Indocin (Indomethacin) – Oral: Uses, Side Effects, Dosages
What Is Indocin?
Indocin (indomethacin) is an orally administered prescription medication used to treat inflammation, pain, and swelling resulting from osteoarthritis, rheumatoid arthritis (RA), ankylosing spondylitis, or other forms of arthritis. Indocin is approved for use in adults and adolescents 14 and older.
Indocin, containing the active ingredient indomethacin, is categorized as a nonsteroidal anti-inflammatory drug (NSAID; a type of drug used to treat various orthopedic conditions, such as arthritis).
Like other NSAIDs, Indocin blocks certain substances in the body that cause inflammation and pain. One such pain-signaling substance is prostaglandins. NSAIDs block an enzyme called cyclooxygenase (COX), which is responsible for generating prostaglandins.
Some NSAIDs are available over-the-counter (OTC), but Indocin isn’t one of them. Instead, Indocin is a prescription medication.
Therapeutically equivalent, generic alternatives to Indocin (containing the active ingredient indomethacin) are available.
Specifically, generic indomethacin is available as an oral immediate-release (IR) capsule, an extended-release (long-acting) capsule, an injection, and a rectal suppository.
However, this article will focus on Indocin (indomethacin) oral forms of administration: ER capsule/IR capsule (generic indomethacin) and liquid suspension (brand-name Indocin).
Drug Facts
Generic Name: Indomethacin
Brand Name(s): Indocin
Drug Availability: Prescription
Administration Route: Oral
Therapeutic Classification: NSAID
Available Generically: Yes (generic ER capsule/IR capsule form)
Controlled Substance: No
Active Ingredient: Indomethacin
Dosage Form(s): Liquid suspension, ER capsule, IR capsule
What Is Indocin Used For?
The FDA has approved Indocin to treat the following arthritis-associated conditions in adults and adolescents 14 and older:
- Moderate to severe RA, including acute (short-term) flares and chronic (long-term) management of the disease
- Moderate to severe ankylosing spondylitis (arthritis that primarily affects the spine)
- Moderate to severe osteoarthritis (the most common form of arthritis)
- Acute shoulder pain, such as bursitis or tendinitis
- Acute gouty arthritis (a form of arthritis characterized by sudden, severe attacks of pain that primarily affects the big toe)
How to Take Indocin
To take Indocin, follow the instructions from your healthcare provider, which you can find on your prescription label. You may need to take this medication multiple times per day.
Indomethacin capsules and the Indocin liquid suspension form are usually taken two to four times a day. In comparison, generic ER capsules are usually taken once or twice daily.
All oral forms of this medication should be taken with food, immediately after meals, or with antacids.
Swallow the capsules whole; do not split, chew, or crush them. Conversely, shake the liquid suspension well before each use to mix the medication evenly.
Follow the directions on your prescription label carefully and ask your healthcare provider to explain any part you do not understand. Take indomethacin exactly as directed.
Do not take more or less of it or more often than your healthcare provider prescribes it.
Storage
Store Indocin at room temperature (68 F to 77 F), away from heat, moisture, and direct light. Keep the medication in your labeled prescription bottle if you need to travel with it.
Keep this medication away from areas susceptible to high levels of heat and moisture (e.g., the bathroom).
As with all medications, keep this medication out of reach of children and pets.
Off-Label Uses
Your healthcare provider may prescribe indomethacin for reasons other than its FDA-approved uses. This is referred to as off-label use.
Examples of off-label uses of Indocin include to:
How Long Does Indocin Take to Work?
Indocin starts working right away, but it may take a week or longer of continued use before you experience symptom relief.
What Are the Side Effects of Indocin?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
Common side effects associated with the use of Indocin include:
Taking Indocin with food is recommended to help prevent or minimize digestive discomforts.
Severe Side Effects
Contact your healthcare provider immediately if you develop severe side effects after taking indomethacin. If life-threatening or if you are experiencing a medical emergency, call 911 immediately.
The FDA has issued strong warnings (boxed warnings) for this medication. The boxed warning for indomethacin includes the important precautions listed below.
