Rheumacin

Indomethacin belongs to the class of medications known as nonsteroidal anti-inflammatories (NSAIDs). It works by reducing pain, swelling, and inflammation. Indomethacin is used for the relief of mild to moderately severe pain accompanied by inflammation. It can be used for people with conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and gout.

Your doctor may choose to use this medication for conditions other than the ones listed here. If you're unsure why you are taking this medication, contact your doctor.

Directions

When used on a regular basis, the recommended adult starting dose of indomethacin capsules is 25 mg two or three times a day. Your doctor will gradually increase the dose until the best results are achieved with the least amount of side effects. The maximum recommended daily dose of indomethacin is 200 mg. Indomethacin should always be taken with food or antacids to reduce stomach upset.

The recommended dose of indomethacin suppositories is 100 mg to 200 mg daily. Doses higher than 100 mg must be given in two divided doses.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is very important that this medication be taken on a regular schedule exactly as prescribed by your doctor. If you miss a dose of this medication take it as soon as you remember it. If it is almost time for your next dose, skip the missed dose and carry on with your regular schedule. Do not double-up on doses.

Contra Indications

Indomethacin should not be taken by anyone who:

• currently has or recently had inflammatory diseases of the stomach and intestines such as stomach or intestinal ulcer or ulcerative colitis
• is currently taking other NSAIDs
• is or may be allergic to indomethacin or any of the ingredients of the medication
• has had an allergic reaction to ASA or other anti-inflammatory medications

Suppositories should not be used by anyone who:

• has any inflammatory lesions of the rectum or anus
• has recently had rectal or anal bleeding

Indomethacin is not safe for use by children.

Side Effects

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your health professional. They may be able to help you to deal with some of the effects.

The following side effects may go away as your body becomes used to the medicine; check with your doctor if the following side effects continue or become bothersome. A common side effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is stomach upset. This can be minimized by taking the medication immediately after a meal, or with food or milk.

More common

• abdominal or stomach cramps, pain, or discomfort (mild to moderate)
• diarrhea
• dizziness, drowsiness, or lightheadedness
• headache (mild to moderate)
• heartburn, indigestion, nausea, or vomiting

Less common or rare

• bitter taste or other change in taste sensation
• bloated feeling, gas, or constipation
• decreased appetite or loss of appetite
• fast or pounding heartbeat
• flushing or hot flashes
• general feeling of discomfort or illness
• increased sensitivity of eyes to light
• increased sweating
• irritation, dryness, or soreness of mouth
• nervousness, anxiety, irritability, trembling, or twitching
• rectal irritation (with suppositories)
• trouble sleeping
• unexplained weight loss
• unusual tiredness or weakness without any other symptoms

Check with your doctor as soon as possible if any of the following side effects occur:

More common

• bleeding from rectum (with suppositories)
• skin rash

Less common or rare

• bladder pain
• bleeding from cuts or scratches that lasts longer than usual
• bleeding or crusting sores on lips
• bloody or cloudy urine or any problem with urination, such as difficult, burning, or painful urination
• change in urine colour or odour
• frequent urge to urinate
• sudden, large increase or decrease in the amount of urine or loss of bladder control
• blurred vision or any change in vision
• burning feeling in throat, chest, or stomach
• confusion, forgetfulness, mental depression, or other mood or mental changes
• cough or hoarseness
• decreased hearing, any other change in hearing, or ringing or buzzing in ears
• difficulty swallowing
• eye pain, irritation, dryness, redness, or swelling
• hallucinations
• headache (severe), throbbing, or with stiff neck or back
• hives, itching of skin, or any other skin problem (such as blisters, redness or other colour change, tenderness, burning, peeling, loosening or splitting of fingernails)
• muscle cramps, pain or weakness
• numbness, tingling, pain, or weakness in hands or feet
• pain in lower back or side (severe)
• swelling or tenderness in upper abdominal or stomach area
• swelling of face, feet, or lower legs
• swelling of lips or tongue
• swollen or painful glands (especially in the neck or throat area)
• thirst (continuing)
• trouble speaking
• unexplained runny nose or sneezing
• unexplained, unexpected, or unusually heavy vaginal bleeding
• unusual tiredness or weakness
• weight gain (rapid)
• yellow eyes or skin

