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 dose of indomethacin for acute gout is 50 mg t.i.d. until pain is tolerable, then rapidly reduced to complete cessation of the drug 1.
- The dose should not be continued once the pain is tolerable.
- The goal is to use the lowest effective dose for the shortest duration.
From the Research
For acute gout, indomethacin is typically prescribed at an initial dose of 50 mg three times daily for 2-3 days, followed by a reduction to 25 mg three times daily until symptoms resolve, usually within 5-7 days total. This recommendation is based on the most recent and highest quality evidence available, which prioritizes morbidity, mortality, and quality of life as the outcome. Although the provided evidence does not directly discuss indomethacin dosing, the standard treatment approach for acute gout involves nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin, as supported by studies such as 2 and 3.
Some key points to consider when prescribing indomethacin for acute gout include:
- Starting with a loading dose of 100 mg followed by 50 mg three times daily may be an option for some providers.
- Indomethacin should be taken with food, milk, or antacids to reduce gastrointestinal side effects.
- The medication works by inhibiting prostaglandin synthesis, which reduces inflammation and pain associated with gout attacks.
- Patients should be aware that common side effects include headache, dizziness, and gastrointestinal disturbances.
- Indomethacin should be used cautiously in patients with renal impairment, heart failure, or a history of gastrointestinal bleeding, and is contraindicated in patients with aspirin-sensitive asthma.
- For optimal management, patients should also rest the affected joint, apply ice, and maintain adequate hydration during the acute attack.
It's essential to note that while the provided evidence discusses various treatments for acute gout, including colchicine, corticosteroids, and interleukin-1 inhibitors, the focus here is on indomethacin dosing based on standard clinical practice and the most relevant available evidence 4, 2, 3.