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Indomethacin (Oral route)

Pronunciation:

in-doe-METH-a-sin

Brand Names:

  • Indocin
  • Indocin SR
  • Tivorbex

Dosage Forms:

  • Capsule
  • Suspension
  • Capsule, Extended Release

Warnings:

Oral route(Capsule;Capsule, Extended Release;Suspension)

NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Indomethacin is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. NSAIDs can also cause an increased risk of serious gastrointestinal adverse events especially in the elderly, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal .

Classifications:

Therapeutic—

Analgesic

Pharmacologic—

NSAID

Chemical—

Acetic Acid (class)

Uses of This Medicine:

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate acute pain and relieve symptoms of arthritis (osteoarthritis and rheumatoid arthritis) or gout, such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will help you only as long as you continue to take it.

Indomethacin is also used to treat ankylosing spondylitis, which is a type of arthritis that affects the joints in the spine. This medicine may also be used to treat painful shoulder caused by bursitis or tendinitis.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of indomethacin capsules, suspension, and suppositories in children younger than 14 years of age. Safety and efficacy have not been established.

Appropriate studies have not been performed on the relationship of age to the effects of Tivorbex™ capsules in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of indomethacin in the elderly. However, elderly patients may be more sensitive to the effects of indomethacin than younger adults, and are more likely to have unwanted side effects (eg, confusion, psychosis) and age-related kidney or stomach problems, which may require caution and an adjustment in the dose for patients receiving indomethacin.

Pregnancy—

Pregnancy CategoryExplanation
1st TrimesterCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.
2nd TrimesterCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.
3rd TrimesterDStudies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Ketorolac

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abciximab
  • Apixaban
  • Ardeparin
  • Argatroban
  • Beta Glucan
  • Bivalirudin
  • Certoparin
  • Cilostazol
  • Citalopram
  • Clopidogrel
  • Clovoxamine
  • Cyclosporine
  • Dabigatran Etexilate
  • Dalteparin
  • Danaparoid
  • Desirudin
  • Digoxin
  • Duloxetine
  • Enoxaparin
  • Eptifibatide
  • Erlotinib
  • Escitalopram
  • Femoxetine
  • Feverfew
  • Flesinoxan
  • Fluoxetine
  • Fondaparinux
  • Ginkgo
  • Gossypol
  • Heparin
  • Lepirudin
  • Levomilnacipran
  • Meadowsweet
  • Methotrexate
  • Milnacipran
  • Nadroparin
  • Nefazodone
  • Parnaparin
  • Paroxetine
  • Pemetrexed
  • Pentosan Polysulfate Sodium
  • Pentoxifylline
  • Potassium
  • Pralatrexate
  • Prasugrel
  • Protein C
  • Reviparin
  • Rivaroxaban
  • Sibutramine
  • Tacrolimus
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Zimeldine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Acetohexamide
  • Alacepril
  • Alprenolol
  • Amiloride
  • Amlodipine
  • Arotinolol
  • Atenolol
  • Azilsartan Medoxomil
  • Azosemide
  • Befunolol
  • Bemetizide
  • Benazepril
  • Bendroflumethiazide
  • Benzthiazide
  • Bepridil
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Bopindolol
  • Bucindolol
  • Bumetanide
  • Bupranolol
  • Buthiazide
  • Candesartan Cilexetil
  • Canrenoate
  • Captopril
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Chlorothiazide
  • Chlorpropamide
  • Chlorthalidone
  • Cilazapril
  • Clopamide
  • Cyclopenthiazide
  • Delapril
  • Desvenlafaxine
  • Dilevalol
  • Diltiazem
  • Dipyridamole
  • Enalaprilat
  • Enalapril Maleate
  • Eprosartan
  • Esmolol
  • Ethacrynic Acid
  • Felodipine
  • Flunarizine
  • Fosinopril
  • Furosemide
  • Gallopamil
  • Gentamicin
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Hydrochlorothiazide
  • Hydroflumethiazide
  • Imidapril
  • Indapamide
  • Irbesartan
  • Isradipine
  • Labetalol
  • Lacidipine
  • Landiolol
  • Levobetaxolol
  • Levobunolol
  • Lidoflazine
  • Lisinopril
  • Lithium
  • Losartan
  • Manidipine
  • Mepindolol
  • Methyclothiazide
  • Metipranolol
  • Metolazone
  • Metoprolol
  • Moexipril
  • Nadolol
  • Nebivolol
  • Nicardipine
  • Nifedipine
  • Nilvadipine
  • Nimodipine
  • Nipradilol
  • Nisoldipine
  • Nitrendipine
  • Olmesartan Medoxomil
  • Oxprenolol
  • Penbutolol
  • Pentopril
  • Perindopril
  • Pindolol
  • Piretanide
  • Polythiazide
  • Pranidipine
  • Propranolol
  • Quinapril
  • Ramipril
  • Sotalol
  • Spirapril
  • Spironolactone
  • Talinolol
  • Tasosartan
  • Telmisartan
  • Temocapril
  • Tertatolol
  • Timolol
  • Tolazamide
  • Tolbutamide
  • Torsemide
  • Trandolapril
  • Triamterene
  • Trichlormethiazide
  • Valsartan
  • Verapamil
  • Warfarin
  • Xipamide
  • Zofenopril

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Anemia or
  • Bleeding problems or
  • Blood clots or
  • Depression or other mental changes or
  • Edema (fluid retention or body swelling) or
  • Heart attack, history of or
  • Heart disease (eg, congestive heart failure) or
  • Hypertension (high blood pressure) or
  • Kidney disease or
  • Liver disease (eg, hepatitis), history of or
  • Parkinson's disease or
  • Seizures or epilepsy, history of or
  • Stomach or intestinal ulcers or bleeding, history of or
  • Stroke, history of—Use with caution. May make these conditions worse.
  • Aspirin-sensitive asthma, history of or
  • Aspirin sensitivity, history of—Should not be used in patients with these conditions.
  • Heart surgery (eg, coronary artery bypass graft [CABG] surgery)—Should not be used to relieve pain right before or after the surgery.

