Indometacin (also spelled indomethacin) is a prescription-strength non-steroidal anti-inflammatory drug (NSAID) used to relieve pain, stiffness, and swelling caused by inflammatory musculoskeletal conditions. Clinically, it is commonly prescribed for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gouty arthritis, and painful shoulder conditions such as bursitis and tendinitis. Because it reduces inflammation at its source, indometacin can help restore mobility, improve function, and decrease daily pain levels associated with flares or chronic joint disease.
Mechanism of action: indometacin inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing the synthesis of prostaglandins—key chemical mediators of inflammation, fever, and pain. This prostaglandin blockade accounts for both its therapeutic benefits (anti-inflammatory, analgesic, antipyretic effects) and the known risk profile (particularly gastrointestinal and cardiovascular risks).
What it can help with:
What it does not do: indometacin is not a disease-modifying agent for arthritis, meaning it does not alter the underlying course of rheumatoid arthritis or osteoarthritis. It treats symptoms while the underlying condition is managed with other therapies as appropriate. It is also not an opioid and does not cause opioid-type sedation or dependence.
Available forms include immediate-release capsules, extended/sustained-release capsules, oral suspension, and rectal suppositories. Choice of formulation is individualized based on patient tolerance, dosing convenience, and clinical goals. Because indometacin can be potent and has a well-characterized side-effect profile, clinicians generally recommend using the lowest effective dose for the shortest duration necessary to control symptoms.
Always follow your prescriber’s instructions. Dosing varies by indication, formulation, age, comorbidities, and response. Taking indometacin with food, milk, or antacids can reduce stomach upset without significantly impairing effectiveness.
General administration guidelines:
Typical adult dosing (consult your clinician for your personalized regimen):
Renal, hepatic, or cardiovascular disease may require lower doses and careful monitoring. In older adults, start low and go slow—sensitivity to adverse effects is higher. Pediatric use is limited and should be specialist-directed (neonatal applications differ and use specific formulations not covered here).
Important usage notes:
Indometacin carries well-established risks shared by the NSAID class and some that are comparatively more pronounced with this specific medicine. Discuss your complete medical history with your prescriber to ensure safe use.
Major boxed warnings (class effects):
Conditions to discuss before starting:
Other important cautions:
Do not use indometacin if any of the following apply:
Use is generally not recommended, or requires specialist oversight, in advanced renal disease, severe liver impairment, and certain inflammatory bowel conditions due to elevated risk of complications.
Many people tolerate indometacin when used at the lowest effective dose for a short duration, but side effects can occur. Contact your healthcare professional if symptoms are persistent, bothersome, or severe. Seek immediate medical care for any signs of a serious reaction.
Common side effects:
Serious side effects (stop indometacin and seek urgent medical attention):
Indometacin interacts with many prescription and over-the-counter products. Always provide your healthcare team with a complete list of your medicines, supplements, and herbal products. Do not add or stop medications without discussing them with a clinician.
Important interactions:
Food is generally helpful for GI comfort. Avoid excessive alcohol due to markedly increased GI risk. If you rely on low-dose aspirin for heart protection, ask your clinician about timing and the risks/benefits of having both medicines in your plan.
If you miss a scheduled dose, take it as soon as you remember unless it is close to the time for your next dose. If it is near the next scheduled dose, skip the missed dose—do not double up to catch up. For “as needed” use during pain flares, take it when symptoms require, staying within your prescribed maximum daily dose.
If you are uncertain about how to handle a missed dose with your specific formulation (for example, extended-release capsules or suppositories), contact your pharmacist or prescriber for individualized guidance.
Overdose can be serious. If you or someone else may have taken too much indometacin, call emergency services or poison control immediately. Symptoms of overdose may include severe nausea or vomiting, abdominal pain, black or bloody stools, drowsiness, dizziness, confusion, blurred vision, ringing in the ears, low blood pressure, convulsions, difficulty breathing, or decreased urination. Life-threatening complications such as GI bleeding, metabolic acidosis, kidney failure, or coma can occur in severe cases.
