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indomethacin (Rectal route)

Pronunciation

in-doe-METH-a-sin

Rectal route(Suppository)

NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Indomethacin is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery. NSAIDs can also cause an increased risk of serious gastrointestinal adverse events especially in the elderly, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal .

Commonly used brand name(s)

In the U.S.

  • Indocin

In Canada

  • Indocid
  • Novo-Methacin Suppositories
  • Ratio-Indomethacin
  • Rhodacine

Available Dosage Forms:

  • Suppository

Therapeutic Class: Analgesic

Pharmacologic Class: NSAID

Chemical Class: Acetic Acid (class)

Uses For indomethacin

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain and help relieve symptoms of arthritis (e.g., osteoarthritis and rheumatoid arthritis) or gout, such as inflammation, swelling, stiffness, and joint pain. However, indomethacin does not cure arthritis and will help you only as long as you continue to take it.

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

Indomethacin is also used to treat ankylosing spondylitis, which is a type of arthritis that affects the joints in the spine. indomethacin may also be used to treat painful shoulder caused by bursitis or tendinitis.

indomethacin is available only with your doctor's prescription.

Before Using indomethacin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For indomethacin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to indomethacin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of indomethacin in children below 14 years of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of indomethacin in the elderly. However, elderly patients may be more sensitive to the effects of indomethacin than younger adults, and are more likely to have unwanted effects (e.g., stomach ulcers, confusion, psychosis) and age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving indomethacin.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking indomethacin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using indomethacin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Ketorolac

Using indomethacin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abciximab
  • Apixaban
  • Ardeparin
  • Argatroban
  • Beta Glucan
  • Bivalirudin
  • Certoparin
  • Cilostazol
  • Citalopram
  • Clopidogrel
  • Clovoxamine
  • Cyclosporine
  • Dabigatran Etexilate
  • Dalteparin
  • Danaparoid
  • Desirudin
  • Digoxin
  • Duloxetine
  • Enoxaparin
  • Eptifibatide
  • Erlotinib
  • Escitalopram
  • Femoxetine
  • Feverfew
  • Flesinoxan
  • Fluoxetine
  • Fondaparinux
  • Ginkgo
  • Gossypol
  • Heparin
  • Lepirudin
  • Levomilnacipran
  • Meadowsweet
  • Methotrexate
  • Milnacipran
  • Nadroparin
  • Nefazodone
  • Parnaparin
  • Paroxetine
  • Pemetrexed
  • Pentosan Polysulfate Sodium
  • Pentoxifylline
  • Potassium
  • Pralatrexate
  • Prasugrel
  • Protein C
  • Reviparin
  • Rivaroxaban
  • Sibutramine
  • Tacrolimus
  • Ticlopidine
  • Tinzaparin
  • Tirofiban
  • Venlafaxine
  • Vilazodone
  • Vortioxetine
  • Zimeldine

Using indomethacin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Acetohexamide
  • Alacepril
  • Alprenolol
  • Amiloride
  • Amlodipine
  • Arotinolol
  • Atenolol
  • Azilsartan Medoxomil
  • Azosemide
  • Befunolol
  • Bemetizide
  • Benazepril
  • Bendroflumethiazide
  • Benzthiazide
  • Bepridil
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Bopindolol
  • Bucindolol
  • Bumetanide
  • Bupranolol
  • Buthiazide
  • Candesartan Cilexetil
  • Canrenoate
  • Captopril
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Chlorothiazide
  • Chlorpropamide
  • Chlorthalidone
  • Cilazapril
  • Clopamide
  • Cyclopenthiazide
  • Delapril
  • Desvenlafaxine
  • Dilevalol
  • Diltiazem
  • Dipyridamole
  • Enalaprilat
  • Enalapril Maleate
  • Eprosartan
  • Esmolol
  • Ethacrynic Acid
  • Felodipine
  • Flunarizine
  • Fosinopril
  • Furosemide
  • Gallopamil
  • Gentamicin
  • Gliclazide
  • Glimepiride
  • Glipizide
  • Gliquidone
  • Glyburide
  • Hydrochlorothiazide
  • Hydroflumethiazide
  • Imidapril
  • Indapamide
  • Irbesartan
  • Isradipine
  • Labetalol
  • Lacidipine
  • Landiolol
  • Levobetaxolol
  • Levobunolol
  • Lidoflazine
  • Lisinopril
  • Lithium
  • Losartan
  • Manidipine
  • Mepindolol
  • Methyclothiazide
  • Metipranolol
  • Metolazone
  • Metoprolol
  • Moexipril
  • Nadolol
  • Nebivolol
  • Nicardipine
  • Nifedipine
  • Nilvadipine
  • Nimodipine
  • Nipradilol
  • Nisoldipine
  • Nitrendipine
  • Olmesartan Medoxomil
  • Oxprenolol
  • Penbutolol
  • Pentopril
  • Perindopril
  • Pindolol
  • Piretanide
  • Polythiazide
  • Pranidipine
  • Propranolol
  • Quinapril
  • Ramipril
  • Sotalol
  • Spirapril
  • Spironolactone
  • Talinolol
  • Tasosartan
  • Telmisartan
  • Temocapril
  • Tertatolol
  • Timolol
  • Tolazamide
  • Tolbutamide
  • Torsemide
  • Trandolapril
  • Triamterene
  • Trichlormethiazide
  • Valsartan
  • Verapamil
  • Warfarin
  • Xipamide
  • Zofenopril

