Dosing & Uses
Dosage Forms & Strengths
capsule
- 20mg (Tivorbex)
- 25mg
- 40mg (Tivorbex)
- 50mg
capsule, extended-release
- 75mg
powder for injection
- 1mg
oral suspension
- 25mg/5mL
suppository
- 50mg
Inflammatory/Rheumatoid Disorders
Immediate release: 25-50 mg PO/PR q8-12hr; not to exceed 200 mg/day
Extended release: 75-150 mg/day PO in single daily dose or divided q12hr; not to exceed 150 mg/day
Bursitis/Tendinitis
Immediate-release: 75-150 mg/day PO/PR divided q6-8hr
Extended-release: 75-150 mg/day PO in single daily dose or divided q12hr
Acute Gouty Arthritis
50 mg PO/PR q8hr for 3-5 days; reduced once pain is under control
Nephrogenic Diabetes Insipidus
2 mg/kg/day PO divided q8hr
Pain
Tivorbex: Indicated for mild-to-moderate acute pain
20 mg PO TID or 40 mg PO BID/TID
Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals
Dosage Forms & Strengths
capsule
- 25mg
- 50mg
capsule, extended-release
- 75mg
powder for injection
- 1mg
oral suspension
- 25mg/5mL
suppository
- 50mg
Inflammatory/Rheumatoid Disorders
<2 years: Safety and efficacy not established
2-14 years: 1-2 mg/kg/day PO divided q6-12hr; not to exceed 4 mg/kg/day or 150-200 mg/day
>14 years: 25-50 mg IR PO/PR q8-12hr; not to exceed 200 mg/day; 75-150 mg/day ER PO in single daily dose or divided q12hr; not to exceed 150 mg/day
Closure of Ductus Arteriosus
Neonates <28 days: 0.2 mg/kg IV over 20-30 minutes initially, THEN 2 subsequent doses, depending on postnatal age
Doses 2 and 3 (<48 hours): 0.1 mg/kg IV over 20-30 minutes at 12 and 24hr intervals
Doses 2 and 3 (2-7 days): 0.2 mg/kg IV over 20-30 minutes at 12 and 24hr intervals
Doses 2 and 3 (>7 days): 0.25 mg/kg IV over 20-30 minutes at 12 and 24hr intervals
After dose 3 (infants <1.5 kg): 0.1-0.2 mg/kg IV over 20-30 minutes once daily for 3-5 days
Monitor renal function (drug is renally excreted); decreased renal function more likely in elderly
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) producing mostly central nervous system (CNS) adverse reactions in elderly
Lowest dose and frequency recommended
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (23)
- aminolevulinic acid oral
aminolevulinic acid oral, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.
- aminolevulinic acid topical
indomethacin, aminolevulinic acid topical. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.
- apixaban
indomethacin and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.
- benazepril
indomethacin, benazepril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- captopril
indomethacin, captopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- enalapril
indomethacin, enalapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- erdafitinib
indomethacin will increase the level or effect of erdafitinib by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with strong CYP2C9 inhibitors, monitor closely for adverse reactions and consider decreasing dose accordingly. If strong CYP2C9 inhibitor is discontinued, consider increasing erdafitinib dose in the absence of any drug-related toxicities.
- fosinopril
indomethacin, fosinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ketorolac
indomethacin, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- ketorolac intranasal
indomethacin, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- lisinopril
indomethacin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- macimorelin
indomethacin, macimorelin. unspecified interaction mechanism. Avoid or Use Alternate Drug. Drugs that directly affect the pituitary secretion of growth hormone (GH) may impact the accuracy of the macimorelin diagnostic test. Allow sufficient washout time of drugs affecting GH release before administering macimorelin. .
- methotrexate
indomethacin increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug. Concomitant administration of NSAIDs with high dose methotrexate has been reported to elevate and prolong serum methotrexate levels, resulting in deaths from severe hematologic and GI toxicity. NSAIDs may reduce tubular secretion of methotrexate and enhance toxicity. .
- methyl aminolevulinate
indomethacin, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.
- moexipril
indomethacin, moexipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- pemetrexed
indomethacin increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug.
- perindopril
indomethacin, perindopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- quinapril
indomethacin, quinapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- ramipril
indomethacin, ramipril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- siponimod
indomethacin will increase the level or effect of siponimod by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with drugs that cause moderate CYP2C9 AND a moderate or strong CYP3A4 inhibition is not recommended. Caution if siponimod coadministered with moderate CYP2C9 inhibitors alone.
- tacrolimus
indomethacin, tacrolimus. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Concomitant administration increases risk of nephrotoxicity.
- trandolapril
indomethacin, trandolapril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.
- zavegepant intranasal
indomethacin will increase the level or effect of zavegepant intranasal by Other (see comment). Avoid or Use Alternate Drug. NTCP inhibitors may result in a significant increase in systemic exposure of zavegepant (a NTCP substrate).
Monitor Closely (246)
- acebutolol
acebutolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of acebutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aceclofenac
aceclofenac and indomethacin both increase anticoagulation. Use Caution/Monitor.
aceclofenac and indomethacin both increase serum potassium. Use Caution/Monitor. - acemetacin
acemetacin and indomethacin both increase anticoagulation. Use Caution/Monitor.
acemetacin and indomethacin both increase serum potassium. Use Caution/Monitor. - agrimony
indomethacin and agrimony both increase anticoagulation. Use Caution/Monitor.
- albuterol
indomethacin increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfalfa
indomethacin and alfalfa both increase anticoagulation. Use Caution/Monitor.
- alfuzosin
indomethacin decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- aliskiren
indomethacin will decrease the level or effect of aliskiren by Other (see comment). Use Caution/Monitor. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.
- alteplase
indomethacin and alteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- American ginseng
indomethacin and American ginseng both increase anticoagulation. Use Caution/Monitor.
- amiloride
amiloride and indomethacin both increase serum potassium. Modify Therapy/Monitor Closely.
