Indometacin (also spelled indomethacin) is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, stiffness, and swelling related to inflammatory and rheumatic conditions. By inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, it lowers prostaglandin production, which in turn reduces inflammation, alleviates pain, and decreases fever. Compared with some other NSAIDs, indometacin is especially effective for acute inflammatory pain, such as a gout flare, but may carry a higher risk of gastrointestinal and central nervous system side effects in some people. For this reason, clinicians typically aim for the lowest effective dose over the shortest necessary duration.
Common indications in adults include:
Indometacin is sometimes used off-label for specific headache disorders such as paroxysmal hemicrania and hemicrania continua, which are known to be highly indometacin-responsive. Such use should be guided by a specialist. In hospital settings, intravenous indomethacin has other uses, but those are beyond the scope of routine outpatient treatment and require close monitoring by clinicians.
As with all NSAIDs, indometacin is symptom-relieving. It does not change the underlying cause of arthritis or gout, but by controlling inflammation, it can help you maintain activity levels, participate in physical therapy, and improve your quality of life while disease-modifying or urate-lowering therapies take effect if prescribed.
Indometacin is available as immediate-release capsules or tablets (commonly 25 mg and 50 mg), extended-release capsules (commonly 75 mg), and rectal suppositories (commonly 50 mg). Your dose and schedule depend on the condition being treated, your other health conditions, and how you respond to therapy. Always follow your prescriber’s instructions.
Typical adult oral dosing ranges:
Maximum total daily dose for most adults is 200 mg. Lower limits may be recommended in older adults or those with kidney, liver, or gastrointestinal risk factors. Use the smallest effective dose for the shortest possible time.
How to take indometacin safely:
Additional prescribing and monitoring considerations:
All NSAIDs, including indometacin, carry important safety considerations. Understanding these helps you balance benefits and risks.
To minimize risk, use the lowest effective indometacin dose for the shortest duration needed to control symptoms, and keep your healthcare provider informed about new or worsening symptoms.
Do not use indometacin if any of the following apply to you:
Use with caution or avoid rectal suppositories if you have proctitis, recent rectal bleeding, or severe hemorrhoids. People with seizure disorders or a history of mood changes may be more sensitive to central nervous system side effects; careful monitoring is recommended.
Most people tolerate indometacin when used appropriately, but side effects can occur. Many are dose-related and improve with dose reduction or after stopping the medicine.
Common side effects:
Less common but more serious effects (seek prompt medical attention):
If you develop concerning symptoms, stop indometacin and contact your healthcare provider or emergency services right away.
Indometacin has many potential interactions. Always provide a complete list of your prescription medicines, over-the-counter drugs, vitamins, and herbal supplements to your healthcare provider and pharmacist.
Medications and substances that may interact with indometacin include:
In addition to drug–drug interactions, certain medical conditions (e.g., dehydration, heart failure, advanced age) heighten the risk of adverse effects when taking NSAIDs. Regular follow-up helps keep your treatment safe and effective.
If you miss a dose, take it as soon as you remember unless it is close to the time of your next dose. If it is near the next scheduled dose, skip the missed dose and resume your regular schedule. Do not double up or take extra doses to make up for a missed one. For pain taken as needed, take a dose when symptoms recur but do not exceed the total daily maximum.
Taking too much indometacin can be dangerous. Symptoms of overdose may include severe nausea or vomiting, intense stomach pain, drowsiness, confusion, headache, dizziness, fainting, difficulty breathing, seizures, or signs of bleeding. If you suspect an overdose, call emergency services or contact a poison control center immediately. Do not wait for symptoms to worsen.
Store indometacin at room temperature, ideally 68°F to 77°F (20°C to 25°C), away from excess heat, light, and moisture. Keep the medication in its original container with the lid tightly closed and out of reach of children and pets. If you use suppositories, protect them from excessive heat to prevent melting; follow the storage instructions on the specific product label.
Indometacin is an FDA-approved, prescription-only NSAID in the United States. Because of important safety considerations—including the risk of cardiovascular events, gastrointestinal bleeding, kidney effects, and drug interactions—federal and state laws require that a licensed healthcare professional evaluate patients and authorize use. U.S. pharmacies dispense indometacin only with a valid prescription or a documented clinician order.
How access typically works in the U.S.:
It is not legal to import or purchase indometacin for U.S. use without appropriate clinician authorization. Always obtain this medicine through licensed healthcare providers and accredited pharmacies that comply with federal and state regulations.
