Medical and Pharmacy Editor: Jay Marks, M.D.

GENERIC NAME: indomethacin

BRAND NAME: Indocin, Indocin-SR

DRUG CLASS AND MECHANISM: Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that reduces fever, pain and inflammation. It is similar to ibuprofen (Motrin) and naproxen (Naprosyn, Aleve). Indomethacin works by reducing the production of prostaglandins. Prostaglandins are chemicals that the body uses to cause fever, pain and inflammation. Indomethacin blocks the enzymes that make prostaglandins (cyclooxygenase 1 and 2) and thereby reduces the levels of prostaglandins. As a result, fever, pain and inflammation are reduced. Indomethacin is available in a sustained (slow) release form (Indocin-SR). Indomethacin was first approved by the FDA in January, 1965.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Capsules: 25 and 50 mg; Capsules, sustained release: 75 mg; Suspension: 25 mg/ml; Suppositories: 50 mg.

STORAGE: Capsules should be kept at room temperature 15-30°C (59-86°F). Oral suspension and suppositories should be kept below 30°C (86°F). The oral suspension should not be frozen.

PRESCRIBED FOR: Indomethacin is used for the treatment of inflammation and pain caused by rheumatoid arthritis, ankylosing spondylitis, gouty arthritis, osteoarthritis, and soft tissue injuries such as tendinitis and bursitis.

DOSING: The recommended dose for adults is 50-200 mg per day split into 2-3 doses. Indomethacin should be taken with food in order to reduce stomach discomfort.

DRUG INTERACTIONS: Cholestyramine (Questran) and colestipol (Colestid) may decrease the absorption of indomethacin by acting as a mechanical barrier to absorption. Indomethacin and other NSAIDs may decrease the elimination of lithium by the kidneys and, therefore, increase the blood level of lithium, which could lead to lithium toxicity.

PREGNANCY: Use during pregnancy has not been adequately studied. Indomethacin may have adverse effects on the fetus.

NURSING MOTHERS: Indomethacin is excreted in breast milk and therefore should be avoided by nursing mothers.

SIDE EFFECTS: The most common side effects are nausea, vomiting, diarrhea, stomach discomfort, heartburn, rash, headache, dizziness and drowsiness. Indomethacin may cause or worsen stomach or intestinal bleeding or ulcers. It may lead to perforation of the intestine. Indomethacin also can increase blood pressure and decrease kidney function. Individuals who have nasal polyps or are allergic to aspirin or other NSAIDs should not use indomethacin because there is an increased risk of severe allergic reactions in these individuals.

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Last Editorial Review: 7/8/2002