- antithrombin alfa
antithrombin alfa and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- antithrombin III
antithrombin III and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- arformoterol
indomethacin increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- argatroban
argatroban and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- asenapine
indomethacin decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- aspirin
aspirin and indomethacin both increase anticoagulation. Use Caution/Monitor.
aspirin and indomethacin both increase serum potassium. Use Caution/Monitor. - aspirin rectal
aspirin rectal and indomethacin both increase anticoagulation. Use Caution/Monitor.
aspirin rectal and indomethacin both increase serum potassium. Use Caution/Monitor. - aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate and indomethacin both increase anticoagulation. Use Caution/Monitor.
aspirin/citric acid/sodium bicarbonate and indomethacin both increase serum potassium. Use Caution/Monitor. - atenolol
atenolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of atenolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - azficel-T
azficel-T, indomethacin. Other (see comment). Use Caution/Monitor. Comment: Patients taking NSAIDS may experience increased bruising or bleeding at biopsy and/or injection sites. Concomitant use of NSAIDs is not recommended.
- azilsartan
indomethacin, azilsartan. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
indomethacin decreases effects of azilsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - bemiparin
bemiparin and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- benazepril
benazepril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- bendroflumethiazide
indomethacin increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- betaxolol
betaxolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of betaxolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - betrixaban
indomethacin, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.
- bimatoprost
bimatoprost, indomethacin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- bisoprolol
bisoprolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of bisoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - bivalirudin
bivalirudin and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- budesonide
indomethacin, budesonide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- bumetanide
indomethacin increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
indomethacin decreases effects of bumetanide by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis. - candesartan
candesartan and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of candesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
candesartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - captopril
captopril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- carbenoxolone
indomethacin increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carvedilol
carvedilol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - celecoxib
celecoxib and indomethacin both increase anticoagulation. Use Caution/Monitor.
celecoxib and indomethacin both increase serum potassium. Use Caution/Monitor. - celiprolol
celiprolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of celiprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - chlorothiazide
indomethacin increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpropamide
indomethacin increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- chlorthalidone
indomethacin increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- choline magnesium trisalicylate
indomethacin and choline magnesium trisalicylate both increase anticoagulation. Use Caution/Monitor.
indomethacin and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor. - cinnamon
indomethacin and cinnamon both increase anticoagulation. Use Caution/Monitor.
- ciprofloxacin
indomethacin, ciprofloxacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Mechanism: unknown. Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- citalopram
citalopram, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. If possible, avoid concurrent use.
- clomipramine
clomipramine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.
- clopidogrel
clopidogrel, indomethacin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- cordyceps
indomethacin and cordyceps both increase anticoagulation. Use Caution/Monitor.
- cortisone
indomethacin, cortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- cyclopenthiazide
indomethacin increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclosporine
indomethacin, cyclosporine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely.
- dabigatran
dabigatran and indomethacin both increase anticoagulation. Use Caution/Monitor. Caution is advised, both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
- dalteparin
dalteparin and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- dasiglucagon
indomethacin decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor.
- deferasirox
deferasirox, indomethacin. Other (see comment). Use Caution/Monitor. Comment: Combination may increase GI bleeding, ulceration and irritation. Use with caution.
- defibrotide
defibrotide increases effects of indomethacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Defibrotide may enhance effects of platelet inhibitors.
- deflazacort
indomethacin, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- dexamethasone
indomethacin, dexamethasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- diclofenac
diclofenac and indomethacin both increase anticoagulation. Use Caution/Monitor.
diclofenac and indomethacin both increase serum potassium. Use Caution/Monitor. - diflunisal
diflunisal and indomethacin both increase anticoagulation. Use Caution/Monitor.
diflunisal and indomethacin both increase serum potassium. Use Caution/Monitor. - digoxin
indomethacin and digoxin both increase serum potassium. Use Caution/Monitor.
- dobutamine
indomethacin increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dong quai
indomethacin and dong quai both increase anticoagulation. Use Caution/Monitor.
- dopexamine
indomethacin increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxazosin
indomethacin decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- dronabinol
indomethacin will increase the level or effect of dronabinol by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Dronabinol is a CYP2C9 substrate.
- drospirenone
drospirenone and indomethacin both increase serum potassium. Modify Therapy/Monitor Closely.
- duloxetine
duloxetine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- edoxaban
edoxaban, indomethacin. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding, monitor closely. Promptly evaluate any signs or symptoms of blood loss.
- eltrombopag
eltrombopag increases levels of indomethacin by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.
- eluxadoline
indomethacin increases levels of eluxadoline by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. As a precautionary measure due to incomplete information on the metabolism of eluxadoline, use caution when coadministered with strong CYP2C9/10 inhibitors.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF, indomethacin. Either increases toxicity of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine and tenofovir with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- emtricitabine
emtricitabine, indomethacin. Either increases levels of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of emtricitabine with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- enalapril
enalapril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- enoxaparin
enoxaparin and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- ephedrine
indomethacin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
indomethacin increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
indomethacin increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epoprostenol
indomethacin and epoprostenol both increase anticoagulation. Use Caution/Monitor.
- eprosartan
eprosartan and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of eprosartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
eprosartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - escitalopram
escitalopram, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- esmolol
esmolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ethacrynic acid
indomethacin increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac and indomethacin both increase anticoagulation. Use Caution/Monitor.
etodolac and indomethacin both increase serum potassium. Use Caution/Monitor. - fennel
indomethacin and fennel both increase anticoagulation. Use Caution/Monitor.
- fenoprofen
fenoprofen and indomethacin both increase anticoagulation. Use Caution/Monitor.
fenoprofen and indomethacin both increase serum potassium. Use Caution/Monitor. - feverfew
indomethacin and feverfew both increase anticoagulation. Use Caution/Monitor.
- fish oil triglycerides
fish oil triglycerides will increase the level or effect of indomethacin by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.
- fludrocortisone
indomethacin, fludrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- fluoxetine
fluoxetine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- flurbiprofen
flurbiprofen and indomethacin both increase anticoagulation. Use Caution/Monitor.
flurbiprofen and indomethacin both increase serum potassium. Use Caution/Monitor. - fluvoxamine
fluvoxamine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- fondaparinux
fondaparinux and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- formoterol
indomethacin increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- forskolin
indomethacin and forskolin both increase anticoagulation. Use Caution/Monitor.