HealthSouth Walton Rehabilitation Hospital offers a legal and structured solution for acquiring Indometacin without a formal paper prescription visit by arranging clinician evaluation and authorization within its care pathway. Under this model, a licensed practitioner assesses your condition via in-person or telehealth services and, when appropriate, authorizes dispensing through partnered pharmacies or the hospital’s outpatient services—ensuring compliance with all applicable U.S. laws and patient safety standards while reducing barriers to timely care.
This information is provided for educational purposes only and is not a substitute for personalized medical advice, diagnosis, or treatment. Always consult a licensed healthcare professional to determine whether indometacin is appropriate for your condition, how to use it safely, and how it may interact with your other medications and health conditions. If you experience severe or concerning symptoms, seek medical attention immediately.
Indometacin is a prescription nonsteroidal anti-inflammatory drug (NSAID) that reduces pain, swelling, and fever by blocking COX-1 and COX-2 enzymes, lowering prostaglandin production in the body.
It’s used for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, bursitis, tendinitis, acute gout flares, and certain headache disorders like paroxysmal hemicrania and hemicrania continua. In hospitals, IV indometacin is sometimes used for patent ductus arteriosus in preterm infants.
Typical adult dosing is 25–50 mg two to three times daily for immediate-release, or 75 mg once or twice daily for extended-release; the maximum daily dose is generally 150–200 mg depending on indication. Use the lowest effective dose for the shortest duration your clinician recommends.
Taking it with food, milk, or an antacid can reduce stomach upset without meaningfully changing effectiveness. Avoid lying down for 10 minutes after swallowing capsules.
Pain relief often begins within 30–60 minutes, with peak effect around 2 hours for immediate-release capsules. Effects typically last 4–6 hours for immediate-release and longer with sustained-release forms.
Common effects include stomach upset, heartburn, nausea, dizziness, headache, and drowsiness. Fluid retention, elevated blood pressure, and ringing in the ears can also occur.
Seek urgent help for chest pain, shortness of breath, weakness on one side, black or bloody stools, vomiting blood, severe stomach pain, sudden swelling or weight gain, decreased urination, severe rash, or allergic reactions including wheezing or facial swelling.
Avoid if you’ve had an allergic reaction or asthma attack with aspirin or other NSAIDs, active GI bleeding or ulcers, severe heart failure, or right before/after coronary bypass surgery. People with kidney disease, liver disease, uncontrolled hypertension, or a history of GI bleeding need extra caution and medical supervision.
Long-term use increases risks of stomach ulcers/bleeding, kidney injury, high blood pressure, and cardiovascular events. If ongoing therapy is necessary, use the lowest effective dose, consider a gastroprotective agent like a PPI, and monitor regularly.
It is available as immediate-release capsules, sustained-release capsules, rectal suppositories, and oral suspension in some regions. Choice of form depends on the condition, dosing convenience, and tolerability.
Like all NSAIDs, it can raise blood pressure and increases the risk of heart attack and stroke, especially with higher doses, longer use, and in people with cardiovascular disease. Discuss cardiovascular risk before starting.
It can reduce kidney blood flow, causing acute kidney injury, fluid retention, and high potassium; risk is higher in dehydration, older age, and with ACE inhibitors/ARBs and diuretics. It can elevate liver enzymes and rarely cause serious liver injury; your clinician may monitor labs.
Yes, but use caution. Indometacin can cause dizziness, drowsiness, blurred vision, or confusion in some people; avoid driving until you know how it affects you.
Bleeding risk increases with anticoagulants (warfarin, DOACs), antiplatelets (clopidogrel), SSRIs/SNRIs, and steroids. It can reduce the effect of ACE inhibitors/ARBs and some diuretics while increasing kidney risk, raise levels of lithium, methotrexate, and digoxin, and add to nephrotoxicity with cyclosporine; avoid combining with other NSAIDs.
For ongoing use, clinicians often check blood pressure, kidney function (creatinine, eGFR, potassium), liver enzymes, and sometimes a blood count, especially in older adults or those at higher risk. Report any GI bleeding symptoms promptly.
If you miss a dose, take it when you remember unless it’s close to your next dose; don’t double up. In overdose or if severe symptoms like intense drowsiness, vomiting, or GI bleeding occur, seek urgent medical care.
Pediatric use is specialist-guided for select conditions; dosing is weight-based and safety monitoring is essential. Do not give to children without medical supervision.