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of indomethacin. Make sure you tell your doctor if you have any other medical problems, especially:

  • Anemia or
  • Bleeding problems or
  • Blood clots or
  • Depression or other mental changes or
  • Edema (fluid retention or body swelling) or
  • Heart attack, history of or
  • Heart disease (e.g., congestive heart failure) or
  • Hepatitis or jaundice, history of or
  • Hypertension (high blood pressure) or
  • Kidney disease or
  • Parkinsonism or
  • Seizures or epilepsy, history of or
  • Stomach ulcers or bleeding, history of or
  • Stroke, history of—Use with caution. May make these conditions worse.
  • Aspirin-sensitive asthma, history of or
  • Aspirin sensitivity, history of or
  • Proctitis (inflammation of the rectum), history of or
  • Rectal bleeding, recent—Should not be used in patients with these conditions.
  • Heart surgery (e.g., coronary artery bypass graft [CABG] surgery)—Should not be used to relieve pain right before or after the surgery.
  • Liver disease—Use with caution. Effects may be increased because of slower removal of the medicine from the body.

Proper Use of indomethacin

For safe and effective use of indomethacin, do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Taking too much of indomethacin may increase the chance of unwanted effects.

indomethacin should come with a medication guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

When used for severe or continuing arthritis, indomethacin must be taken regularly as ordered by your doctor in order for it to help you. indomethacin usually begins to work within one week, but in severe cases up to two weeks or even longer may pass before you begin to feel better. Also, several weeks may pass before you feel the full effects of indomethacin.

Do not take rectal suppositories by mouth.

To use the suppository:

  • If the suppository is too soft to insert, chill it in the refrigerator for 30 minutes or run cold water over it before removing the foil wrapper.
  • Remove the foil wrapper and moisten the suppository with cold water.
  • Lie down on your side and use your finger to push the suppository well up into the rectum
  • Remain lying down for about 15 minutes to keep the suppository from coming out before it melts.
  • Make sure to wash your hands with soap and water before and after inserting indomethacin.

Dosing

The dose of indomethacin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of indomethacin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For rectal dosage form (suppositories):
    • For ankylosing spondylitis, osteoarthritis, rheumatoid arthritis, bursitis, tendinitis, or gout:
      • Adults and teenagers older than 14 years of age—One 50-milligram (mg) suppository, inserted into the rectum up to four times a day.
      • Teenagers and children 14 years of age or younger—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of indomethacin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using indomethacin

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to use it. Blood and urine tests may be needed to check for unwanted effects.

indomethacin may increase your risk of having a heart attack or stroke. This is more likely in people who already have heart disease. People who use indomethacin for a long time might also have a higher risk.

indomethacin may cause bleeding in your stomach or intestines. These problems can happen without warning signs. This is more likely if you have had a stomach ulcer in the past, if you smoke or drink alcohol regularly, are over 60 years of age, are in poor health, or are using certain other medicines (such as a steroid medicine or a blood thinner).

Serious skin reactions can occur during treatment with indomethacin. Check with your doctor right away if you have any of the following symptoms while using indomethacin: blistering, peeling, loosening of the skin; chills; cough; diarrhea; fever; itching; joint or muscle pain; red skin lesions; sore throat; sores, ulcers, white spots in the mouth or on the lips; or unusual tiredness or weakness.

Some possible warning signs of serious side effects that can occur during treatment with indomethacin may include black, tarry stools; decreased urination; severe stomach pain; skin rash; swelling of the face, fingers, feet, or lower legs; unusual bleeding or bruising; unusual weight gain; vomiting of blood or material that looks like coffee grounds; or yellow skin or eyes. Also, signs of serious heart problems could occur, such as chest pain, tightness in chest, fast or irregular heartbeat, unusual flushing or warmth of the skin, weakness, or slurring of speech. Stop using indomethacin and check with your doctor right away if you notice any of these warning signs.

indomethacin may also cause a serious type of allergic reaction called anaphylaxis. Although this is rare, it may occur more often in patients who are allergic to aspirin or to any of the nonsteroidal anti-inflammatory drugs (NSAIDs). Anaphylaxis can be life-threatening and requires immediate medical attention. The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, wheezing, or fainting. Other signs may include changes in color of the skin of the face; very fast but irregular heartbeat or pulse; hive-like swellings on the skin; and puffiness or swellings of the eyelids or around the eyes. If these effects occur, get emergency help at once.

Using indomethacin in the last few months of a pregnancy can harm your unborn baby. If you think you have become pregnant while using the medicine, tell your doctor right away.

Check with your doctor immediately if blurred vision, difficulty in reading, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

indomethacin may cause some people to become dizzy, lightheaded, drowsy, or less alert than they are normally. Even if used at bedtime, it may cause some people to feel drowsy or less alert on arising. Make sure you know how you react to indomethacin before you drive, use machines, or do anything else that could be dangerous if you are not alert.