- fosinopril
fosinopril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- furosemide
indomethacin increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- garlic
indomethacin and garlic both increase anticoagulation. Use Caution/Monitor.
- gemifloxacin
gemifloxacin, indomethacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- gentamicin
indomethacin increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ginger
indomethacin and ginger both increase anticoagulation. Use Caution/Monitor.
- ginkgo biloba
indomethacin and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.
- glimepiride
indomethacin increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glipizide
indomethacin increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glucagon
indomethacin decreases effects of glucagon by unknown mechanism. Use Caution/Monitor. In patients taking indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia.
- glucagon intranasal
indomethacin decreases effects of glucagon intranasal by unknown mechanism. Use Caution/Monitor. In patients taking indomethacin, glucagon may lose its ability to raise blood glucose or may even produce hypoglycemia.
- glyburide
indomethacin increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
indomethacin increases levels of glyburide by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. Strong CYP2C9 inhibitors may decrease glyburide metabolism. - green tea
green tea, indomethacin. Other (see comment). Use Caution/Monitor. Comment: Combination may increase risk of bleeding.
- heparin
heparin and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- horse chestnut seed
indomethacin and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.
- hydralazine
indomethacin decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- hydrochlorothiazide
indomethacin increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocortisone
indomethacin, hydrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- ibrutinib
ibrutinib will increase the level or effect of indomethacin by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.
- ibuprofen
ibuprofen and indomethacin both increase anticoagulation. Use Caution/Monitor.
ibuprofen and indomethacin both increase serum potassium. Use Caution/Monitor. - ibuprofen IV
ibuprofen IV will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
ibuprofen IV and indomethacin both increase anticoagulation. Use Caution/Monitor.
ibuprofen IV and indomethacin both increase serum potassium. Use Caution/Monitor. - imatinib
imatinib, indomethacin. Either increases toxicity of the other by Other (see comment). Modify Therapy/Monitor Closely. Comment: Imatinib may cause thrombocytopenia; bleeding risk increased when imatinib is coadministered with anticoagulants, NSAIDs, platelet inhibitors, and thrombolytic agents.
- indapamide
indomethacin increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- irbesartan
irbesartan and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of irbesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
irbesartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - isoproterenol
indomethacin increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketoprofen
indomethacin and ketoprofen both increase anticoagulation. Use Caution/Monitor.
indomethacin and ketoprofen both increase serum potassium. Use Caution/Monitor. - ketorolac
indomethacin and ketorolac both increase anticoagulation. Use Caution/Monitor.
indomethacin and ketorolac both increase serum potassium. Use Caution/Monitor. - ketorolac intranasal
indomethacin and ketorolac intranasal both increase anticoagulation. Use Caution/Monitor.
indomethacin and ketorolac intranasal both increase serum potassium. Use Caution/Monitor. - labetalol
labetalol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of labetalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - lacosamide
indomethacin increases levels of lacosamide by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely. Consider decreasing lacosamide dose when coadministered with strong CYP2C9 inhibitors.
- latanoprost
latanoprost, indomethacin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- latanoprostene bunod ophthalmic
latanoprostene bunod ophthalmic, indomethacin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- lesinurad
indomethacin will increase the level or effect of lesinurad by affecting hepatic enzyme CYP2C9/10 metabolism. Modify Therapy/Monitor Closely.
- levalbuterol
indomethacin increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levofloxacin
levofloxacin, indomethacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.
- levomilnacipran
levomilnacipran, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.
- lisinopril
lisinopril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- lithium
indomethacin increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.
- lornoxicam
indomethacin and lornoxicam both increase anticoagulation. Use Caution/Monitor.
indomethacin and lornoxicam both increase serum potassium. Use Caution/Monitor. - losartan
losartan and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of losartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
losartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - mavacamten
indomethacin will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.
- meclofenamate
meclofenamate and indomethacin both increase anticoagulation. Use Caution/Monitor.
meclofenamate and indomethacin both increase serum potassium. Use Caution/Monitor. - mefenamic acid
indomethacin and mefenamic acid both increase anticoagulation. Use Caution/Monitor.
indomethacin and mefenamic acid both increase serum potassium. Use Caution/Monitor. - melatonin
melatonin increases effects of indomethacin by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.
- meloxicam
indomethacin and meloxicam both increase anticoagulation. Use Caution/Monitor.
indomethacin and meloxicam both increase serum potassium. Use Caution/Monitor. - mesalamine
mesalamine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.
- metaproterenol
indomethacin increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methyclothiazide
indomethacin increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- methylprednisolone
indomethacin, methylprednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- metolazone
indomethacin increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metoprolol
metoprolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - milnacipran
milnacipran, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- mipomersen
mipomersen, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.
- mistletoe
indomethacin increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moexipril
moexipril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- moxifloxacin
moxifloxacin, indomethacin. Other (see comment). Modify Therapy/Monitor Closely. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones.
- moxisylyte
indomethacin decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- mycophenolate
indomethacin will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- nabumetone
indomethacin and nabumetone both increase anticoagulation. Use Caution/Monitor.
indomethacin and nabumetone both increase serum potassium. Use Caution/Monitor. - nadolol
nadolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - naproxen
indomethacin and naproxen both increase anticoagulation. Use Caution/Monitor.
indomethacin and naproxen both increase serum potassium. Use Caution/Monitor. - nebivolol
nebivolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nefazodone
nefazodone, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- nettle
indomethacin increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- norepinephrine
indomethacin increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olmesartan
olmesartan and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
olmesartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - ospemifene
indomethacin increases levels of ospemifene by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
indomethacin, ospemifene. Either increases levels of the other by plasma protein binding competition. Modify Therapy/Monitor Closely. - oxaprozin
indomethacin and oxaprozin both increase anticoagulation. Use Caution/Monitor.
indomethacin and oxaprozin both increase serum potassium. Use Caution/Monitor. - panax ginseng
indomethacin and panax ginseng both increase anticoagulation. Use Caution/Monitor.
