From the Guidelines
Indomethacin should be used with caution and at the lowest effective dose for the shortest duration possible to minimize the risk of gastrointestinal and cardiovascular complications, as evidenced by high-quality studies 1.
Key Points
- Indomethacin is a potent non-steroidal anti-inflammatory drug (NSAID) used to treat moderate to severe inflammatory conditions, including gout attacks, rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis.
- The typical adult dosage ranges from 25-50 mg taken 2-3 times daily with food to minimize gastrointestinal side effects, with a maximum daily dose of 200 mg.
- For acute gout, treatment usually begins with 50 mg three times daily until symptoms subside.
- Indomethacin works by inhibiting cyclooxygenase enzymes (COX-1 and COX-2), which reduces the production of prostaglandins responsible for pain, inflammation, and fever.
- Common side effects include stomach upset, headache, dizziness, and drowsiness.
- Serious risks include gastrointestinal bleeding, kidney problems, and cardiovascular events, particularly with prolonged use.
- It should be avoided in patients with aspirin allergy, severe kidney disease, heart failure, or during the third trimester of pregnancy.
- Patients should take the lowest effective dose for the shortest duration possible and stay well-hydrated while using this medication.
Considerations
- Moderate-quality evidence showed no difference between different types of NSAIDs, including indomethacin, in terms of efficacy for treating acute gout 1.
- However, indomethacin is commonly considered as the first-line NSAID for treatment of acute gout due to its potent anti-inflammatory effects.
- The use of indomethacin should be carefully weighed against the potential risks, particularly in patients with a history of gastrointestinal or cardiovascular disease.
- Alternative treatments, such as colchicine or corticosteroids, may be considered in patients who are at high risk for complications or who have contraindications to NSAID use 1.
From the FDA Drug Label
Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that exhibits antipyretic and analgesic properties. Its mode of action, like that of other anti-inflammatory drugs, is not known. However, its therapeutic action is not due to pituitary-adrenal stimulation. Indomethacin is a potent inhibitor of prostaglandin synthesis in vitro Concentrations are reached during therapy which have been demonstrated to have an effect in vivo as well.
Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that has antipyretic and analgesic properties. Its therapeutic action is due to the inhibition of prostaglandin synthesis. Key points about indomethacin include:
- Mechanism of action: inhibition of prostaglandin synthesis
- Therapeutic effects: relief of symptoms of inflammation, pain, and fever
- Uses: treatment of rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, and acute gouty arthritis 2 Cardiovascular risks associated with indomethacin include:
- Increased risk of serious CV thrombotic events
- Worsening of preexisting hypertension
- Increased risk of heart failure 2 Gastrointestinal risks associated with indomethacin include:
- Risk of ulceration, bleeding, and perforation
- Increased risk of GI bleeding in patients with a prior history of ulcer disease or gastrointestinal bleeding 2
From the Research
Indomethacin Overview
- Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) with potent antipyretic, analgesic, and anti-inflammatory activity 3
- It has been effectively used in the management of mild-to-moderate pain since the mid-1960s 3
Efficacy and Tolerability
- A retrospective study of 67 patients with moderate to severe rheumatoid arthritis, osteoarthritis, or ankylosing spondylitis found that indomethacin was well tolerated and effective in controlling signs of active inflammation 4
- A single-blind, crossover trial of 30 rheumatoid arthritis patients found that indomethacin was effective in combination with naproxen suppositories, but had similar side effects to other NSAIDs 5
- A review of the literature found that indomethacin has demonstrated efficacy in the treatment of various painful conditions, including acute gouty arthritis pain 3
Comparison to Other NSAIDs
- A double-blind cross-over study of 63 patients with rheumatoid arthritis found that naproxen was better tolerated than indomethacin, but had similar efficacy 6
- A review of NSAID-induced organ damage found that indomethacin, like other NSAIDs, can cause adverse effects in gastrointestinal, cardiovascular, hepatic, renal, cerebral, and pulmonary complications 7