Formulary
Indometacin: Indications, Dosing, Side Effects and Interactions
Indometacin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Indometacin: Indications, Dosing, Side Effects and Interactions
Indometacin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Pain and moderate to severe inflammation in rheumatic disease and other musculoskeletal disorders**
- **Adult** (By Mouth Using Immediate-Release Medicines): 50-200 mg daily in divided doses.
- **Adult** (By Rectum): 100 mg 1-2 times a day, dose to be administered at night and in the morning if required, combined oral and rectal treatment maximum total daily dose 150-200 mg.
- **Adult** (By Mouth Using Modified-Release Medicines): 75 mg 1-2 times a day.
**Acute gout**
- **Adult** (By Mouth Using Immediate-Release Medicines): 150-200 mg daily in divided doses.
- **Adult** (By Rectum): 100 mg 1-2 times a day, dose to be administered at night and in the morning if required, combined oral and rectal treatment maximum total daily dose 150-200 mg.
- **Adult** (By Mouth Using Modified-Release Medicines): 75 mg 1-2 times a day.
**Dysmenorrhoea**
- **Adult** (By Mouth Using Immediate-Release Medicines): Up to 75 mg daily.
- **Adult** (By Rectum): 100 mg 1-2 times a day, dose to be administered at night and in the morning if required, combined oral and rectal treatment maximum total daily dose 150-200 mg.
- **Adult** (By Mouth Using Modified-Release Medicines): 75 mg daily.
**Relief of pain and inflammation in rheumatic diseases including juvenile idiopathic arthritis for indometacin**
- **Child** (By mouth using immediate-release medicines): 0.5-1 mg/kg twice daily.
Cautions
General cautions: Allergic disorders; cardiac impairment (NSAIDs may impair renal function); cerebrovascular disease; coagulation defects; connective-tissue disorders; dehydration (risk of renal impairment); elderly (risk of serious side-effects and fatalities); epilepsy; heart failure; history of gastro-intestinal disorders (e.g. ulcerative colitis, Crohn's disease); ischaemic heart disease; may mask symptoms of infection; parkinsonism; peripheral arterial disease; psychiatric disturbances; risk factors for cardiovascular events; uncontrolled hypertension Specific cautions: With rectal use Avoid rectal administration in proctitis; avoid rectal administration in recent rectal bleeding
Contraindications
Active gastro-intestinal bleeding; active gastro-intestinal ulceration; history of gastro-intestinal bleeding related to previous NSAID therapy; history of gastro-intestinal perforation related to previous NSAID therapy; history of recurrent gastro-intestinal haemorrhage (two or more distinct episodes); history of recurrent gastro-intestinal ulceration (two or more distinct episodes); severe heart failure
Side effects
General side-effects: Frequency not known Agranulocytosis; alopecia; anaphylactic reaction; angioedema; anxiety; appetite decreased; arrhythmias; asthma; blood disorder; bone marrow disorders; breast abnormalities; chest pain; coma; confusion; congestive heart failure; constipation; corneal deposits; depression; diarrhoea; disseminated intravascular coagulation; dizziness; drowsiness; dysarthria; erythema nodosum; eye disorder; eye pain; fatigue; fluid retention; flushing; gastrointestinal discomfort; gastrointestinal disorders; gynaecomastia; haemolytic anaemia; haemorrhage; hallucination; headache; hearing impairment; hepatic disorders; hyperglycaemia; hyperhidrosis; hyperkalaemia; hypotension; inflammatory bowel disease; insomnia; leucopenia; movement disorders; muscle weakness; nausea; nephritis tubulointerstitial; nephrotic syndrome; oedema; oral disorders; palpitations; pancreatitis; paraesthesia; peripheral neuropathy; photosensitivity reaction; platelet aggregation inhibition; psychiatric disorders; renal failure (more common in patients with pre-existing renal impairment); respiratory disorders; seizures; severe cutaneous adverse reactions (SCARs); skin reactions; syncope; thrombocytopenia; tinnitus; urine abnormalities; vasculitis; vertigo; vision disorders; vomiting Specific side-effects: Frequency not known With oral use Dyspnoea; malaise; pulmonary oedema; sigmoid lesion perforation Side-effects, further information For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non-steroidal anti-inflammatory drugs
Interactions
**Other interactions (31):**
- Aspirin : the use of indometacin with aspirin or other salicylates is not recommended.
- A study in normal volunteers showed that chronic administration of 3.6 g aspirin with indometacin lowered the indometacin blood levels by approximately 20%.
- Diflunisal : co-administration of diflunisal with indometacin increases the plasma level of indometacin by about a third, with a concomitant decrease in renal clearance.
- Other NSAIDS : the concomitant use of indometacin with other NSAIDs is not recommended due to the increased possibility of gastro-intestinal toxicity, with little or no increase in efficacy.
- Anticoagulants : although clinical studies suggest that indometacin does not influence the hypoprothrombinaemia induced by anticoagulants, patients also receiving anticoagulants should be closely...
- Probenecid : co-administration of probenecid may increase plasma levels of indometacin.
Pregnancy
Important safety information For indometacin MHRA/CHM advice: NSAIDs: potential risks following prolonged use after 20 weeks of pregnancy (June 2023) See Non-steroidal anti-inflammatory drugs .
Breast feeding
With oral use or rectal use: Amount probably too small to be harmful-manufacturers advise avoid. Use with caution during breast-feeding.
Hepatic impairment
Manufacturer advises caution in mild to moderate impairment; avoid in severe impairment (increased risk of gastro-intestinal bleeding and fluid retention).
Renal impairment
In general, for NSAIDs the MHRA advises to avoid where possible; if necessary, use with caution (risk of fluid retention and further renal impairment, including renal failure). For indometacin , avoid in severe impairment. M
Medicinal forms
Solution,Capsule,Suppository
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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