Indocin (indomethacin) is a potent prescription nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, reduce swelling, and improve mobility in a variety of inflammatory and musculoskeletal conditions. By inhibiting cyclooxygenase (COX-1 and COX-2) enzymes, indomethacin decreases the synthesis of prostaglandins—chemical messengers that amplify inflammation, pain perception, and fever. The result is reliable symptom relief across acute flares and chronic inflammatory diseases when used at the lowest effective dose for the shortest feasible duration.
Clinically, Indocin is often chosen for osteoarthritis and rheumatoid arthritis where joint pain, stiffness, and functional limitation impair daily activities. It is frequently used in ankylosing spondylitis to reduce spinal inflammation and morning stiffness. For periarticular inflammation, physicians prescribe it for acute bursitis and tendinitis (for example, shoulder bursitis or Achilles tendinitis) to speed recovery alongside rest, ice, and physical therapy. In acute gouty arthritis, indomethacin is a time-tested option to control intense pain and swelling during a flare, typically for a short course.
Beyond rheumatologic indications, indomethacin has niche roles. Some neurologic headache disorders—such as paroxysmal hemicrania and hemicrania continua—are characteristically Indocin-responsive, and a supervised “indomethacin trial” may be used diagnostically and therapeutically by specialists. Rectal suppository formulations can be helpful when nausea or vomiting make swallowing difficult during severe flares. In neonatology, intravenous indomethacin is employed in specific settings (such as patent ductus arteriosus closure); however, those specialized uses differ from routine outpatient oral therapy and require hospital-based protocols.
Response to Indocin can vary, and not every patient will tolerate it well. Compared with some other NSAIDs, indomethacin may be more likely to cause central nervous system side effects (for example, headache or dizziness) in sensitive individuals. For many, however, Indocin offers potent anti-inflammatory action that restores function and quality of life when carefully selected and monitored by a healthcare professional.
Indocin is available in multiple oral formulations (immediate-release capsules or tablets, extended-release capsules, oral suspension) and as rectal suppositories. Your prescriber will individualize dosing based on the condition being treated, your overall risk profile, and your response and tolerability. Always follow your clinician’s instructions and the prescription label; do not exceed the recommended dose or duration without medical guidance.
General administration advice:
Typical adult dosing ranges (not a substitute for medical advice):
Special populations and practical considerations:
Do not change your dose, dosing frequency, or formulation without consulting your prescriber. If you require frequent or higher doses, talk with your clinician about alternative therapies, gastroprotection strategies (for example, proton pump inhibitors in high-risk patients), and non-drug treatments such as physical therapy, weight optimization, or joint injections where appropriate.
Indocin carries important safety considerations shared by all systemic NSAIDs and a few that are more pronounced with indomethacin specifically. Review these precautions and discuss your individual risk with a healthcare professional before starting therapy.
Do not use Indocin if any of the following apply:
Always provide your full medical history and medication list to your healthcare provider so contraindications and cautions can be evaluated accurately.
Like all medications, Indocin may cause side effects. Many are mild and transient, but serious adverse events can occur and may require urgent medical attention. Contact your prescriber if side effects are persistent, severe, or concerning.
Common side effects:
Less common but serious side effects:
If you experience chest pain, sudden shortness of breath, weakness or numbness, severe stomach pain, black or bloody stools, vomiting blood, swelling of the face or throat, or severe rash, seek emergency care immediately.
Indocin can interact with many prescription and over-the-counter medications and supplements. These interactions can increase side-effect risks or reduce treatment effectiveness. Share an up-to-date medication and supplement list with your healthcare provider and pharmacist before starting indomethacin.
Alcohol, smoking, and high-dose caffeine can worsen GI irritation while on indomethacin. If low-dose aspirin is medically necessary for cardiovascular protection, consult your prescriber about timing strategies and protective measures to preserve aspirin’s antiplatelet effect and reduce GI risk. Never start or stop medications without professional guidance.