It’s best to avoid or strictly limit alcohol because the combination increases the risk of stomach irritation, ulcers, and bleeding. If you do drink, keep intake low and never binge while on an NSAID.
Avoid NSAIDs at 20 weeks of pregnancy and later due to risks of fetal kidney problems and low amniotic fluid, and strictly avoid at 30 weeks and beyond due to premature ductus arteriosus closure. If an NSAID is considered before 20 weeks, use only if necessary, at the lowest dose and shortest duration, under obstetric guidance.
Small amounts pass into breast milk; short-term use is generally compatible, but monitor the infant for feeding difficulty, vomiting, or unusual sleepiness. For prolonged or high-dose therapy, discuss alternatives or timing feeds to minimize exposure.
Yes, most clinicians advise stopping at least 24–48 hours before procedures to reduce bleeding risk, sometimes longer depending on the operation and your risk factors. Always follow the specific instructions from your surgeon or dentist.
Indometacin may worsen these conditions and increases the chance of bleeding; alternatives or co-prescription of a proton pump inhibitor are often preferred. Report any new or worsening heartburn, black stools, or abdominal pain immediately.
Indometacin can worsen kidney function, raise blood pressure, and cause fluid retention, so it may be inappropriate or require close monitoring and dose adjustments. Many patients with these conditions are steered toward safer options.
Older adults have higher risks of GI bleeding, kidney injury, and cardiovascular events with NSAIDs. If needed, use the lowest effective dose, add gastroprotection, and monitor closely.
Dehydration and high-intensity endurance efforts increase the risk of NSAID-related kidney injury; hydrate well and avoid taking indometacin right before or during strenuous events. Consider non-NSAID strategies for pain control around competition.
Indometacin is generally more potent for inflammation (for example, acute gout), but has a higher risk of GI, kidney, and central nervous system side effects. Ibuprofen has a safer tolerability profile and is often preferred for everyday pain at OTC doses.
Both are effective NSAIDs; naproxen has a longer half-life for twice-daily dosing and is often better tolerated. Indometacin may be more effective for gout flares but carries higher rates of dizziness, headache, and GI issues.
Diclofenac provides strong anti-inflammatory effects and multiple formulations (including topical), but may have higher cardiovascular risk. Indometacin is potent but often less well tolerated; choice depends on your cardiovascular, GI, and kidney risk profile.
Meloxicam is COX-2–preferential, often causing fewer stomach problems and allowing once-daily dosing. Indometacin can be more potent for acute inflammatory conditions but tends to have more CNS and GI side effects.
Celecoxib offers similar pain relief with lower rates of GI ulcers/bleeding, making it preferable in high GI-risk patients when NSAID therapy is necessary. Indometacin may be chosen for indometacin-responsive headaches or gout, but celecoxib may be safer for long-term use in many patients.
Ketorolac is a very potent short-term analgesic (max 5 days) used perioperatively or for severe acute pain, with high GI and renal risks if overused. Indometacin is used more for inflammatory conditions like gout and arthritis, not as a primary short-term surgical analgesic.
Piroxicam’s long half-life allows once-daily dosing, but it carries a high risk of GI toxicity. Indometacin often causes more CNS side effects; neither is typically first-line for chronic use in older adults.
Etodolac is relatively COX-2–preferential, generally improving GI tolerability compared with nonselective NSAIDs. Indometacin may provide stronger anti-inflammatory relief for select conditions but with higher rates of dizziness and GI upset.
Sulindac is a prodrug sometimes chosen when minimizing direct renal prostaglandin inhibition is desired, and it has niche roles (e.g., polyposis syndromes). Indometacin is often superior for indometacin-responsive headaches and gout but may be less tolerable.
Aspirin irreversibly inhibits platelets and is used for cardiovascular protection; indometacin is not. For pain, indometacin is generally stronger, but taking it with low-dose aspirin can increase GI bleeding and may blunt aspirin’s cardioprotective effect—separate dosing and ask your clinician.
Topical NSAIDs deliver pain relief to joints like the knee or hand with much lower systemic exposure and fewer GI or cardiovascular risks. Indometacin works body-wide but brings higher systemic side-effect risks.
Both can work, but indometacin has been a traditional first choice for acute gout due to potent anti-inflammatory action. Naproxen may be better tolerated in some patients; whichever is chosen, early dosing and adequate anti-inflammatory coverage are key.