Additionally, rare but serious side effects of Indocin and some of their symptoms can include:
- Gastrointestinal (GI) bleeding or ulcers: Pain in your abdomen, vomit that looks bloody or like coffee grounds, or bloody or tar-like bowel movements
- Serious cardiovascular problems, such as heart attack or stroke: Chest pain, sudden fluid retention (known as edema), pain or numbness in your arm or shoulder, trouble with speech, or difficulty moving one side of your body
- Skin reactions: Rash, urticaria (hives), itching, peeling, or other skin-related signs of an allergic reaction
- Liver damage: Abdominal pain, nausea, vomiting, jaundice (yellowish skin or eyes), or changes in liver enzymes based on liver function tests
- Kidney failure: Fluid retention, changes in urination, or electrolyte disturbances
- Heart failure: Swelling, shortness of breath, sudden weight gain
- Hypertension (high blood pressure)
- Changes in vision
Long-Term Side Effects
Taking indomethacin or other NSAIDs long-term, especially in high doses, can greatly increase the risk of serious side effects, such as GI bleeding or ulcers.
Other long-term side effects of Indocin may include:
People with certain health conditions are at an increased risk of these side effects.
Talk with your healthcare provider about the best way to monitor for side effects and help prevent them while taking this medication.
Dosage: How Much Indocin Should I Take?
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The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
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For oral dosage forms (capsules or suspension):
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For acute gouty arthritis:
- Adults—50 milligrams (mg) three times a day. Your doctor may decrease your dose as needed.
- Children 15 years of age and older—Dose is based on body weight and must be determined by your doctor.
- Children younger than 14 years of age—Use and dose must be determined by your doctor.
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For acute painful shoulder (bursitis or tendinitis):
- Adults—75 to 150 milligrams (mg) per day, divided into three or four equal doses, and taken for 1 to 2 weeks as determined by your doctor.
- Children 15 years of age and older—Dose is based on body weight and must be determined by your doctor.
- Children younger than 14 years of age—Use and dose must be determined by your doctor.
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For mild to moderate acute pain:
- Adults—20 milligrams (mg) three times a day, or 40 mg two or three times a day.
- Children—Use and dose must be determined by your doctor.
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For moderate to severe ankylosing spondylitis, osteoarthritis, or rheumatoid arthritis:
- Adults—25 milligrams (mg) two or three times a day. Your doctor may increase your dose by 25 or 50 mg per day, as needed. However, the total dose is usually not more than 200 mg per day.
- Children 15 years of age and older—Dose is based on body weight and must be determined by your doctor.
- Children younger than 14 years of age—Use and dose must be determined by your doctor.
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For acute gouty arthritis:
Modifications
The following modifications (changes) should be kept in mind when using Indocin:
Pregnancy: NSAIDs, including Indocin, can cause serious damage to a developing fetus. Discuss with your healthcare provider whether you’re pregnant or plan to become pregnant, and weigh the benefits and risks of taking Indocin during pregnancy.
Breastfeeding: Based on clinical data, Indocin may be present in human milk. Therefore, the health benefits of breastfeeding should be considered along with the parent’s clinical need for Indocin.
Talk with your healthcare provider if you plan to breastfeed, to weigh the benefits and risks of taking Indocin while nursing and the different ways to feed your baby.
Adults over 65: Older adults are at greater risk for NSAID-associated serious cardiovascular, GI, and/or kidney-negative reactions.
Therefore, it’s possible that if you’re over the age of 65, your healthcare provider may start your treatment with Indocin at a lower dose to confirm you can properly tolerate the drug.
Kidney issues: Indomethacin and its metabolites are known to be substantially expelled through the kidneys, and the risk of adverse reactions to this drug may be greater in people with impaired kidney function.
If you have a history of CKD or another kidney-related issue, your healthcare provider may monitor you more closely or adjust your dose accordingly.
Children: Indocin is only approved for adolescents 14 and older.
Missed Dose
If you miss a dose of Indocin, take the next dose as soon as possible.
If it is almost time for your next dose of Indocin, you can skip the dose you missed and continue your regular dosing schedule. Do not take a double dose of Indocin, even if you missed a dose.
Try to help yourself remember to keep your appointments and take your medication routinely.
Overdose: What Happens If I Take Too Much Indocin?
Taking too much Indocin can lead to serious health complications.
An overdose of indomethacin may cause liver or kidney failure, heart problems, GI bleeding or ulcers, or seizures.
Call your healthcare provider or the Poison Control Center immediately if you think you or someone else may have ingested or overdosed on Indocin.
If someone collapses or isn’t breathing after taking Indocin, call 911 immediately.
What Happens If I Overdose on Indocin?
If you think you or someone else may have overdosed on Indocin, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn’t breathing after taking Indocin, call 911 immediately.
Precautions
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It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it. Blood and urine tests may be needed to check for unwanted effects.
Your doctor may recommend monitoring your blood pressure while using this medicine. .