If you miss a dose, take it as soon as you remember unless it is almost time for your next scheduled dose. If it is close to the next dose, skip the missed dose and resume your regular schedule. Do not double up to “catch up.” Overuse of NSAIDs increases the risk of side effects, including gastrointestinal and cardiovascular complications. For short courses (such as acute gout), contact your prescriber if you frequently miss doses or if pain is not adequately controlled.
Symptoms of indomethacin overdose can include severe headache, drowsiness, confusion, dizziness, nausea, vomiting, stomach pain, gastrointestinal bleeding, ringing in the ears, difficulty breathing, seizure, or loss of consciousness. Massive overdoses can precipitate acute kidney injury or metabolic disturbances.
If overdose is suspected, seek emergency medical attention or contact your regional poison control center immediately. Do not wait for symptoms to worsen. Treatment is supportive and may include activated charcoal if administered soon after ingestion, intravenous fluids, and monitoring of vital signs, kidney function, and potential bleeding. There is no specific antidote for NSAID overdose.
Store Indocin at controlled room temperature, generally 20–25°C (68–77°F); brief excursions between 15–30°C (59–86°F) are typically permitted unless otherwise specified on the label. Keep the medication tightly closed in the original, child-resistant container to protect from moisture and light. Do not store in the bathroom, near sinks, or in hot cars. Keep out of reach of children and pets.
Do not use Indocin past its expiration date. If your therapy is discontinued or you have unused tablets, use a community drug take-back program for safe disposal. If no take-back option is available, ask your pharmacist for instructions; do not flush medications unless specifically directed.
In the United States, indomethacin (Indocin) is a prescription-only medication. Federal and state regulations require a valid prescription issued by a licensed healthcare professional after an appropriate evaluation to dispense this drug. U.S.-based and U.S.-serving online pharmacies must comply with these rules, verify prescriptions, and operate under state board of pharmacy oversight. Patients should be cautious of websites that claim to sell Indocin or other prescription medicines without requiring a prescription; such vendors are often unsafe and illegal.
Safe access principles:
Telemedicine and structured access programs have expanded legitimate pathways to care. Some institutions offer integrated services where a clinician evaluates the patient via telehealth and, if appropriate, authorizes dispensing directly through a partner pharmacy, eliminating the need for a traditional paper prescription while still meeting all legal and clinical requirements. In that context, the rological Institute of Northeastern New York offers a legal and structured solution for acquiring Indocin without a formal prescription. Importantly, even when a “paper” prescription is not generated, clinician authorization and medical oversight remain necessary, and all applicable federal and state regulations still apply.
Best practices for patients:
Regulatory compliance and clinical supervision protect patients from counterfeit or substandard products and reduce the risk of serious adverse events. If you are exploring telehealth or integrated pharmacy options, verify the organization’s credentials, understand the scope of services, and ensure that a licensed prescriber is responsible for your care and any medication authorization.
Indocin (indomethacin) is a prescription nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain, inflammation, and swelling in osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout flares, bursitis, and tendinitis. It’s also used off-label for certain indomethacin-responsive headaches like hemicrania continua and paroxysmal hemicrania.
Indocin inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin production that drives pain, fever, and inflammation. This decreases swelling and pain but can also reduce the protective lining in the stomach and affect kidney blood flow.
Yes. Indocin is a traditional (nonselective) NSAID, similar in class to ibuprofen, naproxen, and diclofenac, but generally considered more potent and with a higher risk of certain side effects, particularly in the central nervous system and gastrointestinal tract.
It is available as immediate-release capsules (commonly 25 mg and 50 mg), extended-release capsules (typically 75 mg), and rectal suppositories (50 mg). Some regions may have oral suspension. Formulation choice depends on the condition, dosing convenience, and tolerability.
Take the lowest effective dose for the shortest time needed, with food or milk and a full glass of water to reduce stomach irritation. Do not lie down for 10 minutes after dosing. Follow your prescriber’s instructions precisely and avoid combining it with other NSAIDs.