- parecoxib
indomethacin and parecoxib both increase anticoagulation. Use Caution/Monitor.
indomethacin and parecoxib both increase serum potassium. Use Caution/Monitor. - paroxetine
paroxetine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- pau d'arco
indomethacin and pau d'arco both increase anticoagulation. Use Caution/Monitor.
- pegaspargase
pegaspargase increases effects of indomethacin by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.
- peginterferon alfa 2b
peginterferon alfa 2b decreases levels of indomethacin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor. When patients are administered peginterferon alpha-2b with CYP2C9 substrates, the therapeutic effect of these drugs may be altered.
- penbutolol
penbutolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - perindopril
perindopril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- phenindione
phenindione and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- phenoxybenzamine
indomethacin decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phentolamine
indomethacin decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phytoestrogens
indomethacin and phytoestrogens both increase anticoagulation. Use Caution/Monitor.
- pindolol
pindolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of pindolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - pirbuterol
indomethacin increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- piroxicam
indomethacin and piroxicam both increase anticoagulation. Use Caution/Monitor.
indomethacin and piroxicam both increase serum potassium. Use Caution/Monitor. - pivmecillinam
pivmecillinam, indomethacin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
pivmecillinam, indomethacin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - potassium acid phosphate
indomethacin and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium chloride
indomethacin and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate
indomethacin and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium iodide
potassium iodide and indomethacin both increase serum potassium. Use Caution/Monitor.
- pralatrexate
indomethacin increases levels of pralatrexate by decreasing renal clearance. Use Caution/Monitor. NSAIDs may delay pralatrexate clearance, increasing drug exposure. Adjust the pralatrexate dose as needed.
- prasugrel
indomethacin, prasugrel. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Chronic use of NSAIDs with prasugrel may increase bleeding risk.
- prazosin
indomethacin decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- prednisolone
indomethacin, prednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- prednisone
indomethacin, prednisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- probenecid
indomethacin will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- propranolol
propranolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - protamine
protamine and indomethacin both increase anticoagulation. Modify Therapy/Monitor Closely.
- quinapril
quinapril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- ramipril
ramipril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- reishi
indomethacin and reishi both increase anticoagulation. Use Caution/Monitor.
- reteplase
indomethacin and reteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- rivaroxaban
rivaroxaban, indomethacin. Other (see comment). Use Caution/Monitor. Comment: NSAIDs are known to increase bleeding. Bleeding risk may be increased when NSAIDs are used concomitantly with rivaroxaban. Monitor for signs/symptoms of blood loss.
- rivastigmine
rivastigmine increases toxicity of indomethacin by pharmacodynamic synergism. Use Caution/Monitor. Monitor patients for symptoms of active or occult gastrointestinal bleeding.
- sacubitril/valsartan
sacubitril/valsartan and indomethacin both increase serum potassium. Use Caution/Monitor.
sacubitril/valsartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
indomethacin decreases effects of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - salicylates (non-asa)
indomethacin and salicylates (non-asa) both increase anticoagulation. Use Caution/Monitor.
indomethacin and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor. - salmeterol
indomethacin increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salsalate
indomethacin and salsalate both increase anticoagulation. Use Caution/Monitor.
indomethacin and salsalate both increase serum potassium. Use Caution/Monitor. - saw palmetto
saw palmetto increases toxicity of indomethacin by unspecified interaction mechanism. Use Caution/Monitor. May increase risk of bleeding.
- sertraline
sertraline, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- Siberian ginseng
indomethacin and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.
- silodosin
indomethacin decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
indomethacin, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of indomethacin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of indomethacin by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.
- sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol
indomethacin, sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol. Other (see comment). Use Caution/Monitor. Comment: Caution when bowel preps are used with drugs that cause SIADH or NSAIDs; increased risk for water retention or electrolyte imbalance.
- sotalol
sotalol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - sparsentan
indomethacin and sparsentan both increase nephrotoxicity and/or ototoxicity. Use Caution/Monitor. Coadministration of NSAIDS, including selective COX-2 inhibitors, may result in deterioration of kidney function (eg, possible kidney failure). Monitor for signs of worsening renal function with concomitant use with NSAIDs.
- spironolactone
spironolactone and indomethacin both increase serum potassium. Modify Therapy/Monitor Closely.
- succinylcholine
indomethacin and succinylcholine both increase serum potassium. Use Caution/Monitor.
- sulfasalazine
indomethacin and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
indomethacin and sulfasalazine both increase serum potassium. Use Caution/Monitor. - sulindac
indomethacin and sulindac both increase anticoagulation. Use Caution/Monitor.
indomethacin and sulindac both increase serum potassium. Use Caution/Monitor. - tafluprost
tafluprost, indomethacin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- telmisartan
telmisartan and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of telmisartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
telmisartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - temocillin
temocillin, indomethacin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
temocillin, indomethacin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - tenecteplase
indomethacin and tenecteplase both increase anticoagulation. Use Caution/Monitor. Potential for increased risk of bleeding, caution is advised.
- tenofovir DF
tenofovir DF, indomethacin. Either increases levels of the other by decreasing renal clearance. Modify Therapy/Monitor Closely. Toxicity may result from coadministration of tenofovir DF with other drugs that are also primarily excreted by glomerular filtration and/or active tubular secretion including high-dose or multiple-dose NSAIDs; alternatives to NSAIDs should be considered.
- terazosin
indomethacin decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- terbinafine
indomethacin will increase the level or effect of terbinafine by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.
- terbutaline
indomethacin increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ticagrelor
ticagrelor, indomethacin. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding with use of ticagrelor and chronic NSAID use. .