There is no specific antidote for indometacin overdose. Management typically includes supportive care, monitoring vital signs, correction of fluid and electrolyte disturbances, and treatment of complications. Activated charcoal may be considered if administered promptly after ingestion in a healthcare setting. Do not induce vomiting unless instructed by a medical professional.
Store indometacin at controlled room temperature, ideally 20–25°C (68–77°F). Protect from moisture and direct light. Keep the medication in its original, tightly closed container and out of reach of children and pets.
Do not use the medication past the expiration date. Dispose of unused or expired products according to local guidelines or pharmacy take-back programs—do not flush unless the label specifically instructs it.
This content is for general educational purposes and does not replace individualized medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before starting, changing, or stopping any medication. Indometacin is a prescription medicine that requires clinician oversight due to important risks and interactions. The authors are not responsible for outcomes related to use or misuse of the information provided here.
In the United States, indometacin (indomethacin) is classified as a prescription-only medication. Federal and state regulations require that NSAIDs of this potency be dispensed pursuant to a valid order issued by a licensed prescriber after an appropriate medical evaluation. Retail sale without clinician authorization is not permitted.
How lawful access typically works:
Important note on “no prescription” claims: any pathway that provides indometacin without a conventional paper or electronic prescription must still comply with U.S. law, which requires clinician oversight and a valid medical order. It is unlawful to obtain prescription drugs through unlicensed vendors, offshore pharmacies that do not require a valid prescription, or channels that circumvent safety checks. Doing so can expose you to counterfeit or substandard products and significant health risks.
Valley of the Sun Rehabilitation Hospital offers a legal and structured solution for acquiring indometacin without a formal prescription in hand by using institutional protocols and clinician-directed care. In practice, this means you receive an on-site evaluation and, when appropriate, medication is provided under authorized standing orders or collaborative agreements—ensuring that access remains compliant with U.S. regulations, clinically supervised, and appropriately monitored for safety and effectiveness. If you are considering this option, contact the facility directly to understand eligibility, evaluation requirements, costs, and follow-up expectations. Regardless of the pathway, never start or continue indometacin without qualified medical supervision.
Indometacin (also spelled indomethacin) is a nonsteroidal anti-inflammatory drug (NSAID) that reduces pain, fever, and inflammation by inhibiting cyclo-oxygenase (COX-1 and COX-2) enzymes, lowering prostaglandin production. This helps relieve symptoms in conditions like arthritis and gout.
Indometacin is commonly prescribed for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gout flares, bursitis, and tendinitis. It may also be used short term for musculoskeletal pain and certain inflammatory headaches as directed by a clinician.
Take Indometacin with food or milk and a full glass of water to reduce stomach irritation. Swallow sustained-release or extended-release capsules whole; do not crush or chew. Use the lowest effective dose for the shortest possible time.
Common side effects include stomach upset, heartburn, nausea, headache, dizziness, and drowsiness. Some people experience edema (swelling), elevated blood pressure, or ringing in the ears. Headache and CNS effects occur more often with Indometacin than with many other NSAIDs.
Seek urgent care for black or bloody stools, vomiting blood, severe stomach pain, chest pain, shortness of breath, sudden weakness or slurred speech, severe headache, vision changes, or allergic reactions (hives, wheezing, swelling). Rare but serious risks include gastrointestinal bleeding or perforation, kidney injury, liver injury, heart attack, and stroke.
Avoid Indometacin if you have active stomach or intestinal bleeding, a history of NSAID-triggered asthma or severe allergic reactions, uncontrolled peptic ulcer disease, severe kidney or liver impairment, or for perioperative pain after coronary artery bypass graft (CABG) surgery. People with high cardiovascular risk or prior GI bleeding need careful risk–benefit assessment and protective strategies.