This medicine may raise your risk of having a heart attack or stroke. This is more likely in people who already have heart disease. People who use this medicine for a long time might also have a higher risk. Check with your doctor right away if you or your child has chest pain that may spread to your arms, jaw, back, or neck, trouble breathing or speaking, headache, nausea, unusual sweating, or faintness.
This medicine may cause bleeding in your stomach or intestines. These problems can happen without warning signs. This is more likely if you have had a stomach ulcer in the past, you smoke or drink alcohol regularly, are over 60 years of age, are in poor health, or are using certain other medicines (eg, steroid medicine or a blood thinner).
Check with your doctor right away if you have any symptoms of liver problems including dark-colored urine or pale stools, nausea, vomiting, loss of appetite, pain in your upper stomach, or yellow skin or eyes.
Serious skin reactions can occur during treatment with this medicine. Check with your doctor right away if you have any of the following symptoms while taking this medicine: blistering, peeling, loosening of the skin, chills, cough, diarrhea, fever, itching, joint or muscle pain, red skin lesions, sore throat, sores, ulcers, white spots in the mouth or on the lips, or unusual tiredness or weakness.
Possible warning signs of some serious side effects that can occur during treatment with this medicine may include black, tarry stools, decreased urination, severe stomach pain, skin rash, swelling of the face, fingers, feet, or lower legs, unusual bleeding or bruising, unusual weight gain, vomiting of blood or material that looks like coffee ground, or yellow skin or eyes. Also, signs of serious heart problems could occur such as chest pain, tightness in the chest, fast or irregular heartbeat, unusual flushing or warmth of the skin, weakness, or slurring of speech. Check with your doctor immediately if you notice any of these warning signs.
This medicine may also cause a serious type of allergic reaction called anaphylaxis. Although this is rare, it may occur more often in patients who are allergic to aspirin or to any of the nonsteroidal anti-inflammatory drugs (NSAIDs). Anaphylaxis can be life-threatening and requires immediate medical attention. The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, or fainting. Other signs may include changes in color of the skin of the face, very fast but irregular heartbeat or pulse, hive-like swellings on the skin, and puffiness or swellings of the eyelids or around the eyes. If these effects occur, get emergency help at once.
Using this medicine during the later part of a pregnancy can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.
This medicine may cause a delay in ovulation for women and may affect their ability to have children. If you plan to have children, talk with your doctor before using this medicine.
Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
This medicine may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Even if taken at bedtime, it may cause some people to feel drowsy or less alert on arising. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert.
Before having any kind of surgery or medical tests, tell your doctor that you are taking this medicine. It may be necessary for you to stop treatment for a while, or to change to a different nonsteroidal anti-inflammatory drug before your procedure.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
What Are Reasons I Shouldn’t Take Indocin?
You should not take Indocin if:
- You’ve had an allergic reaction to Indocin or any of its ingredients
- You have a history of asthma, hives, or trouble breathing after taking an NSAID
- You will undergo a coronary artery bypass graft (CABG; a surgery conducted to improve blood circulation within the heart) or have had this surgery recently
What Other Medications Interact With Indocin?
Many different types of drugs can interact with Indocin.
To help reduce the risk of harmful drug interactions, be sure to tell your healthcare provider and pharmacist about your prescription medications, supplements, and OTC or other drug medications before taking Indocin.
Types of medications that can interact with indomethacin (or other NSAIDs) include but are not limited to the following:
Many OTC pain relievers and cold medicines contain aspirin or other NSAIDs. Therefore, while taking Indocin, you should check with your healthcare provider before using these products or any others containing these ingredients.
What Medications Are Similar?
Other nonsteroidal anti-inflammatory drugs (NSAIDs) similar to Indocin include:
In most cases, you should only take one NSAID at a time unless your healthcare provider specifically instructs otherwise. However, one common exception is taking low-dose aspirin to prevent heart disease while taking a different NSAID, such as indomethacin, for inflammation or pain.
Still, the combination could increase the risk of GI complications, so it’s important to check with your healthcare provider before using aspirin with indomethacin.
How Can I Stay Healthy While Taking Indocin?
Besides taking Indocin, varying treatments or lifestyle changes can help to manage pain and inflammation.
For example, you might consider applying a heating pad or a cold compress to the painful or swollen area.
Other recommendations depend on the reason you’re taking Indocin. For instance, if you have gout, certain diet changes can help reduce the risk of flare-ups.
If you have arthritis pain, your provider may suggest trying alternative approaches, such as:
Additionally, weight loss can help reduce stress on your joints, easing pain symptoms.
Medical Disclaimer
Verywell Health’s drug information is meant for educational purposes and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some drug content, as indicated on the page.
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