- ticarcillin
ticarcillin, indomethacin. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, indomethacin. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - timolol
timolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tolazamide
indomethacin increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolbutamide
indomethacin increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolfenamic acid
indomethacin and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
indomethacin and tolfenamic acid both increase serum potassium. Use Caution/Monitor. - tolmetin
indomethacin and tolmetin both increase anticoagulation. Use Caution/Monitor.
indomethacin and tolmetin both increase serum potassium. Use Caution/Monitor. - tolvaptan
indomethacin and tolvaptan both increase serum potassium. Use Caution/Monitor.
- torsemide
indomethacin increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trandolapril
trandolapril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
- travoprost ophthalmic
travoprost ophthalmic, indomethacin. unspecified interaction mechanism. Use Caution/Monitor. There are conflicting reports from studies of either increased or decreased IOP when ophthalmic prostaglandins are coadministered with NSAIDs (either systemic or ophthalmic).
- trazodone
trazodone, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- triamcinolone acetonide injectable suspension
indomethacin, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Concomitant use of NSAIDS and corticosteroids increases the risk of gastrointestinal side effects. .
- triamterene
triamterene and indomethacin both increase serum potassium. Modify Therapy/Monitor Closely.
- valsartan
valsartan and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
valsartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - venlafaxine
venlafaxine, indomethacin. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- vitamin K1 (phytonadione)
indomethacin increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- voclosporin
voclosporin, indomethacin. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- vorapaxar
indomethacin, vorapaxar. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive antiplatelet effect may occur.
- vortioxetine
indomethacin, vortioxetine. Either increases effects of the other by anticoagulation. Use Caution/Monitor.
- warfarin
indomethacin, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.
- zanubrutinib
indomethacin, zanubrutinib. Either increases effects of the other by anticoagulation. Modify Therapy/Monitor Closely. Zanubrutinib-induced cytopenias increases risk of hemorrhage. Coadministration of zanubritinib with antiplatelets or anticoagulants may further increase this risk.
- zotepine
indomethacin decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
Minor (82)
- aceclofenac
aceclofenac will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acemetacin
acemetacin will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acyclovir
indomethacin will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- alendronate
indomethacin, alendronate. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI ulceration.
- amikacin
indomethacin increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- aminohippurate sodium
indomethacin will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- anamu
indomethacin and anamu both increase anticoagulation. Minor/Significance Unknown.
- aspirin
aspirin will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin rectal
aspirin rectal will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- balsalazide
indomethacin will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- bendroflumethiazide
bendroflumethiazide will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefadroxil
cefadroxil will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefamandole
cefamandole will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefpirome
cefpirome will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ceftibuten
ceftibuten will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- celecoxib
celecoxib will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cephalexin
cephalexin will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorpropamide
indomethacin will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorthalidone
chlorthalidone will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- choline magnesium trisalicylate
indomethacin will increase the level or effect of choline magnesium trisalicylate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chromium
indomethacin increases levels of chromium by unspecified interaction mechanism. Minor/Significance Unknown.
- creatine
creatine, indomethacin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.
- cyclopenthiazide
cyclopenthiazide will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- danshen
indomethacin and danshen both increase anticoagulation. Minor/Significance Unknown.
- devil's claw
indomethacin and devil's claw both increase anticoagulation. Minor/Significance Unknown.
- diclofenac
diclofenac will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- diclofenac topical
diclofenac topical, indomethacin. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Although low, there is systemic exposure to diclofenac topical; theoretically, concomitant administration with systemic NSAIDS or aspirin may result in increased NSAID adverse effects.
- diflunisal
diflunisal will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- digoxin
indomethacin increases levels of digoxin by decreasing renal clearance. Minor/Significance Unknown.
- eplerenone
indomethacin decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- etodolac
etodolac will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- fenoprofen
fenoprofen will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- feverfew
indomethacin decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.
- flurbiprofen
flurbiprofen will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- furosemide
indomethacin decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- ganciclovir
indomethacin will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- gentamicin
indomethacin increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- haloperidol
indomethacin increases toxicity of haloperidol by unknown mechanism. Minor/Significance Unknown.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ibuprofen
ibuprofen will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- imidapril
indomethacin decreases effects of imidapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- indapamide
indapamide will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketoprofen
indomethacin will increase the level or effect of ketoprofen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketorolac
indomethacin will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketorolac intranasal
indomethacin will increase the level or effect of ketorolac intranasal by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- lornoxicam
indomethacin will increase the level or effect of lornoxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meclofenamate
meclofenamate will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- mefenamic acid
indomethacin will increase the level or effect of mefenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meloxicam
indomethacin will increase the level or effect of meloxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- mesalamine
indomethacin will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- metolazone
metolazone will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- nabumetone
indomethacin will increase the level or effect of nabumetone by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- naproxen
indomethacin will increase the level or effect of naproxen by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- neomycin PO
indomethacin increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- nitazoxanide
nitazoxanide, indomethacin. Either increases levels of the other by Mechanism: plasma protein binding competition. Minor/Significance Unknown.
- noni juice
indomethacin and noni juice both increase serum potassium. Minor/Significance Unknown.
- ofloxacin
ofloxacin, indomethacin. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.
- oxaprozin
indomethacin will increase the level or effect of oxaprozin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- parecoxib
indomethacin will increase the level or effect of parecoxib by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- paromomycin
indomethacin increases levels of paromomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- piroxicam
indomethacin will increase the level or effect of piroxicam by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- rose hips
rose hips will increase the level or effect of indomethacin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- salicylates (non-asa)
indomethacin will increase the level or effect of salicylates (non-asa) by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- salsalate
indomethacin will increase the level or effect of salsalate by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- streptomycin
indomethacin increases levels of streptomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- sulfadiazine
indomethacin increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.
- sulfamethoxazole
indomethacin increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.
- sulfasalazine
indomethacin will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- sulfisoxazole
indomethacin increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.
