From the Guidelines
Indomethacin is considered a high-risk medication due to its potential to cause significant gastrointestinal, renal, and cardiovascular complications, and its use should be limited to specific conditions where benefits outweigh the risks. This medication has a higher rate of serious gastrointestinal side effects, including stomach ulcers, bleeding, and perforation, particularly in elderly patients 1. Indomethacin also poses greater risks for kidney damage, especially in people with existing kidney problems or those who are dehydrated. It can cause more central nervous system effects like headaches, dizziness, and confusion than other NSAIDs. Additionally, indomethacin may interfere with blood pressure medications and can worsen heart failure in susceptible individuals. Some of the key points to consider when prescribing indomethacin include:
- The potential for gastrointestinal complications, which can be modified but not eliminated through careful use of coxibs and gastroprotective therapies 1
- The cardiovascular risks associated with indomethacin, especially at higher doses, which may be greater than those associated with other NSAIDs 1
- The potential for indomethacin to decrease the cardiovascular benefits of ASA therapy, which should be taken into account when prescribing this medication 1
- The need to prescribe the lowest effective dose for the shortest duration to minimize the risks associated with indomethacin 1.
From the FDA Drug Label
A patient with symptoms and/or signs suggesting liver dysfunction, or in whom an abnormal liver test values has occurred, should be evaluated for evidence of the development of a more severe hepatic reaction while on therapy with indomethacin. Indomethacin, like other NSAIDs, can cause GI discomfort and, rarely, serious GI side effects, such as ulcers and bleeding, which may result in hospitalization and even death Indomethacin, like other NSAIDs, can cause serious skin side effects such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations and even death Patients should be informed of the warning signs and symptoms of hepatotoxicity (e. g., nausea, fatigue, lethargy, pruritus, jaundice, right upper quadrant tenderness and "flu-like" symptoms).
Indomethacin is considered "bad" because it can cause:
- Liver dysfunction: Indomethacin can cause liver damage, and patients with abnormal liver test values should be evaluated for evidence of a more severe hepatic reaction.
- GI side effects: Indomethacin can cause serious GI side effects, such as ulcers and bleeding, which may result in hospitalization and even death.
- Serious skin side effects: Indomethacin can cause serious skin side effects, such as exfoliative dermatitis, SJS, and TEN, which may result in hospitalizations and even death.
- Hepatotoxicity: Indomethacin can cause hepatotoxicity, and patients should be informed of the warning signs and symptoms, such as nausea, fatigue, and jaundice 2.
From the Research
Adverse Effects of Indomethacin
- Indomethacin may have adverse effects on kidney function, including a temporary sodium and water retention and a decrease in glomerular filtration rate 3.
- It may also lower plasma renin activity (PRA) 3.
- In patients with chronic kidney disease, indomethacin may reduce urinary excretion of glomerular and tubular damage markers, but not renal inflammation markers 4.
- In diabetic patients with nephropathy, indomethacin may reduce glomerular filtration rate and albuminuria by inhibiting prostaglandin synthesis 5.
Central Nervous System (CNS) Effects
- Indomethacin may affect the central nervous system, but a study found no evidence of decreased mental alertness and motor coordination in healthy individuals 6.
- The study suggested that patients may not need to be cautioned about avoiding activities requiring mental alertness and motor coordination, such as driving a car 6.