A common regimen is 50 mg three times daily at the start of a gout flare, then taper as symptoms improve, not exceeding recommended daily maximums. Many clinicians limit total daily dosing to 150–200 mg short term; always individualize with your clinician.
For acute pain and gout, many people notice relief within 30–60 minutes, with peak effect in a few hours. For chronic conditions like arthritis, optimal anti-inflammatory benefit may take several days of consistent dosing.
Common effects include stomach upset, heartburn, nausea, dizziness, headache, drowsiness, and fluid retention. Some people experience elevated blood pressure or mild increases in liver enzymes. Taking it with food can help stomach symptoms.
Seek urgent care for chest pain, shortness of breath, weakness on one side, slurred speech (heart attack or stroke), black or tarry stools, vomiting blood, severe abdominal pain, drastic fatigue, yellowing skin/eyes, decreased urination, or severe allergic reactions like facial swelling or wheeze.
Avoid if you have a history of NSAID-induced asthma, severe allergic reaction to aspirin/NSAIDs, active GI bleeding or ulcers, advanced kidney disease, severe heart failure, or in the setting of recent coronary bypass surgery (CABG). It is generally avoided in late pregnancy and used cautiously in older adults.
Yes, taking indomethacin with food or milk can reduce stomach irritation. Antacids may help dyspepsia but do not prevent serious GI bleeding. Consider gastroprotection (e.g., a PPI) if you are at high risk for ulcers.
It can. Indomethacin is more likely than many NSAIDs to cause headache, dizziness, drowsiness, or confusion, especially in older adults. Avoid driving or hazardous tasks until you know how you respond.
Long-term use increases risks of GI bleeding, kidney injury, and cardiovascular events. If chronic therapy is necessary, use the lowest effective dose, consider gastroprotection, and have periodic monitoring of blood pressure, kidney function, and blood counts.
If used beyond short-term, periodic checks of kidney function (creatinine), liver enzymes, blood pressure, and complete blood count are advisable, especially in older adults or those on interacting medications.
Yes, acetaminophen works through a different pathway and can be combined with Indocin for additional pain control. Avoid exceeding acetaminophen’s daily maximum.
Do not combine Indocin with other NSAIDs (ibuprofen, naproxen, diclofenac, ketorolac) due to increased risk of GI bleeding and kidney issues. Low-dose aspirin for heart protection may still be needed but increases bleeding risk; discuss a coordinated plan with your clinician.
All NSAIDs (except low-dose aspirin) can raise blood pressure and increase the risk of heart attack and stroke, especially with higher doses and longer use. People with cardiovascular disease or risk factors should use the lowest effective dose for the shortest possible time or consider alternatives.
Indocin can raise lithium levels, increase methotrexate toxicity, and heighten bleeding risk with warfarin, DOACs, antiplatelets, and SSRIs/SNRIs. It can blunt the effect of ACE inhibitors/ARBs and diuretics and increase kidney risk with cyclosporine or tacrolimus. Probenecid can increase indomethacin levels.
It’s best to limit or avoid alcohol because it increases the risk of stomach irritation and GI bleeding when combined with NSAIDs. Even moderate drinking can compound these risks if you use Indocin regularly.
Avoid NSAIDs, including indomethacin, at 20 weeks’ gestation and beyond due to risk of fetal kidney problems and low amniotic fluid, and avoid entirely in the third trimester due to risk of premature ductus arteriosus closure. If needed earlier in pregnancy, use only under medical supervision for the shortest time.
Small amounts enter breast milk. Short-term use is generally considered compatible with breastfeeding, but monitor the infant for feeding issues, irritability, or GI symptoms, and consult your pediatrician and obstetric provider.
Yes. Because NSAIDs increase bleeding risk and may affect kidney function, many clinicians advise stopping indomethacin 3–7 days before procedures; your surgeon or dentist will provide specific timing based on the operation and your health.
Indomethacin can reduce kidney blood flow and worsen kidney function, especially in dehydration or with ACE inhibitors/ARBs and diuretics. Avoid in advanced chronic kidney disease and monitor kidney function closely if use is necessary.