Proper Use of This Medicine:

For safe and effective use of this medicine, do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Taking too much of this medicine may increase the chance of unwanted effects.

This medicine should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

When used for severe or continuing arthritis, this medicine must be taken regularly as ordered by your doctor in order for it to help you. This medicine usually begins to work within 1 week, but in severe cases up to two weeks or even longer may pass before you begin to feel better. Also, several weeks may pass before you feel the full effects of this medicine.

Shake the oral suspension well before each use. Measure the medicine with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

It is best to take this medicine with food.

Check with your doctor first before changing dosage forms (eg, capsules, suspension). These forms are very different from each other.

Dosing—

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.

  • For oral dosage forms (capsules or suspension):
    • 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.
    • 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.
    • 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.
    • 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.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

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.

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).

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, wheezing, 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 late pregnancy can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.

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.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common
Acid or sour stomach
belching
diarrhea
heartburn
indigestion
nausea
stomach discomfort, upset, or pain
vomiting
Rare
Abdominal or stomach cramping, burning, or tenderness
back or leg pains
bleeding gums
blistering, peeling, or loosening of the skin
bloody or black, tarry stools
blue lips and fingernails
blurred vision
breast enlargement and tenderness
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
burning upper abdominal pain
canker sores
change in consciousness
change in hearing
chest pain, discomfort, or burning
clay colored stools
cloudy or bloody urine
confusion
continuing diarrhea
cough or hoarseness
coughing that sometimes produces a pink frothy sputum
cracks in the skin
dark urine
decreased appetite
decreased vision or any change in vision
depression
difficult or labored breathing
difficulty with swallowing
dilated neck veins
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position
double vision
dry mouth
extreme fatigue
false sense of well-being
feeling of unreality
feeling of warmth
fever with or without chills
flushed, dry skin
fruit-like breath odor
general body swelling
greatly decreased frequency of urination or amount of urine
hair loss
headache
heavier menstrual periods
increased hunger
increased sweating
increased thirst
increased urination
irregular breathing
irritation and swelling of the eye
jerky movements of the head, face, mouth, and neck
joint pain
large, flat, blue or purplish patches in the skin
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
loss of appetite
loss of balance control
loss of bladder control
loss of consciousness
loss of hearing
loss of heat from the body
lower back or side pain
mask-like face
mental confusion
mood swings
muscle aches, pains, or weakness
muscle spasm or jerking of all extremities
nervousness
noisy, rattling breathing
nosebleeds
numbness or tingling in the hands, feet, or lips
pain in the ankles or knees
pain or discomfort in the upper stomach, or throat
pain with swallowing
painful or difficult urination
painful, red lumps under the skin, mostly on the legs
pale skin
persistent bleeding or oozing from puncture sites, mouth, or nose
personality changes
pinpoint red or purple spots on the skin
pounding in the ears
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
red skin lesions, often with a purple center
red, irritated eyes
red, swollen skin
redness of the face, neck, arms and occasionally, upper chest
scaly skin
seeing double
seeing, hearing, or feeling things that are not there
seizures
sense of detachment from self or body
severe constipation
severe mental changes
severe or continuing stomach pain
shuffling walk
skin rash, hives or welts, itching
slow, fast, irregular, pounding, or racing heartbeat or pulse
slowed movements
slurred speech
small red or purple spots on the skin
sore throat
sores, ulcers, or white spots on the lips or tongue or inside the mouth
stiffness of the arms and legs
sudden loss of consciousness
sugar in the urine
swelling in the legs and ankles
swelling of the face, fingers, feet, or lower legs
swelling of the breasts or breast soreness in both females and males
swollen or painful glands
tightness in the chest
trembling and shaking of the fingers and hands
troubled breathing at rest
troubled breathing with exertion
unexplained weight loss
unpleasant breath odor
unsteadiness or awkwardness
unusual bleeding or bruising
unusual tiredness or weakness
vaginal bleeding
vomiting of blood or material that looks like coffee grounds
weakness in the arms, hands, legs, or feet
weight gain
yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Confusion about identity, place, and time
severe headache
unusual drowsiness, dullness, or feeling of sluggishness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Mild headache
Less common
Continuing ringing or buzzing or other unexplained noise in the ears
difficulty having a bowel movement (stool)
discouragement
feeling sad or empty
general feeling of discomfort or illness
hearing loss
irritability
loss of interest or pleasure
sleepiness
trouble with concentrating
Rare
Anxiety
bloated or full feeling
changes in patterns and rhythms of speech
excess air or gas in the stomach or intestines
feeling of constant movement of self or surroundings
involuntary muscle movements
lightheadedness
passing gas
sensation of spinning
tiredness
trouble with speaking
trouble sleeping

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 4/4/2014

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