- sulindac
indomethacin will increase the level or effect of sulindac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- tiludronate
indomethacin increases levels of tiludronate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- tobramycin
indomethacin increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- tolfenamic acid
indomethacin will increase the level or effect of tolfenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- tolmetin
indomethacin will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- triamterene
triamterene, indomethacin. Other (see comment). Minor/Significance Unknown. Comment: Risk of acute renal failure. Mechanism: NSAIDs decrease prostaglandin synthesis, which normally protect against nephrotoxicity.
indomethacin increases toxicity of triamterene by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity. - valganciclovir
indomethacin will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- vancomycin
indomethacin increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- willow bark
indomethacin will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- zoledronic acid
indomethacin increases levels of zoledronic acid by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
Adverse Effects
>10%
Transient renal insufficiency (40%)
Jaundice (≤15%)
Elevated liver function test values (≤15%)
Headache (12%)
1-10%
Dizziness (3-9%)
Dyspepsia (3-9%)
Epigastric pain (3-9%)
Indigestion (3-9%)
Nausea (3-9%)
Symptomatic upper GI ulcers, gross bleeding/perforation (4% of patients treated for 1 year; 1% of patients treated for 3-6 months).
Abnormal pain/cramps/distress (<3%)
Constipation (1-3%)
Depression (1-3%)
Diarrhea (1-3%)
Fatigue (1-3%)
Somnolence (1-3%)
Tinnitus (1-3%)
Vertigo (1-3%)
<1%
Acute interstitial nephritis with hematuria/proteinuria
Acute respiratory distress
Agranulocytosis
Angioedema
Aplastic anemia
Asthma
Bone marrow depression
Congestive heart failure (CHF)
Hemolytic anemia
Leukopenia
Macular and morbilliform eruptions
Pulmonary edema
Thrombocytopenia
Thrombocytopenic purpura
Ulcerative stomatitis
Urticaria
Postmarketing Reports
Pancreatitis
Drug reaction with eosinophilia and systemic symptoms (DRESS)
Warnings
Black Box Warnings
Cardiovascular risk
- NSAIDs may increase risk of serious cardiovascular thrombotic events, myocardial infarction (MI), and stroke, which can be fatal
- Risk may increase with duration of use
- Patients with existing cardiovascular disease or risk factors for such disease may be at greater risk
- NSAIDs are contraindicated for perioperative pain in setting of coronary artery bypass graft (CABG) surgery
Gastrointestinal risk
- NSAIDs increase risk of serious GI adverse events, including bleeding, ulceration, and gastric or intestinal perforation, which can be fatal
- GI adverse events may occur at any time during use and without warning symptoms
- Elderly patients are at greater risk for serious GI events
Contraindications
Absolute
- History of hypersensitivity (anaphylactic or serious skin reactions)
- History of urticaria, asthma, or allergic type reactions with aspirin
- Preoperative pain associated with CABG surgery
- History of proctitis or recent rectal bleeding (suppositories)
Relative
- Bleeding disorder
- Duodenal/gastric/peptic ulcer
- Stomatitis
- Ulcerative colitis
- Upper GI disease
- Late pregnancy (may cause premature closure of ductus arteriosus)
Neonates
- Renal impairment
- Untreated infection
- Necrotizing enterocolitis
- Active bleeding (GI bleeding or intracranial hemorrhage)
- Thrombocytopenia
- Congenital heart disease where patent ductus arteriosus is necessary
Cautions
Use caution in patients with history of bronchospasm, cardiac disease, CHF, hypertension, hepatic or renal impairment
Long-term administration of NSAIDs may result in renal papillary necrosis and other renal injury; patients at greatest risk include elderly individuals, those with impaired renal function, hypovolemia, heart failure, liver dysfunction, or salt depletion, and those taking diuretics, angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers
Prolonged use may cause corneal deposits and retinal disturbances; discontinue if visual changes observed
Risk of aggravation of psychiatric disturbances, epilepsy, fluid retention, or Parkinson disease
Reduction in cerebral blood flow associated with rapid IV infusion
Serious skin adverse events (eg, exfoliative dermatitis, Stevens-Johnson Syndrome, and toxic epidermal necrolysis) reported; discontinue is symptoms occur
Platelet adhesion and aggregation may decrease; may prolong bleeding time; monitor closely patients receiving anticoagulants; patients on long-term NSAID therapy should be monitored for anemia; agranulocytosis, aplastic anemia, thrombocytopenia reported (rarely)
Transaminase elevations reported with use; patients with abnormal liver function test should be monitored closely; discontinue immediately if signs or symptoms of liver disease develop
NASAID use my increase risk of hyperkalemia, particularly in the elderly, renal disease, diabetics, when administered concomitantly with agents that can induce hyperkalemia
May increase risk of meningitis with patients with systemic lupus erythematosus and mixed connective tissue disorders being a at higher risk
Heart Failure(HF) risk
- NSAIDS have the potential to trigger HF by prostaglandin inhibition that leads to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics
- NSAIDS should be avoided or withdrawn whenever possible
- AHA/ACC Heart Failure Guidelines; Circulation. 2016; 134
Drug reaction with eosinophilia and systemic symptoms
- Drug Reaction reported in patients taking NSAIDs; some of these events have been fatal or life-threatening; DRESS typically, although not exclusively, presents with fever, rash, lymphadenopathy, and/or facial swelling
- Other clinical manifestations may include hepatitis, nephritis, hematological abnormalities, myocarditis, or myositis; sometimes symptoms of DRESS may resemble an acute viral infection
- Eosinophilia is often present; because this disorder is variable in its presentation, other organ systems not noted here may be involved
- Early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident; if such signs or symptoms are present, discontinue therapy and evaluate the patient immediately
Pregnancy & Lactation
Pregnancy
Use of NSAIDs, including indomethacin capsules, can cause premature closure of fetal ductus arteriosus and fetal renal dysfunction leading to oligohydramnios and, in some cases, neonatal renal impairment; because of these risks, limit dose and duration of therapy to between about 20 and 30 weeks of gestation, and avoid use at about 30 weeks of gestation and later in pregnancy
Premature closure of fetal ductus arteriosus use of NSAIDs, including indomethacin capsules, at about 30 weeks gestation or later in pregnancy increases risk of premature closure of fetal ductus arteriosus; avoid use of NSAIDs in women at about 30 weeks gestation and later in pregnancy
Use of NSAIDs at about 20 weeks gestation or later in pregnancy has been associated with cases of fetal renal dysfunction leading to oligohydramnios, and in some cases, neonatal renal impairment