Before having any kind of surgery or medical tests, tell your doctor that you are using indomethacin. It may be necessary for you to stop treatment for a while, or to change to a different nonsteroidal anti-inflammatory drug before your procedure.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. .

indomethacin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common
  • Acid or sour stomach
  • belching
  • diarrhea
  • heartburn
  • indigestion
  • nausea
  • stomach discomfort, upset, or pain
  • vomiting
Rare
  • Abdominal or stomach cramping, burning, or tenderness
  • back or leg pains
  • bleeding gums
  • blistering, peeling, or loosening of the skin
  • bloody or black, tarry stools
  • blue lips and fingernails
  • blurred vision
  • breast enlargement and tenderness
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • burning upper abdominal pain
  • canker sores
  • change in consciousness
  • change in hearing
  • chest pain, discomfort, or burning
  • clay colored stools
  • cloudy or bloody urine
  • confusion
  • continuing diarrhea
  • cough or hoarseness
  • coughing that sometimes produces a pink frothy sputum
  • cracks in the skin
  • dark urine
  • decreased appetite
  • decreased vision or any change in vision
  • depression
  • difficult or labored breathing
  • difficulty with swallowing
  • dilated neck veins
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position
  • double vision
  • dry mouth
  • extreme fatigue
  • false sense of well-being
  • feeling of unreality
  • feeling of warmth
  • fever with or without chills
  • flushed, dry skin
  • fruit-like breath odor
  • general body swelling
  • greatly decreased frequency of urination or amount of urine
  • hair loss
  • headache
  • heavier menstrual periods
  • hives or welts
  • increased hunger
  • increased sweating
  • increased thirst
  • increased urination
  • irregular breathing
  • irritation and swelling of the eye
  • itching skin
  • jerky movements of the head, face, mouth, and neck
  • joint pain
  • large, flat, blue or purplish patches in the skin
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • loss of balance control
  • loss of bladder control
  • loss of consciousness
  • loss of hearing
  • loss of heat from the body
  • lower back or side pain
  • mask-like face
  • mental confusion
  • mood swings
  • muscle aches, pains, or weakness
  • muscle spasm or jerking of all extremities
  • nervousness
  • noisy, rattling breathing
  • nosebleeds
  • numbness or tingling in the hands, feet, or lips
  • pain in ankles or knees
  • pain or discomfort in upper stomach or throat
  • pain with swallowing
  • painful or difficult urination
  • painful, red lumps under the skin, mostly on the legs
  • pale skin
  • persistent bleeding or oozing from puncture sites, mouth, or nose
  • personality changes
  • pinpoint red or purple spots on the skin
  • pounding in the ears
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • red, swollen skin
  • redness of the face, neck, arms and occasionally, upper chest
  • scaly skin
  • seeing double
  • seeing, hearing, or feeling things that are not there
  • seizures
  • sense of detachment from self or body
  • severe constipation
  • severe mental changes
  • severe or continuing stomach pain
  • shortness of breath
  • shuffling walk
  • skin rash
  • slow, fast, irregular, pounding, or racing heartbeat or pulse
  • slowed movements
  • slurred speech
  • small red or purple spots on the skin
  • sore throat
  • sores, ulcers, or white spots on the lips or tongue or inside the mouth
  • stiffness of the arms and legs
  • sudden loss of consciousness
  • sugar in the urine
  • swelling in the legs and ankles
  • swelling of the face, fingers, feet, or lower legs
  • swelling of the breasts or breast soreness in both females and males
  • swollen or painful glands
  • tightness in the chest
  • trembling and shaking of the fingers and hands
  • troubled breathing at rest
  • troubled breathing with exertion
  • unexplained weight loss
  • unpleasant breath odor
  • unsteadiness or awkwardness
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vaginal bleeding
  • vomiting of blood or material that looks like coffee grounds
  • weakness in the arms, hands, legs, or feet
  • weight gain
  • wheezing
  • yellow eyes or skin
Incidence not known
  • Frequent urge to defecate
  • rectal bleeding, burning, dryness, itching, or pain
  • straining while passing stool

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
  • Confusion about identity, place, and time
  • severe headache
  • unusual drowsiness, dullness, or feeling of sluggishness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Mild headache
Less common
  • Continuing ringing or buzzing or other unexplained noise in the ears
  • difficulty having a bowel movement (stool)
  • discouragement
  • feeling sad or empty
  • general feeling of discomfort or illness
  • hearing loss
  • irritability
  • loss of interest or pleasure
  • sleepiness
  • trouble with concentrating
Rare
  • Anxiety
  • bloated full feeling
  • changes in patterns and rhythms of speech
  • excess air or gas in the stomach or intestines
  • feeling of constant movement of self or surroundings
  • involuntary muscle movements
  • lightheadedness
  • passing gas
  • sensation of spinning
  • sleeplessness
  • tiredness
  • trouble with speaking
  • trouble sleeping
  • unable to sleep

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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