From the FDA Drug Label
Acute gouty arthritis. Suggested Dosage: Indomethacin capsules 50 mg t.i.d. until pain is tolerable. The dose should then be rapidly reduced to complete cessation of the drug. For indomethacin dosing for gout after failed prednisone, the suggested dosage is 50 mg t.i.d. until pain is tolerable, then rapidly reduce to complete cessation of the drug 1.
- The total daily dose should be adjusted based on individual patient response.
- Definite relief of pain has been reported within 2 to 4 hours.
- It is essential to use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
From the Research
For gout that has not responded to prednisone, indomethacin can be prescribed at a dose of 50 mg three times daily for acute attacks, typically for 3-5 days, then tapered to 25 mg three times daily until symptoms resolve, usually within 7-10 days total. The maximum daily dose should not exceed 200 mg. Start treatment as soon as possible after gout symptoms appear for best results. Indomethacin works by inhibiting prostaglandin synthesis, reducing inflammation and pain in the affected joint. According to the most recent study 2, gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within synovium of joints, and standard pharmacotherapies for gout flares include the options of colchicine, NSAIDs, and oral or intramuscular corticosteroids. Some key points to consider when prescribing indomethacin include:
- Take the medication with food or milk to reduce gastrointestinal side effects
- Patients should stay well-hydrated and avoid alcohol during treatment
- Those with kidney disease, heart failure, or a history of peptic ulcer disease may need dose adjustments or alternative medications
- Monitor for side effects including stomach upset, dizziness, and fluid retention
- If symptoms worsen or do not improve within 48 hours, medical reassessment is recommended. Other studies 3, 4, 5 also support the use of indomethacin for gout, but the most recent study 2 provides the most up-to-date guidance. Note that study 6 is not relevant to the treatment of gout with indomethacin.