Indocin (indomethacin) is a potent nonsteroidal anti-inflammatory drug (NSAID) specifically formulated to manage moderate to severe inflammatory conditions and associated pain. As a prescription medication, it operates by inhibiting prostaglandin synthesis, effectively reducing inflammation, swelling, stiffness, and joint pain. It is a cornerstone therapy in rheumatology and other specialties for its proven efficacy in managing chronic inflammatory diseases. This product card provides a comprehensive, expert-level overview for healthcare professionals and informed patients.

Features

• Active Ingredient: Indomethacin
• Available Forms: Immediate-release capsules (25 mg, 50 mg), sustained-release capsules (75 mg), oral suspension (25 mg/5 mL), suppositories (50 mg)
• Pharmacologic Class: Nonsteroidal Anti-inflammatory Drug (NSAID)
• Mechanism of Action: Potent inhibitor of cyclooxygenase (COX-1 and COX-2) enzymes
• Prescription Status: Rx-only in most jurisdictions
• Half-life: Approximately 4.5 hours (immediate-release); 5-6 hours (sustained-release)

Benefits

• Provides significant reduction in inflammation and pain associated with rheumatic diseases
• Improves joint mobility and functional capacity in arthritic conditions
• Effective in managing acute gouty arthritis flares
• Can help close a patent ductus arteriosus in premature infants (IV form)
• Reduces morning stiffness and swelling in inflammatory arthritis
• May decrease dependency on opioid analgesics for pain management

Common use

Indocin is primarily indicated for the symptomatic treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis. It is also used in managing other inflammatory conditions such as bursitis, tendinitis, and acute shoulder pain. In neonatal care, the intravenous formulation is specifically employed for pharmacologic closure of hemodynamically significant patent ductus arteriosus in premature infants. Off-label uses may include treatment of pericarditis and certain headache syndromes, though these applications require careful specialist supervision.

Dosage and direction

Dosage must be individualized based on the condition being treated, formulation used, and patient response. For rheumatoid arthritis: Initial dose 25 mg two or three times daily, may increase by 25-50 mg daily at weekly intervals until satisfactory response is achieved (maximum 150-200 mg daily). For acute gout: 50 mg three times daily until pain is tolerable, then rapidly reduce dose. For osteoarthritis: 25 mg two or three times daily, maximum 150-200 mg daily. Sustained-release capsules (75 mg) are typically administered once or twice daily. Should be taken with food, milk, or antacids to minimize gastrointestinal upset. The lowest effective dose for the shortest duration should be used.

Precautions

Patients should be monitored for signs of gastrointestinal ulceration or bleeding, particularly those with history of peptic ulcer disease. Use with caution in patients with cardiovascular risk factors or established heart disease. Renal function should be assessed before initiation and periodically during therapy, especially in elderly patients or those with pre-existing renal impairment. May cause fluid retention and edema; use cautiously in patients with hypertension, heart failure, or other conditions predisposing to fluid retention. Can cause serious skin reactions; discontinue at first appearance of skin rash or other signs of hypersensitivity.

Contraindications

History of asthma, urticaria, or other allergic-type reactions after taking aspirin or other NSAIDs. Peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. Known hypersensitivity to indomethacin or any component of the formulation. Third trimester of pregnancy. Significant renal impairment. Active peptic ulcer disease, recent gastrointestinal bleeding or perforation. Severe hepatic impairment or active liver disease. Inflammatory bowel disease.

Possible side effect

Common (≥1%): Nausea, vomiting, dyspepsia, diarrhea, abdominal pain, headache, dizziness, drowsiness. Less common: Gastrointestinal ulceration/bleeding, hypertension, edema, tinnitus, pruritus, rash, increased liver enzymes. Serious: Acute renal failure, hepatotoxicity, aseptic meningitis, anaphylactic reactions, severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), congestive heart failure, myocardial infarction, stroke. Psychiatric: Depression, confusion, hallucinations (especially in elderly patients).

Drug interaction

Significant interactions occur with: Anticoagulants (increased bleeding risk), other NSAIDs or aspirin (increased GI toxicity), ACE inhibitors/ARBs (diminished antihypertensive effect, risk of renal impairment), diuretics (reduced diuretic and antihypertensive effects, risk of renal impairment), lithium (increased lithium levels), methotrexate (increased methotrexate toxicity), cyclosporine (increased nephrotoxicity), probenecid (increased indomethacin levels), SSRIs/SNRIs (increased bleeding risk).

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. For sustained-release formulations, particular attention should be paid to maintaining consistent dosing intervals.

Overdose

Symptoms may include drowsiness, nausea, vomiting, epigastric pain, gastrointestinal bleeding, coma, seizures, hypertension, acute renal failure, and respiratory depression. Management is supportive and symptomatic. There is no specific antidote. Gastric lavage or activated charcoal may be considered if presentation is early. Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion are not likely to be effective due to high protein binding.

Storage

Store at controlled room temperature (20-25°C or 68-77°F); excursions permitted to 15-30°C (59-86°F). Keep in original container, tightly closed. Protect from moisture and light. Keep out of reach of children and pets. Do not use after expiration date. Oral suspension should not be frozen. Suppositories should be stored below 30°C (86°F); may be refrigerated.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Indocin is a prescription medication that should only be used under the supervision of a qualified healthcare professional. The prescribing physician should be consulted for diagnosis and treatment decisions. Individual response to medication may vary. Not all uses, precautions, side effects, or interactions are listed here. Full prescribing information should be reviewed before initiation of therapy.

Reviews

“Indocin remains one of our most effective NSAIDs for managing inflammatory arthritis flares. Its potency is particularly valuable for patients who have inadequate response to other agents. The sustained-release formulation offers convenient dosing that improves compliance.” - Rheumatologist, 15 years experience

“While highly effective for acute gout, we must remain vigilant about gastrointestinal and cardiovascular risks, particularly in our older patient population. The benefits often outweigh risks when used appropriately for limited durations.” - Internist, 12 years experience

“Having tried multiple medications for my ankylosing spondylitis, Indocin provided the most significant relief from morning stiffness and spinal pain. The side effects were manageable when taken with food and under close monitoring.” - Patient with 8 years treatment history

“The neonatal IV formulation has been transformative in managing patent ductus arteriosus in preterm infants, though requires careful hemodynamic monitoring. It remains a valuable tool in our NICU.” - Neonatologist, 10 years experience