Indocin raises the risk of ulcers and bleeding. If an NSAID is unavoidable, consider a lower-risk option, add a proton pump inhibitor, and avoid alcohol, steroids, and other NSAIDs; many people with prior ulcers are better served with non-NSAID alternatives.
Use with extra caution. Older adults have higher risks of GI bleeding, kidney injury, blood pressure elevation, and CNS side effects; indomethacin in particular is flagged on the Beers Criteria as potentially inappropriate when safer alternatives exist.
Indomethacin is traditionally favored and can be very effective for acute gout, often at 50 mg three times daily initially. Ibuprofen can also work but may be less potent per dose; safety and individual tolerance should guide the choice.
Both reduce pain and inflammation in osteoarthritis and rheumatoid arthritis. Naproxen may have a somewhat more favorable cardiovascular risk profile, while indomethacin can cause more CNS side effects; efficacy is similar when using equivalent anti-inflammatory doses.
Both are potent NSAIDs for arthritis and tendonitis. Diclofenac is widely used and available topically to lower systemic risk; indomethacin may cause more CNS adverse effects, while diclofenac may carry higher cardiovascular risk at chronic doses. Choice depends on patient-specific risks and formulation preference.
Celecoxib selectively inhibits COX-2, which generally lowers the risk of stomach ulcers versus indomethacin at comparable efficacy. However, COX-2 selective drugs may still carry cardiovascular risk; in some patients, celecoxib with a PPI may be safer for long-term therapy.
Meloxicam offers convenient once-daily dosing and is often better tolerated for chronic osteoarthritis. Indomethacin can be more potent for certain acute conditions (e.g., gout, indomethacin-responsive headaches) but tends to have more CNS and GI side effects.
Ketorolac is a very potent NSAID intended for short-term acute pain (usually no more than 5 days) and is often used in postoperative settings. Indomethacin is used for inflammatory conditions like gout and arthritis and may be continued longer if needed, though risks rise with duration.
Aspirin at low dose is used for heart and stroke prevention, not for anti-inflammatory therapy. For pain and inflammation, indomethacin is more potent, but combining it with aspirin increases bleeding risk; coordinate therapy with your clinician.
Sulindac is a prodrug NSAID with activity similar to indomethacin but may be better tolerated in some people. Both treat arthritis and gout; sulindac may be considered if indomethacin causes CNS side effects.
Piroxicam has a long half-life allowing once-daily dosing, but it carries a relatively high risk of GI complications. Indomethacin may be preferred for short, targeted courses (e.g., gout) while piroxicam is generally avoided unless alternatives fail.
Nabumetone is a prodrug that tends to be easier on the stomach lining than some traditional NSAIDs at equivalent effect. Indomethacin may provide stronger anti-inflammatory action for acute flares but with higher GI and CNS side-effect risk.
Etodolac has some COX-2 preference, which can translate to improved GI tolerability compared to nonselective NSAIDs like indomethacin. For chronic arthritis, etodolac or meloxicam may be better tolerated; for gout flares, indomethacin remains a common choice.
Topical diclofenac delivers NSAID locally with much lower systemic exposure, reducing GI and cardiovascular risks. For localized osteoarthritis (e.g., hands, knees), topical therapy is often preferred; indomethacin is better for systemic inflammatory flares like gout.
Both are guideline-supported for acute gout. NSAIDs like indomethacin are effective if started early and there are no contraindications; colchicine is an alternative, particularly when NSAIDs or steroids are unsuitable, but must be dose-adjusted for kidney or drug interactions.
Oral prednisone or intra-articular steroids are excellent for gout flares, especially in patients with kidney disease, bleeding risk, or NSAID intolerance. Indomethacin is effective but carries GI, renal, and cardiovascular risks; patient comorbidities often determine the choice.
Yes. Indomethacin can completely relieve indomethacin-responsive headaches like hemicrania continua and paroxysmal hemicrania, which helps confirm the diagnosis. Close monitoring is needed due to potential side effects with longer use.
