Indomethacin

About Indomethacin

Indomethacin blocks the COX enzymes that make prostaglandins, reducing pain, swelling and fever. Its label covers moderate to severe rheumatoid arthritis including flares, moderate to severe ankylosing spondylitis and osteoarthritis, acute painful shoulder from bursitis or tendinitis, and acute gouty arthritis; it is not labeled for ordinary aches, and the label limits it to the lowest dose for the shortest time. Capsules are taken two to four times a day, usually starting at 25 mg, and the total daily dose does not exceed 200 mg. For a gout attack the label gives 50 mg three times a day until the pain is tolerable, then a rapid reduction to stopping. The 75 mg extended-release capsule is taken once or twice a day and is not used for gout attacks.

Headache, dizziness, indigestion and nausea are the most common side effects; the label also warns of central nervous system effects such as depression and drowsiness, and of eye changes on long-term use. The boxed warning covers heart attack and stroke, which can occur early in treatment and rise with longer use, and stomach or bowel bleeding, ulcers and perforation that can occur without warning, more often in older people and those with a history of ulcers. It is not used around coronary bypass surgery or in people whose asthma or hives are triggered by aspirin or other NSAIDs, and from about 20 weeks of pregnancy it is avoided or limited. It can also raise blood pressure, strain the heart and kidneys, and cause serious skin and liver reactions.

The suspension, which contains a small amount of alcohol, suits people who cannot swallow capsules and is dosed like them. The suppository, kept in the refrigerator, covers the same conditions for people who cannot take it by mouth and is not used with proctitis or recent rectal bleeding. The label says it should not be prescribed for children aged 14 and younger unless other drugs have failed or caused toxicity. Tivorbex, a lower-strength brand capsule that was labeled for acute pain, is recorded by the FDA as discontinued, as are the Indocin capsules and suppositories; the Indocin suspension is still sold.

Taking Indomethacin

How to take it

With food or right after a meal: two to four times a day for capsules and the suspension, once or twice a day for the extended-release capsule, which is swallowed whole. Shake the suspension well before each dose. Suppositories are for rectal use only.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip it and carry on as usual. Do not double up.

Storage

Capsules and the suspension at room temperature, protected from light, in a tightly closed container away from moisture; do not freeze the suspension. Keep suppositories in the refrigerator. Keep everything out of reach of children.

Interactions to know about

Warfarin and other blood thinners, aspirin, other NSAIDs, oral steroids and SSRI or SNRI antidepressants raise the risk of bleeding. With ACE inhibitors, ARBs, beta blockers and diuretics it can blunt their effect and strain the kidneys, and with triamterene it has caused kidney injury. It raises lithium, methotrexate and digoxin levels. Seek care for black stools, vomiting blood, chest pain, breathlessness or swelling.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Indomethacin differs from pharmacy to pharmacy

Indomethacin capsules have many makers and cost pharmacies little, so a quote is mostly the dispensing fee and markup. The extended-release capsule has fewer makers and costs more per day, and a prescription names one form, so the price follows the choice.

The suspension has few makers and is priced by the bottle, and the suppositories must be refrigerated and come from a handful of makers, so a pharmacy that does not stock them orders them in and quotes accordingly.

Ways to pay less for Indomethacin without insurance

• Ask whether indomethacin capsules are on the pharmacy’s flat-price generic list.
• If the extended-release capsule is quoted high, ask the prescriber whether plain capsules would suit you; they are separate prescriptions.
• For a gout attack, ask for only the quantity needed, and check that the pharmacy has it in stock so treatment is not delayed.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Indomethacin

1. 1.Should I take it with food or milk, and what stomach symptoms mean I should stop?
2. 2.Is it safe with my heart, blood pressure or kidney condition, or my blood thinner?
3. 3.Is this the plain capsule or the extended-release capsule, and how many times a day?
4. 4.How long should I take it for this gout attack?

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