From the Guidelines
For acute gout flares, indomethacin is typically prescribed at an initial dose of 50 mg three times daily for 3-5 days, then tapered to 25 mg three times daily until the flare resolves, usually within 7-10 days total. The choice of indomethacin dosing for gout should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved 1. Some key points to consider when prescribing indomethacin for gout include:
- The maximum daily dose should not exceed 200 mg
- Indomethacin should be taken with food or milk to reduce gastrointestinal side effects
- Patients should be aware of potential side effects including stomach upset, headache, dizziness, and fluid retention
- Indomethacin is contraindicated in patients with severe kidney disease, heart failure, or history of GI bleeding
- It should be used cautiously in elderly patients and those with cardiovascular risk factors
- Adequate hydration should be maintained during treatment, and alcohol should be avoided as it can worsen gout and increase the risk of side effects According to the 2016 updated EULAR evidence-based recommendations for the management of gout, acute flares of gout should be treated as early as possible, and fully informed patients should be educated to self-medicate at the first warning symptoms 1. Additionally, the American College of Physicians recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout, and notes that there is no evidence that indomethacin is more efficacious than other NSAIDs, such as naproxen and ibuprofen 1.
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. The recommended dosing for indomethacin in acute gouty arthritis is:
- 50 mg taken three times a day until pain is tolerable
- The dose should then be rapidly reduced to complete cessation of the drug 2
From the Research
Indomethacin Dosing for Gout
- There are no research papers to assist in answering this question as the provided studies do not mention indomethacin dosing for gout.
- However, the studies discuss the treatment of acute gout with various medications, including NSAIDs, corticosteroids, and colchicine 3, 4, 5, 6, 7.
- NSAIDs, including indomethacin, are commonly used to treat acute gout, but the provided studies do not specify the dosing for indomethacin 4, 5, 7.
- The studies suggest that NSAIDs, corticosteroids, and colchicine are effective treatments for acute gout, but the optimal dosing and treatment regimens may vary depending on the individual patient and the severity of the disease 3, 4, 5, 6, 7.