Indomethacin
INDOCIN
Pronunciation: in-doe-METH-a-sin
“Indigo medicine”
“The N said... NSAID”
The N said “lithium toxicity” → higher risk of lithium toxicity than other NSAIDs
What it isPotent COX-1 and COX-2 inhibitor; inflammatory pain, acute gout, and patent ductus arteriosus closure.
Why this oneThe characteristic NSAID for pharmacologic closure of a patent ductus in premature infants.
What limits it⚑ Headache, dizziness, and confusion are unusually prominent; renal, GI, cardiovascular, and lithium toxicity remain major concerns.
Pearls
- Not for mild-to-moderate pain at any dose: GI risk too high.
- Drug of choice for indomethacin-responsive headaches (paroxysmal hemicrania, hemicrania continua).
Indomethacin prescription history
Animated chart of estimated U.S. prescriptions per year, NSAIDs (1914–2026). Indomethacin enters in 1965 (estimated).
FDA-approved for
- inflammation (~1965)
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityGI bleeding, kidney injury, hypertension and fluid retention; many agents increase lithium concentrations.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Rheumatoid arthritis, ankylosing spondylitis, osteoarthritis | Adults | 25 mg BID–TID | Increase 25–50 mg weekly to 150–200 mg/day | 200 mg/day |
| Acute painful shoulder (bursitis/tendinitis) | Adults | 75–150 mg/day divided in 3–4 doses | 75–150 mg/day in 3–4 divided doses | 150 mg/day |
| Acute gouty arthritis | Adults | 50 mg TID | 50 mg TID until pain tolerable, then taper |
Titration For RA/AS/OA, increase by 25–50 mg at weekly intervals.
Renal Avoid in advanced renal disease unless benefits outweigh risks; monitor renal function.
Hepatic Undefined (monitor; discontinue if liver disease develops).
Instructions
- Use lowest effective dose for shortest duration
- Up to 100 mg of the daily dose may be given at bedtime for night pain/morning stiffness
Available strengths
- cap 25, 50 mg
- susp 25 mg/5 mL
- supp 50 mg
- inj 1 mg
- ER cap 75 mg
Contraindications
- History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs
- In the setting of coronary artery bypass graft (CABG) surgery
Cautions
- Cardiovascular thrombotic events
- GI bleeding/ulceration/perforation
- Hepatotoxicity
- Hypertension
- Heart failure/edema
- Renal toxicity/hyperkalemia
- Serious skin reactions
Adverse reactions
- Headache
- Dizziness
- Dyspepsia
- Nausea
Pregnancy Avoid at ≥30 weeks (premature ductus arteriosus closure); limit use 20–30 weeks (oligohydramnios/neonatal renal impairment).
Lactation May be present in human milk (~0.5% of maternal weight-adjusted dose).
Cost
Generic entry1985
Open Indomethacin in the interactive console ↗
Memory aids: interaction avatars
Open Indomethacin in the interactive console ↗
Self-check
- Which neonatal vessel can indomethacin close?
Patent ductus arteriosus. - Which CNS effects are unusually prominent with indomethacin?
Headache, dizziness and confusion.