Indomethacin

Indications & Dose:

Pain and moderate to severe inflammation in rheumatic disease and other musculoskeletal disorders

• BY MOUTH

Adult: 50–200 mg daily in divided doses

Acute gout

• BY MOUTH

Adult: 150–200 mg daily in divided doses

Dysmenorrhoea

• BY MOUTH

Adult: Up to 75 mg daily

Child

Not recommended. 

Contraindications:

Bronchospasm, nasal polyps, angioedema precipitated by aspirin or other NSAIDs 

Side Effects:

Cautions:

Precautions:

History of GI ulceration, bleeding, or perforation; renal dysfunction, hypertension or cardiac conditions aggravated by fluid retention and edema, history of liver dysfunction, history of coagulation 

Interaction:

Drugs
Aminoglycosides: Reduced clearance with elevated aminoglycoside levels and potential for toxicity (especially indomethacin in premature infants; other NSAIDs probably)

Anticoagulants: Excessive hypoprothrombinemia, decreased platelet aggregation with increased risk of GI bleeding

Antihypertensives (alpha-blockers, angiotensinconverting enzyme inhibitor, angiotensin II receptor blockers, beta blockers, diuretics: Inhibition of antihypertensive and other favorable hemodynamic effects

Corticosteroids: Increased risk of GI ulceration

Cyclosporine: Increased nephrotoxicity risk

Lithium: Decreased clearance of lithium (mediated via prostaglandins) resulting in elevated serum lithium levels and risk of toxicity

Methotrexate: Decreased renal secretion of methotrexate resulting in elevated methotrexate levels and risk of toxicity

Phenylpropanolamine: Possible acute hypertensive reaction

Potassium-sparing diuretics: Additive hyperkalemia potential

Triamterene: Acute renal failure reported with addition of indomethacin; caution with other NSAIDs. 

Warnings:

Adverse Effects:

Lactations:

Crosses placenta; excreted in breast milk

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Anxiety. confusion, depression, dizziness, drowsiness, fatigue, headache, insomnia, tremors
CV : CHF, dysrhythmias, hypertension, palpitations, peripheral edema, tachycardia
EENT: Blurred vision, hearing loss, tinnitus
GI: Anorexia, cholestatic hepatitis, constipation, cramps, diarrhea, dyspepsin, flatulence, GI bleeding, green stools, jaundice, nausea, peptic ulcer

GU: Azotemia, hematuria, nephrotoxicity, oliguria
HEMS: Blood dyscrasias
RESP: Asthma
SKIN: Pruritus, purpura, rash, sweating
MISC: Fever

Patient And Carer Advice: