What are the indications for Indometacine (indomethacin)?

Indications for Indomethacin

Indomethacin is FDA-approved for the treatment of moderate to severe rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, acute painful shoulder (bursitis/tendinitis), and acute gouty arthritis. 1

Primary Indications

Acute Gout

• First-line therapy for acute gouty arthritis at full anti-inflammatory doses 2
• Recommended dosing: Full dosing at FDA-approved anti-inflammatory/analgesic doses 2
• Typically administered until acute attack resolves 2
• Particularly effective for pain relief in acute gout flares

Inflammatory Arthritides

1. Rheumatoid Arthritis

   • Moderate to severe disease including acute flares of chronic disease 1
   • Suppresses inflammation as demonstrated by relief of pain, reduction of fever, swelling, and tenderness 1
   • May enable reduction of steroid dosage in patients receiving steroids for severe forms of rheumatoid arthritis 1

2. Ankylosing Spondylitis

   • Moderate to severe disease 1
   • Used as a comparator drug in multiple clinical trials for AS 2
   • No evidence suggests indomethacin has different effects on pain or stiffness compared to other NSAIDs 2

3. Osteoarthritis

   • Moderate to severe disease 1
   • Provides symptomatic relief but does not alter the progressive course of the underlying disease 1

4. Acute Painful Shoulder

   • Effective for bursitis and/or tendinitis 1

Dosing Considerations

• Use the lowest effective dose for the shortest duration consistent with treatment goals 1
• For acute conditions: Full anti-inflammatory dosing (typically 50-150 mg daily) 3
• Average daily dosage typically ranges from 75-100 mg for chronic conditions 3
• Available in multiple formulations:
  • Standard capsules (rapid absorption)
  • Sustained-release formulations for once or twice daily dosing 4

Clinical Efficacy

• Indomethacin is a potent inhibitor of prostaglandin synthesis 1
• Long-term studies demonstrate good control of signs of active inflammation with daily indomethacin therapy 3
• Provides improvement in functional capability as demonstrated by increased grip strength in rheumatoid arthritis 1
• Improves mobility as demonstrated by decreased walking time in rheumatoid arthritis 1

Important Considerations and Precautions

• Gastrointestinal Risk: Consider gastroprotection with a proton pump inhibitor, especially in high-risk patients 5
• Cardiovascular Effects: May diminish cerebral blood flow; use with caution in patients with cardiovascular risk factors 1
• Renal Function: Monitor renal function periodically, especially in at-risk patients 5
• Elderly Patients: Higher risk of adverse effects; consider lower doses 5
• Drug Interactions: Significant interactions possible; undergoes enterohepatic circulation 6

Alternative Options

When indomethacin is contraindicated or not tolerated:

• Corticosteroids are generally safer and a low-cost treatment option for acute gout 2
• Other NSAIDs (naproxen, ibuprofen) may be as effective with potentially fewer side effects 2
• Colchicine is an alternative for acute gout when used at low doses 2

Long-term studies show that indomethacin can be well-tolerated when patients are carefully selected (those who do not experience initial side effects), with only 13% experiencing mild, transient side effects over periods ranging from 3-20 years of daily use 3.