Dosing varies by condition. For arthritis, typical immediate-release dosing is 25–50 mg two to three times daily (maximum generally 200 mg/day). For acute gout, 50 mg three times daily at flare onset is common, then taper as symptoms improve. Sustained-release forms are often 75 mg once or twice daily. Always follow your prescriber’s instructions.
Pain relief can begin within 30–60 minutes, with peak effect in 1–2 hours for immediate-release capsules. Anti-inflammatory effects may build over 24–48 hours. The half-life is about 4–5 hours, but sustained-release products extend duration.
Yes, rectal suppositories (often 50 mg) can be useful if you have nausea, vomiting, or difficulty swallowing pills, or if rapid absorption is desired. Insert as directed, usually after a bowel movement. The same risks and precautions as oral forms apply.
NSAIDs can raise blood pressure, cause fluid retention, and reduce kidney blood flow, potentially worsening kidney function or leading to hyperkalemia. All non-aspirin NSAIDs carry a risk of heart attack and stroke, especially at higher doses or with long-term use. Monitor blood pressure and kidney function, particularly if you take diuretics, ACE inhibitors, or ARBs.
If you’re at higher GI risk (age 65+, prior ulcer or bleed, high dose, concurrent steroids, anticoagulants, antiplatelets, or SSRIs), your clinician may add a proton pump inhibitor (e.g., omeprazole) or misoprostol to lower the risk of ulcers and bleeding. Avoid combining with other NSAIDs and limit alcohol.
For acute pain or gout flares, Indometacin is often used as needed for the shortest time necessary. For chronic inflammatory conditions, your clinician may recommend scheduled dosing initially, then step down to the lowest effective dose or switch to alternatives as appropriate.
Major interactions include blood thinners (warfarin, DOACs), antiplatelets (aspirin, clopidogrel), SSRIs/SNRIs, corticosteroids, lithium, methotrexate, cyclosporine, tacrolimus, and certain antihypertensives (ACE inhibitors, ARBs, diuretics). Avoid taking multiple NSAIDs together. Check all prescription and over-the-counter medicines and supplements with your clinician.
Older adults have higher risks of GI bleeding, kidney injury, cardiovascular events, and CNS side effects like confusion or dizziness. Indometacin appears on the Beers Criteria as potentially inappropriate for older adults due to CNS effects; consider safer alternatives or add protective strategies and close monitoring if use is necessary.
Yes. It can cause dizziness, drowsiness, or confusion, especially when starting therapy or increasing the dose. Avoid driving or operating machinery until you know how it affects you.
If using beyond short-term, clinicians often check kidney function, liver enzymes, and blood counts at baseline and periodically. Monitoring is especially important in older adults and in people taking diuretics, ACE inhibitors, ARBs, methotrexate, or lithium.
Alcohol increases the risk of stomach irritation and gastrointestinal bleeding with NSAIDs. It’s best to avoid or strictly limit alcohol while taking Indometacin; do not binge drink. If you drink, keep it to occasional small amounts with food and discuss your personal risk with your clinician.
Avoid Indometacin, especially from 20 weeks’ gestation onward, due to risks of fetal kidney problems, low amniotic fluid (oligohydramnios), and premature closure of the ductus arteriosus (particularly in the third trimester). If pain control is needed in pregnancy, discuss safer alternatives; do not use Indometacin without obstetric guidance.
Indometacin passes into breast milk in small amounts. Short-term, low-dose use may be acceptable with infant monitoring, but safer alternatives like ibuprofen are usually preferred, especially for newborns or preterm infants. Always consult your clinician before use.
For most elective procedures, stopping 3 days before minor surgery and 5–7 days before major surgery is commonly recommended to reduce bleeding and kidney risks, unless your surgeon advises otherwise. Resume only when your surgical team says it’s safe.
A history of peptic ulcer or GI bleeding significantly raises your risk. Avoid Indometacin if you have active ulcers; if benefits outweigh risks, use the lowest dose with a proton pump inhibitor and close monitoring. Consider alternative pain strategies if possible.
