Indoseem

Indications

Indomethacin relieves pain, swelling and stiffness in rheumatoid arthritis, osteoarthritis, ankylosing spondylitis (inflammatory arthritis of the spine), acute gout attacks, and painful conditions of muscles, tendons and joints such as bursitis and tendinitis. It may also be used for painful periods.

How It Works

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID). It blocks enzymes called COX-1 and COX-2 that make prostaglandins, chemicals that cause pain, swelling and fever.

Dosage and Administration

• Adults, capsules: usually 25 mg two or three times a day, increased by the doctor if needed. The total is usually 50 to 150 mg a day and should not go above 200 mg a day.
• Sustained-release capsules 75 mg: one capsule once or twice a day.
• Acute gout: usually 150 to 200 mg a day in divided doses until the attack settles, then reduced, as prescribed.
• Suppository 100 mg: one at night, and if needed one more in the morning. The total of capsules and suppositories together should not go above 200 mg a day.
• Children: only as prescribed.

Swallow capsules whole with food, milk or after a meal. Use the lowest dose that works for the shortest time.

Interactions

Do not take with other NSAIDs, including Aspirin, Ibuprofen, Diclofenac or Naproxen. Bleeding risk rises with Warfarin and other blood thinners, Clopidogrel, corticosteroids such as Prednisolone, and antidepressants such as Sertraline or Fluoxetine. It can weaken blood pressure medicines (ACE inhibitors, angiotensin receptor blockers, diuretics) and, together with them, harm the kidneys. It can raise the levels of Lithium, Methotrexate and Digoxin. Probenecid raises indomethacin levels. Avoid with Triamterene.

Contraindications

• Allergy to indomethacin, or asthma, hives or runny nose triggered by Aspirin or other NSAIDs
• Active stomach or duodenal ulcer, or bleeding from the stomach or bowel, now or in the past
• Severe heart failure, severe kidney or liver disease
• Pain relief just after heart bypass surgery
• The last 3 months of pregnancy
• Suppositories: inflammation of the rectum or recent rectal bleeding

Side Effects

Common: indigestion, nausea, stomach pain, diarrhoea, headache (often worse in the morning), dizziness and drowsiness. Others: swelling of the ankles, raised blood pressure, ringing in the ears, blurred vision, low mood or confusion, especially in older people.

Get urgent medical help for black or tarry stools, vomiting blood or material like coffee grounds, severe stomach pain, chest pain, sudden weakness on one side of the body or slurred speech, wheezing or difficulty breathing, swelling of the face or throat, a severe rash or blistering, yellow skin or eyes, or passing much less urine than usual.

Pregnancy and Lactation

Avoid in pregnancy unless a doctor says it is essential. It must not be used in the last 3 months, as it can harm the baby heart and kidneys and delay labour; from 20 weeks onward it should only be used if the doctor specifically advises it. It passes into breast milk and is not recommended while breastfeeding; ask your doctor about a safer option.

Precautions and Warnings

• Risk of heart attack and stroke rises with higher doses and long use, especially in people with heart disease or its risk factors.
• Take extra care if you are older, have had a stomach ulcer, or have high blood pressure, kidney or liver disease, asthma, epilepsy, Parkinson disease or a mental health condition.
• It can cause dizziness and drowsiness; do not drive or use machines if affected.
• Long-term users may need blood tests and eye checks.
• Avoid alcohol, which adds to stomach irritation.

Overdose

Signs include nausea, vomiting, severe headache, dizziness, confusion, drowsiness, stomach pain or bleeding and, rarely, fits. Seek medical help immediately, even if there are no symptoms yet.

Therapeutic Class

Non-steroidal anti-inflammatory drug (NSAID).

Storage

Store capsules below 30°C and suppositories below 25°C, in a dry place, away from light and out of the reach of children.