Indomethacin: What It Is, How It Works, and When It’s Used

When working with Indomethacin, a prescription non‑steroidal anti‑inflammatory drug (NSAID) that reduces pain, swelling, and fever by blocking COX enzymes. Also known as Indocin, it’s commonly prescribed for arthritis, gout attacks, and certain types of bursitis.

Indomethacin belongs to the larger class of NSAIDs, drugs that inhibit cyclooxygenase (COX) enzymes to lower prostaglandin production. By curbing prostaglandins, NSAIDs cut down the signals that cause inflammation and pain. This link between Indomethacin and COX inhibition is why doctors turn to it when other pain relievers aren’t enough.

One of the key targets of Indomethacin is Cyclooxygenase, an enzyme family (COX‑1 and COX‑2) that drives the formation of inflammatory mediators. Blocking COX‑1 can protect the stomach lining, while COX‑2 inhibition mainly reduces swelling. Indomethacin hits both, which explains its strong anti‑inflammatory power but also why it can irritate the gut.

Because it tackles inflammation head‑on, Indomethacin is a go‑to for arthritis, a group of joint diseases marked by pain, stiffness, and swelling. Whether it’s rheumatoid arthritis or osteoarthritis, the drug helps keep joints moving by damping the chemical fire inside them. Patients often notice relief within a few days, especially during flare‑ups.

Gout attacks are another classic scenario where Indomethacin shines. A sudden surge of uric acid crystals triggers intense joint pain, and the rapid COX blockade provided by Indomethacin can calm the attack faster than many alternatives. Doctors usually prescribe a short, high‑dose course to bring the pain under control, then taper down to avoid long‑term side effects.

The drug comes in several dosage forms: oral tablets, capsules, and a liquid suspension for those who have trouble swallowing pills. Typical adult dosing for acute gout starts at 50 mg three times daily, but the exact regimen depends on the condition being treated and the patient’s kidney function. Always follow the prescribing doctor’s guidance because the therapeutic window can be narrow.

Speaking of kidneys, Indomethacin’s impact on renal blood flow is a major safety consideration. By constricting the vessels that feed the kidneys, it can raise serum creatinine levels, especially in people with existing kidney disease or dehydration. Regular lab checks are a smart move when you’re on a longer course.

Gastrointestinal irritation is another common trade‑off. Since Indomethacin blocks COX‑1, the protective mucus lining of the stomach thins, raising the risk of ulcers and bleeding. Taking the drug with food, using the lowest effective dose, or adding a proton‑pump inhibitor can help mitigate this risk. If you notice stomach pain, black stools, or vomiting blood, seek medical help immediately.

Cardiovascular effects also deserve attention. NSAIDs, including Indomethacin, can elevate blood pressure and, in rare cases, contribute to heart attacks or strokes. Patients with a history of heart disease should discuss alternatives with their doctor before starting therapy.

Drug interactions are a real puzzle piece in the Indomethacin picture. Blood thinners like warfarin can become more potent, raising bleed risk. Lithium levels may spike, and certain antihypertensives lose effectiveness. Always list all medications, supplements, and herbal products with your pharmacist to avoid surprises.

Pregnancy and breastfeeding add another layer of caution. Indomethacin crosses the placenta and can affect fetal blood flow, especially in the third trimester. Most guidelines advise avoiding it during pregnancy unless the benefits clearly outweigh the risks. Lactating mothers should also check with their healthcare provider before using the drug.

When you combine the facts—its powerful COX inhibition, its rapid relief for arthritis and gout, its potential GI, kidney, and heart side effects—you see why Indomethacin is both a valuable tool and a medication that demands respect. Below, you’ll find a curated set of articles that dive deeper into specific aspects of Indomethacin, from dosing strategies to safety tips, so you can make informed choices about its use.