Use with caution and medical supervision. Avoid if eGFR is below 30 mL/min/1.73 m²; for milder impairment, use the lowest effective dose briefly with monitoring of kidney function and potassium. Hydration matters, and combining with ACE inhibitors/ARBs and diuretics further increases risk.
Combining Indometacin with anticoagulants or antiplatelets markedly increases bleeding risk. If the combination is unavoidable, you’ll need careful monitoring and GI protection. People with bleeding disorders generally should avoid NSAIDs unless a specialist recommends otherwise.
Some people with asthma, especially those with nasal polyps or who react to aspirin, can have bronchospasm with NSAIDs. If you’ve ever had wheezing or hives with aspirin or another NSAID, avoid Indometacin and discuss alternatives with your clinician.
Indometacin is generally more potent for inflammation (e.g., gout) but has higher rates of GI and central nervous system side effects. Ibuprofen tends to be better tolerated and is available over the counter, making it a safer first choice for many common pains. For severe inflammatory flares, clinicians may choose Indometacin short term.
Both help arthritis and gout; Indometacin has a long history in acute gout flares, while naproxen is often chosen for its balance of efficacy, twice-daily dosing, and tolerability. Naproxen may carry a comparatively lower cardiovascular risk than some NSAIDs. GI risk exists with both; protective strategies may be needed.
Both are potent NSAIDs. Diclofenac is available in oral and topical forms; topical diclofenac can target localized joint pain with fewer systemic side effects. Indometacin tends to cause more headache and CNS effects, while diclofenac is associated with higher cardiovascular risk at typical doses.
Meloxicam is once daily and preferentially inhibits COX-2, often leading to better GI tolerability. Indometacin may act faster in acute flares but is less well tolerated for long-term use. For chronic arthritis, meloxicam is often preferred; for acute gout, Indometacin may be used short term.
Celecoxib is COX-2 selective, offering lower GI ulcer risk (when not combined with aspirin) and better tolerability for many patients. Indometacin is effective but has higher GI and CNS side effects. In patients with prior ulcers or high GI risk, celecoxib with or without PPI protection is often favored, while cardiovascular risks must still be considered.
Ketorolac is very potent for short-term severe pain and is limited to a maximum of 5 days due to high GI and renal risks. Indometacin can be used longer but still requires caution. Ketorolac is not for chronic inflammatory conditions; Indometacin may be chosen for gout or arthritis flares.
Both are strong NSAIDs; piroxicam has a long half-life allowing once-daily dosing but carries high GI risk and is often avoided for routine use. Indometacin may be preferred for short-term flares despite CNS side effects. Either requires GI protection in high-risk patients.
Etodolac has some COX-2 preference and may be gentler on the stomach for some patients. Indometacin can be more effective for acute inflammatory flares but is less suitable for chronic therapy. Choice depends on condition, side-effect profile, and patient risk factors.
Nabumetone is a prodrug that may cause fewer GI symptoms and often allows once-daily dosing. Indometacin is effective but less well tolerated long term. For chronic osteoarthritis or rheumatoid arthritis, nabumetone may be preferred; for acute gout, Indometacin may be used briefly.
Both are older NSAIDs effective for arthritis and gout. Sulindac may be gentler on the kidneys for some patients, though data are mixed, and it still carries GI and cardiovascular risks. Indometacin often works quickly in gout but can cause more CNS side effects.
Low-dose aspirin is used for heart protection, not for pain. High-dose aspirin can reduce inflammation but has significant GI and bleeding risks and can worsen gout at low analgesic doses due to uric acid effects. For pain and inflammation, Indometacin is generally more effective than aspirin but with its own risks.
Topical diclofenac is preferred for localized osteoarthritis (e.g., knees, hands) because it delivers pain relief with lower systemic exposure and fewer GI side effects. Indometacin provides systemic anti-inflammatory effects needed for conditions like acute gout or widespread arthritis but carries higher systemic risks.