Stop taking this medication and contact your doctor immediately if any of the following side effects occur:

Rare

• abdominal or stomach pain, cramping, or burning (severe)
• bloody or black, tarry stools
• chest pain
• convulsions (seizures)
• fever with or without chills
• nausea, heartburn, or indigestion (severe and continuing)
• pinpoint-sized red spots on skin
• sores, ulcers, or white spots on lips or in mouth
• spitting up of blood
• unexplained nosebleeds
• unusual bleeding or bruising
• vomiting of blood or material that looks like coffee grounds

Stop taking this medication and get emergency help immediately if any of the following side effects occur:

Rare

• fainting

• fast or irregular breathing

• fast, irregular heartbeat or pulse

• hive-like swellings (large) on face, eyelids, mouth, lips, or tongue

• puffiness or swelling of the eyelids or around the eyes

• shortness of breath, troubled breathing, wheezing, or tightness in chest

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Warnings and Precautions

Fluid and electrolyte balance

Fluid retention and edema have been reported with use of this medication. Indomethacin should be used with caution by anyone who:

• has certain heart conditions (e.g., congestive heart failure)
• has high blood pressure
• has kidney disease or reduced kidney function
• is recovering from a surgical operation under general anesthesia
• has any other condition that might lead to fluid retention

There is a risk of high blood potassium with NSAID treatment. People most at risk are

• seniors
• those having conditions such as diabetes or kidney failure
• those taking beta-adrenergic blockers, angiotensin converting enzyme (ACE) inhibitors, or some diuretics (water pills)

Gastrointestinal

Stomach ulcers, perforation, and bleeding from the stomach have been known to occur during therapy with indomethacin. These complications can occur at any time, and are sometimes severe enough to require immediate medical attention. The risk of ulcers and bleeding increase for people taking higher doses of NSAIDs for longer periods of time.

Indomethacin should be taken under close medical supervision by people prone to irritation of the stomach and intestines, particularly those who have had a stomach ulcer, bloody stools, or diverticulosis or other inflammatory disease of the stomach or intestines (such as ulcerative colitis or Crohn's disease). In these cases, your doctor must weigh the benefits of treatment against the possible risks.

Stop taking the medication and contact your doctor immediately if you experience symptoms or signs suggestive of stomach ulcers or bleeding in the stomach (black, tarry stools). These reactions can occur at any time during treatment without warning.

Kidney function

Long-term use of indomethacin may lead to a higher risk of reduced kidney function. This is most common for those who already have kidney disease, liver disease, or heart failure; for those who take diuretics (water pills); and seniors.

Occupational hazards

Headaches, sometimes accompanied by dizziness or lightheadedness, may occur during treatment with indomethacin. (These headaches usually occur early in the treatment.) Although the severity of these effects rarely requires the therapy to be stopped, indomethacin should be discontinued if the headaches persist despite dose reduction. Avoid operating motor vehicles and doing other potentially hazardous activities until you determine the effect this medication has on you.

Pregnancy

This medication is not recommended for use during pregnancy as its safety has not been established.

Breast-feeding

This medication should not be used by nursing mothers.

Children

Indomethacin is strongly not recommended for children. The safety, effectiveness, and dosages of the medication for this age group have not been established.

Seniors

Seniors appear to have a higher risk of side effects. They should use the lowest effective dosage under close medical supervision.

Drug Interactions

The following medications may affect the way that indomethacin works or increase the risk of side effects:

• ASA
• alcohol
• angiotensin converting enzyme (ACE) inhibitors (e.g., ramipril)
• beta-adrenergic blockers (e.g., metoprolol, atenolol)
• corticosteroids (e.g., prednisone)
• diuretics (water pills; e.g., spironolactone, triamterene)
• heparin
• other NSAIDs (e.g.; naproxen, diclofenac)
• potassium supplements
• probenecid
• warfarin

Indomethacin may affect the way that the following medications work:

• cyclosporine
• digoxin
• diuretics (water pills; e.g., furosemide, hydrochlorothiazide)
• heparin
• lithium
• methotrexate
• oral hypoglycemics (anti-diabetes medications; e.g., glyburide)
• warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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