Indomethacin
INDOCIN
What it isPotent COX-1 and COX-2 inhibitor; inflammatory pain, acute gout, and patent ductus arteriosus closure.
Why this oneIt is the 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.
FDA-approved for
- inflammation (~1965)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Moderate-to-severe RA (incl acute flares), ankylosing spondylitis, osteoarthritis | Adults | 75 mg QD | 75 mg QD | 75 mg BID (150 mg/day) |
| Acute painful shoulder (bursitis/tendinitis) | Adults | 75 mg QD or BID | 75 mg QD–BID | 75 mg BID (150 mg/day) |
Titration Increase at weekly intervals (per immediate-release guidance) to satisfactory response
Renal Avoid in advanced renal disease unless benefits outweigh risk; monitor renal function
Hepatic Undefined
Instructions
- Use lowest effective dose for shortest duration
- ER 75 mg QD may substitute IR 25 mg TID; ER 75 mg BID may substitute IR 50 mg TID
- Not for acute gouty arthritis
- Do not administer with triamterene
Contraindications
- History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs
- Setting of coronary artery bypass graft (CABG) surgery
Cautions
- CV thrombotic events
- GI bleeding/ulceration/perforation
- Hepatotoxicity
- Hypertension
- Heart failure/edema
- Renal toxicity and hyperkalemia
- Anaphylactic reactions
- Aspirin-sensitive asthma
- Serious skin reactions (SJS/TEN)
- DRESS
- Fetal toxicity (≥20–30 wks gestation)
- Hematologic toxicity/anemia
Adverse reactions
- Headache
- Dizziness
- Dyspepsia
- Nausea
Pregnancy Avoid at ~30 weeks and later (premature ductus closure); limit 20–30 weeks (oligohydramnios/fetal renal dysfunction)
Lactation Present in milk at low levels; weigh benefits and risks
⚠ BOXED WARNINGS
- Cardiovascular thrombotic events
- Gastrointestinal bleeding, ulceration and perforation
Cost, est. cash$5–$150/month
Generic entry1985
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.
Mechanism of action: Indomethacin ballicule
Open Indomethacin in the interactive console ↗
Memory aids: mascots and interaction avatars
“The N said... NSAID”
The N said “lithium toxicity” → higher risk of lithium toxicity than other NSAIDs
