Who should not take Indomethacin (nonsteroidal anti-inflammatory drug, NSAID)?

From the Guidelines

Indomethacin should not be taken by individuals with a history of allergic reactions to indomethacin, aspirin, or other NSAIDs, as well as those with active peptic ulcers, gastrointestinal bleeding, inflammatory bowel disease, or a history of recurrent GI problems. These conditions can be worsened by indomethacin due to its inhibition of protective prostaglandins in the stomach lining, leading to increased risk of gastrointestinal complications, such as dyspepsia, abdominal pain, and GI bleeding 1.

Key Groups to Avoid Indomethacin

• Patients with severe kidney disease, heart failure, or liver impairment, as indomethacin can reduce blood flow to these organs and worsen their function, leading to impaired renal function, cardiovascular complications, or hepatic complications 1.
• Pregnant women, especially in their third trimester, as indomethacin may cause premature closure of the ductus arteriosus in the developing fetus, as well as other potential fetal effects, including increased cutaneous and intracranial bleeding, pulmonary hypertension, and impaired renal function 1.
• People with bleeding disorders or those taking anticoagulants, as indomethacin can increase bleeding risk, with a three to six times increased risk of GI bleeding when used with anticoagulants 1.
• Individuals with uncontrolled high blood pressure, as NSAIDs, including indomethacin, can raise blood pressure, leading to cardiovascular complications, such as worsening hypertension, myocardial infarction, or stroke 1.
• Those planning surgery should stop indomethacin at least a week before the procedure due to bleeding risks, as indomethacin can increase the risk of significant bleeding, particularly when combined with other medications that affect blood clotting 1. Always consult with a healthcare provider before starting or stopping indomethacin, especially if you have any of these conditions, to weigh the potential benefits and risks of treatment and determine the best course of action to minimize morbidity, mortality, and improve quality of life.

From the FDA Drug Label

Indomethacin is contraindicated in patients with known hypersensitivity to indomethacin or the excipients. Indomethacin should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. Indomethacin is contraindicated for the treatment of perioperative pain in the setting of coronary artery bypass graft (CABG) surgery. Advanced Renal Disease No information is available from controlled clinical studies regarding the use of indomethacin in patients with advanced renal disease. Therefore, treatment with indomethacin is not recommended in these patients with advanced renal disease. Indomethacin should not be given to patients with the aspirin triad. In late pregnancy, as with other NSAIDs, indomethacin should be avoided because it may cause premature closure of the ductus arteriosus.

Patients who should not take indomethacin include:

• Those with known hypersensitivity to indomethacin or the excipients
• Those who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
• Those with a history of aspirin triad
• Those undergoing coronary artery bypass graft (CABG) surgery
• Those with advanced renal disease
• Pregnant women in late pregnancy 2, 2

From the Research

Patients Who Should Not Take Indomethacin

The following patients should not take indomethacin:

• Patients with compromised prerenal status, as indomethacin can lead to acute intrinsic renal failure by interfering with the protective mechanism of renal production of prostaglandin 3
• Patients with active inflammation, especially those with inflammatory bowel disease, as NSAIDs like indomethacin can increase the risk of clinical relapse and gastrointestinal toxicity 4
• Patients with chronic kidney disease, as indomethacin may have adverse effects on renal function, although it may also have anti-proteinuric and tubulo-protective effects 5
• Patients with a history of gastric ulcers or gastrointestinal bleeding, as indomethacin can induce gastric damage and increase the risk of ulcers 6

Special Precautions

Indomethacin should be used with caution in patients with:

• Renal impairment, as it can worsen renal function 3
• Gastrointestinal disease, as it can increase the risk of gastrointestinal toxicity and ulcers 4, 6
• Inflammatory bowel disease, as it can increase the risk of clinical relapse 4