Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
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 produces to cause fever and pain that are associated with 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). The FDA first approved indomethacin 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
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
abdominal discomfort.
DRUG INTERACTIONS: Cholestyramine (Questran) and colestipol (Colestid)
may decrease the absorption of indomethacin by binding to indomethacin in the
intestine and preventing absorption into the body. Indomethacin and other NSAIDs
may decrease the elimination of lithium
(Eskalith, Lithobid) by the kidneys and, therefore, increase
the blood level of lithium, which could lead to lithium toxicity.
Indomethacin
may reduce the blood pressure-lowering effects of drugs that are given to
reduce
blood pressure. This may occur because prostaglandins play a role in the
regulation of blood pressure. When indomethacin is used in combination with
aminoglycoside antibiotics (for example, gentamicin) the blood levels of the
aminoglycoside may increase, presumably because the elimination of
aminoglycoside from the body is reduced. This may lead to aminoglycoside-related
side effects.
Individuals taking oral blood thinners or anticoagulants [for example,
warfarin (Coumadin)] should avoid indomethacin because indomethacin also thins the blood,
and excessive blood thinning may lead to bleeding.
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.
NSAIDs reduce the ability
of blood to clot and therefore increase bleeding after an injury.
Indomethacin
may cause ulceration of the stomach or intestine, and the ulcers may bleed.
Sometimes, ulceration and bleeding can occur without abdominal pain, and
black
tarry stools, weakness, and dizziness upon standing (orthostatic hypotension)
may be the only signs of a ulceration.
NSAIDs reduce the flow of blood to the
kidneys and impair function of the kidneys. The impairment is most likely to
occur in patients with preexisting impairment of kidney function or congestive
heart failure, and use of NSAIDs in these patients should be done cautiously.
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.
Fluid retention, blood clots, heart
attacks, hypertension
(high blood pressure), and heart failure have also been associated with the use
of NSAIDs.
Reference: FDA Prescribing Information
Last Editorial Review: 9/16/2008
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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