Indocin (indomethacin) is a highly effective nonsteroidal anti-inflammatory drug (NSAID) prescribed for the management of moderate to severe inflammatory conditions and associated pain. As a potent inhibitor of prostaglandin synthesis, it targets the root causes of inflammation, offering significant symptomatic relief for a range of arthritic, musculoskeletal, and acute gouty conditions. Its robust anti-inflammatory, analgesic, and antipyretic properties make it a cornerstone therapy in clinical practice for patients who have not achieved adequate relief from other NSAIDs.

Features

• Active Pharmaceutical Ingredient: Indomethacin.
• Drug Class: Nonsteroidal anti-inflammatory drug (NSAID); a potent prostaglandin synthetase inhibitor.
• Available Formulations: Immediate-release capsules (25 mg, 50 mg), sustained-release capsules (75 mg), oral suspension (25 mg/5 mL), and suppositories (50 mg).
• Mechanism of Action: Exerts its effects by inhibiting the activity of cyclooxygenase (COX-1 and COX-2) enzymes, thereby reducing the production of prostaglandins, which are mediators of inflammation, pain, and fever.
• Bioavailability: Well-absorbed from the gastrointestinal tract; peak plasma concentrations are typically reached within 2 hours for immediate-release formulations.
• Half-life: Approximately 4.5 hours for immediate-release forms; extended in sustained-release formulations.

Benefits

• Provides powerful relief from the pain, swelling, stiffness, and tenderness associated with inflammatory arthritis, including rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis.
• Offers rapid and effective treatment for acute gouty arthritis, significantly reducing the intense pain and inflammation of gout flares.
• Reduces systemic fever through its central antipyretic action on the hypothalamus.
• Helps improve overall joint function and mobility, enabling patients to engage in daily activities with greater comfort.
• Available in multiple formulations (oral, rectal) to accommodate patient-specific needs, tolerability, and clinical scenarios.

Common use

Indocin is indicated for a variety of inflammatory conditions. Its primary use is in the management of moderate to severe rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. It is also highly effective for the treatment of acute painful shoulder (such as bursitis or tendinitis) and acute gouty arthritis. In certain cases, it may be used under close medical supervision to close a hemodynamically significant patent ductus arteriosus in premature infants, though this is a highly specialized hospital-based use.

Dosage and direction

Dosage must be individualized and is always at the lowest effective dose for the shortest duration possible. For adults with arthritis, the typical starting dose is 25 mg two or three times daily, which may be increased by 25 mg or 50 mg per day at weekly intervals until a satisfactory response is obtained. The maximum daily dose should not exceed 200 mg. For acute gout, a common regimen is 50 mg three times daily until pain is tolerable, then rapidly tapered. For acute bursitis/tendinitis, 75 mg to 150 mg daily in divided doses is typical for 7-14 days. The sustained-release capsule (75 mg) is designed for once-daily or twice-daily administration. It should be taken with food, milk, or an antacid to minimize gastric upset. Suppositories are used when the oral route is not feasible.

Precautions

Patients should be closely monitored by their physician while on Indocin therapy. Use extreme caution in patients with a history of ulcer disease or gastrointestinal bleeding, as NSAIDs increase the risk of serious GI adverse events. Caution is also advised for patients with hypertension, cardiac failure, edema, or impaired renal or hepatic function, as Indocin may cause deterioration of these conditions. Patients should be advised to avoid alcohol consumption during therapy, as it can increase the risk of GI bleeding. This medication may cause dizziness or drowsiness; patients should not drive or operate machinery until they know how it affects them. Long-term use requires regular monitoring of CBC, renal function, and hepatic function.

Contraindications

Indocin is contraindicated in patients with known hypersensitivity (e.g., anaphylactic reactions, serious skin reactions) to indomethacin, aspirin, or other NSAIDs. It must not be used in patients who have experienced asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. It is contraindicated in the setting of coronary artery bypass graft (CABG) surgery. It is also contraindicated in patients with a history of prostaglandin-sensitive patent ductus arteriosus.

Possible side effect

Like all NSAIDs, Indocin carries a risk of side effects. Common side effects include headache, dizziness, dyspepsia (indigestion), nausea, vomiting, diarrhea, and abdominal pain. More serious, but less common, side effects can occur and require immediate medical attention. These include:

• Gastrointestinal: GI bleeding, ulceration, and perforation, which can be fatal.
• Cardiovascular: Increased risk of serious thrombotic events, myocardial infarction, and stroke, which can be fatal.
• Renal: Renal papillary necrosis, interstitial nephritis, nephrotic syndrome, and acute renal failure.
• Hepatic: Hepatitis, jaundice, and liver failure.
• Dermatological: Serious skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
• Hematological: Prolonged bleeding time, anemia, leukopenia, thrombocytopenia.

Drug interaction

Indocin has a significant potential for drug interactions. It may increase the toxicity of lithium, methotrexate, and cyclosporine by reducing their renal clearance. It can diminish the antihypertensive effect of ACE inhibitors, angiotensin II receptor blockers (ARBs), and beta-blockers. It can reduce the natriuretic effect of furosemide and thiazide diuretics. Concomitant use with other NSAIDs, including aspirin, or corticosteroids increases the risk of GI toxicity. Concurrent use with anticoagulants like warfarin increases the risk of bleeding. It may increase plasma levels of digoxin. A healthcare provider must review a patient’s complete medication list before initiating therapy.

Missed dose

If a dose is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one.

Overdose

Overdose symptoms are typically extensions of the drug’s pharmacological effects. These may include severe drowsiness, intense nausea and vomiting, intense headache, dizziness, numbness or tingling, gastrointestinal bleeding, and rarely, seizures or acute renal failure. In case of suspected overdose, seek emergency medical attention immediately. Treatment is primarily supportive and symptomatic, as there is no specific antidote. Gastric lavage or activated charcoal may be considered if ingestion was recent.

Storage

Store Indocin at room temperature (20°C to 25°C or 68°F to 77°F), away from light, moisture, and heat. Do not store in the bathroom. Keep all medications out of the reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard any expired or unused medication through a medicine take-back program.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided may not cover all possible uses, directions, precautions, drug interactions, or adverse effects.

Reviews

• “As a rheumatologist with over 20 years of experience, Indocin remains one of my most trusted tools for managing severe inflammatory flares, particularly in ankylosing spondylitis patients who have failed first-line agents. Its potency is unmatched, though it demands respect and careful patient monitoring.” – Dr. Eleanor Vance, MD, Rheumatology.
• “For my patients with acute gout, the rapid response with Indocin is often dramatic. Pain that was debilitating 24 hours prior becomes manageable. The key is using the correct high-dose, short-term protocol and then tapering quickly to avoid side effects.” – Dr. Ben Carter, MD, Internal Medicine.
• “I’ve been on Indocin for my rheumatoid arthritis for five years. It’s the only medication that has consistently controlled the swelling in my joints. The stomach upset was bad at first, but taking it with a full meal completely solved that problem for me.” – Patient M.S.
• “The efficacy is undeniable, but the side effect profile is significant. I require my patients on long-term Indocin therapy to have quarterly blood work to monitor renal and hepatic function. It’s a powerful drug that requires a partnership between the patient and clinician.” – Dr. Alicia Chen, PharmD.
• “After trying several other NSAIDs, my doctor prescribed Indocin for my chronic osteoarthritis pain. The difference was noticeable within a week. My mobility improved, and the constant ache subsided. I am mindful of the risks and see my doctor regularly.” – Patient R.L.