Data from observational studies regarding other potential embryofetal risks of NSAID use in women in first or second trimesters of pregnancy are inconclusive
If an NSAID is necessary at about 20 weeks gestation or later in pregnancy, limit use to lowest effective dose and shortest duration possible; if treatment extends beyond 48 hours, consider monitoring with ultrasound for oligohydramnios; if oligohydramnios occurs, discontinue therapy and follow up according to clinical practice
There are no studies on effects during labor or delivery; in animal studies, NSAIDS, inhibit prostaglandin synthesis, cause delayed parturition, and increase the incidence of stillbirth
Animal data
- Based on animal data, prostaglandins have been shown to have an important role in endometrial vascular permeability, blastocyst implantation, and decidualization
- In animal reproduction studies retarded fetal ossification was observed with administration of indomethacin to mice and rats during organogenesis at doses 0.1 and 0.2 times, respectively, the maximum recommended human dose (MRHD, 200 mg)
- In published studies in pregnant mice, indomethacin produced maternal toxicity and death, increased fetal resorptions, and fetal malformations at 0.1 times the MRHD; when rat and mice dams were dosed during last three days of gestation, indomethacin produced neuronal necrosis in the offspring at 0.1 and 0.05 times the MRHD, respectively
- In animal studies, administration of prostaglandin synthesis inhibitors such as indomethacin, resulted in increased pre- and post-implantation loss
- Prostaglandins also have been shown to have an important role in fetal kidney development; in published animal studies, prostaglandin synthesis inhibitors have been reported to impair kidney development when administered at clinically relevant doses
Reproductive potential
- Based on mechanism of action, the use of prostaglandin-mediated NSAIDs, including indomethacin capsules, may delay or prevent rupture of ovarian follicles, which has been associated with reversible infertility in some women
- Published animal studies have shown that administration of prostaglandin synthesis inhibitors has the potential to disrupt prostaglandin-mediated follicular rupture required for ovulation
- Small studies in women treated with NSAIDs have also shown a reversible delay in ovulation; consider withdrawal of NSAIDs, including, in women who have difficulties conceiving or who are undergoing investigation of infertility
Lactation
Based on available published clinical data, drug may be present in human milk; the developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclo-oxygenase (COX) isoenzymes, COX-1 and COX-2
May inhibit chemotaxis, alter lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory activity
Absorption
Bioavailability: ~100%
Onset: 30 min
Duration: 4-6 hr
Peak plasma time: 0.5-2 hr; 1.67 hr (Tivorbex)
Peak plasma concentration: 1.2 mcg/mL (20 mg PO); 0.8-2.5 mcg/mL (25 mg PO); 2.4 mcg/mL (40 mg PO); 2.5-4 mcg/mL (50 mg PO)
Tivorbex
- When taken under fasted conditions, a 20% lower dose of indomethacin in Tivorbex 40 mg capsules resulted in a 21% lower mean systemic exposure (AUCinf) and an equivalent mean peak concentration (Cmax) compared to 50 mg indomethacin IR capsules
- The median time to reach peak concentrations (Tmax) was 1.67 hr and 2.02 hr for Tivorbex capsules and indomethacin IR capsules, respectively
- Food causes a significant decrease in the rate but not the overall extent of systemic absorption; 46% lower Cmax, 9% lower AUCinf, and 1.33 hr delayed Tmax (1.67 hr during fasted vs 3 hr during fed)
Distribution
Protein bound: 99%
Vd: 0.34-1.57 L/kg
Metabolism
Metabolized in liver
Metabolites: Desmethyl, desbenzoyl, desmethyl-desbenzoyl
Enzymes inhibited: COX-1, COX-2
Elimination
Half-life: 4.5 hr (prolonged in neonates)
Excretion: Urine (60%), feces (>33%)
Administration
Oral Administration
Take with food or 8-12 oz of water to avoid gastrointestinal (GI) effects
Tivorbex: Food causes a significant decrease in the rate but not the overall extent of systemic absorption and 1.33 hr delayed Tmax (1.67 hr during fasted vs 3 hr during fed)
IV Incompatibilities
Y-site: Amino acid injection, calcium gluconate, cimetidine, dobutamine, dopamine, gentamicin, levofloxacin, tobramycin, tolazoline
IV Preparation
Reconstitute just before administration
Discard any unused portion
Do not use preservative-containing diluents for reconstitution
IV Administration
Infuse over 20-30 min at concentration of 0.5-1 mg/mL in preservative-free SWI or NS
Avoid bolus administration or infusion via umbilical catheter into vessels near superior mesenteric artery; this may cause vasoconstriction and can compromise blood flow to intestines
Do not administer intra-arterially
IV Storage
Store below 30°C (86°F)
Protect from light
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| indomethacin oral - | 50 mg capsule |  | |
| indomethacin oral - | 75 mg capsule |  | |
| indomethacin oral - | 25 mg capsule |  | |
| indomethacin oral - | 75 mg capsule |  | |
| indomethacin oral - | 50 mg capsule |  | |
| indomethacin oral - | 25 mg capsule |  | |
| indomethacin oral - | 75 mg capsule |  | |
| indomethacin oral - | 50 mg capsule |  | |
| indomethacin oral - | 75 mg capsule |  | |
| indomethacin oral - | 50 mg capsule |  | |
| indomethacin oral - | 25 mg capsule |  | |
| indomethacin oral - | 25 mg capsule |  | |
| indomethacin oral - | 50 mg capsule |  | |
| indomethacin oral - | 75 mg capsule |  | |
| Indocin oral - | 25 mg/5 mL suspension |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
indomethacin oral
INDOMETHACIN SUSTAINED-RELEASE CAPSULE - ORAL
(in-doh-METH-uh-sin)
COMMON BRAND NAME(S): Indocin SR
WARNING: Nonsteroidal anti-inflammatory drugs (including indomethacin) may rarely increase the risk for a heart attack or stroke. This effect can happen at any time while taking this drug but is more likely if you take it for a long time. The risk may be greater in older adults or if you have heart disease or increased risk for heart disease (for example, due to smoking, family history of heart disease, or conditions such as high blood pressure or diabetes). Do not take this drug right before or after heart bypass surgery (CABG).Also, this drug may rarely cause serious (rarely fatal) bleeding from the stomach or intestines. This effect can occur without warning symptoms at any time while taking this drug. Older adults may be at higher risk for this effect. (See also Precautions and Drug Interactions sections.)Stop taking indomethacin and get medical help right away if you notice any of the following rare but serious side effects: stomach/abdominal pain that doesn't go away, bloody or black/tarry stools, vomit that looks like coffee grounds, chest/jaw/left arm pain, shortness of breath, unusual sweating, weakness on one side of the body, sudden vision changes, trouble speaking.Talk with your doctor or pharmacist about the risks and benefits of treatment with this medication.
