to treat vascular disease)
- Probenecid (a treatment for gout)
- Tiludronic acid (used to treat bone diseases)
Indometacin may alter the results of some blood or urine tests. If you see another doctor or go into hospital, let them know what medicines you are taking.
This information does not contain all possible interactions. Therefore, before using indometacin, tell your doctor or pharmacist of all the products you use.
Symptoms of an overdose include: headache; nausea; vomiting; epigastric pain; gastrointestinal bleeding. Rarely: diarrhoea; disorientation; excitation; coma; drowsiness; dizziness; tinnitus; fainting. Occasionally: convulsions. In cases of significant poisoning acute renal failure and liver damage are possible.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of indometacin or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.