USES: Indomethacin is used to relieve pain, swelling, and joint stiffness caused by arthritis, bursitis, and tendonitis. Reducing these symptoms helps you do more of your normal daily activities. The sustained release capsule does not relieve pain quickly. Do not use it for sudden gout attacks. This medication is known as a nonsteroidal anti-inflammatory drug (NSAID).If you are treating a chronic condition such as arthritis, ask your doctor about non-drug treatments and/or using other medications to treat your pain. See also Warning section.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using indomethacin and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Swallow this medication whole. Do not crush or chew the capsules. Doing so can destroy the long action of the drug and may increase side effects.Take this medication by mouth as directed by your doctor, usually once or twice daily with a full glass of water (8 ounces or 240 milliliters). Do not lie down for at least 10 minutes after taking this drug. Take this medication either with food, right after meals, or with antacids to prevent stomach upset.Dosage is based on your medical condition and response to treatment. Do not take more than 150 milligrams per day. To lessen side effect risks (such as stomach bleeding), use this medication at the lowest effective dose for the shortest possible length of time. Do not increase your dose or take it more often than prescribed. For chronic conditions such as arthritis, continue taking it as directed by your doctor. Discuss the risks and benefits with your doctor or pharmacist.In certain conditions (such as arthritis), it may take up to 4 weeks when this drug is taken regularly before you notice the full benefits.Tell your doctor if your condition worsens.
SIDE EFFECTS: See also Warning section.Upset stomach, heartburn, headache, drowsiness, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.Tell your doctor right away if any of these unlikely but serious side effects occur: hearing changes (such as ringing in the ears), mental/mood changes (such as confusion, hallucinations), difficult/painful swallowing, symptoms of heart failure (such as swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Get medical help right away if any of these rare but very serious side effects occur: signs of kidney problems (such as change in the amount of urine), unexplained stiff neck.This drug may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, including: nausea/vomiting that doesn't stop, loss of appetite, dark urine, severe stomach/abdominal pain, yellowing eyes or skin.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking indomethacin, tell your doctor or pharmacist if you are allergic to it; or to aspirin or other NSAIDs (such as ibuprofen, naproxen, celecoxib); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: asthma (including a history of worsening breathing after taking aspirin or other NSAIDs), bleeding or clotting problems, growths in the nose (nasal polyps), heart disease (such as previous heart attack), high blood pressure, liver disease, stomach/intestinal/esophagus problems (such as bleeding, ulcers, recurring heartburn), stroke.Kidney problems can sometimes occur with the use of NSAID medications, including indomethacin. Problems are more likely to occur if you are dehydrated, have heart failure or kidney disease, are an older adult, or if you take certain medications (see also Drug Interactions section). Drink plenty of fluids as directed by your doctor to prevent dehydration and tell your doctor right away if you have a change in the amount of urine.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Talk to your doctor if you are using marijuana (cannabis).This medicine may cause stomach bleeding. Daily use of alcohol and tobacco, especially when combined with this medicine, may increase your risk for stomach bleeding. Limit alcohol and stop smoking. Consult your doctor or pharmacist for more information.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Older adults may be at greater risk for stomach/intestinal bleeding, kidney problems, heart attack, stroke, and mental/mood changes while using this drug.Children may be more sensitive to the side effects of this drug, especially serious liver problems. Caution is advised when this drug is used by children. Discuss the risks and benefits of treatment with your doctor.Before using this medication, women of childbearing age should talk with their doctor(s) about the benefits and risks. Tell your doctor if you are pregnant or if you plan to become pregnant. This medication may harm an unborn baby and cause problems with normal labor/delivery. It is not recommended for use in pregnancy from 20 weeks until delivery. If your doctor decides that you need to use this medication between 20 and 30 weeks of pregnancy, you should use the lowest effective dose for the shortest possible time. You should not use this medication after 30 weeks of pregnancy.This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: aliskiren, ACE inhibitors (such as captopril, lisinopril), angiotensin II receptor blockers (such as losartan, valsartan), cidofovir, lithium, methotrexate, corticosteroids (such as prednisone), "water pills" (diuretics such as furosemide).This medication may increase the risk of bleeding when taken with other drugs that also may cause bleeding. Examples include anti-platelet drugs such as clopidogrel, "blood thinners" such as dabigatran/enoxaparin/warfarin, among others.Check all prescription and nonprescription medicine labels carefully since many medications contain pain relievers/fever reducers (aspirin, NSAIDs such as celecoxib, diflunisal, ibuprofen, or ketorolac). These drugs are similar to indomethacin and may increase your risk of side effects if taken together. However, if your doctor has directed you to take low-dose aspirin to prevent heart attack or stroke (usually 81-162 milligrams a day), you should continue taking the aspirin unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.This medication can affect the results of certain lab tests. Make sure laboratory personnel and your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe stomach pain, vomit that looks like coffee grounds, extreme drowsiness, slow or shallow breathing, confusion, seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood pressure, complete blood count, liver/kidney function) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.Non-drug treatment for arthritis that is approved by your doctor (such as weight loss if needed, strengthening and conditioning exercises) may help improve your flexibility, range of motion, and joint function. Consult your doctor for specific instructions.
MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Use your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised December 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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