indometacin: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
indometacin: clinical details
Prescribing considerations
- Assess gastrointestinal, renal, cardiovascular, bleeding and hypersensitivity risks.
- Use particular care in older adults and people with renal or hepatic dysfunction, diabetes, heart failure, hypertension, volume depletion, asthma, epilepsy, parkinsonism or psychiatric disorders.
- Indometacin can cause fluid retention, inhibit platelet aggregation and mask signs of infection.
- Discuss reversible impairment of ovulation when fertility is relevant.
- Review persistent headache, neurological symptoms, visual disturbance or rectal irritation.
Contraindications and cautions
- Hypersensitivity to indometacin or the product excipients
- Active or previous peptic ulcer, or recurrent gastrointestinal lesions
- Previous asthma, urticaria or rhinitis triggered by aspirin or another NSAID, including the specified nasal-polyp syndrome
- History of proctitis or recent rectal bleeding
- Third trimester of pregnancy
- Breastfeeding for the selected product
- Concurrent diflunisal
Monitoring
- Monitor renal function in patients with reduced renal reserve or other renal risk factors.
- Periodically assess for anaemia, gastrointestinal toxicity and liver dysfunction where clinically appropriate.
- Consider potassium monitoring when renal impairment or interacting medicines increase hyperkalaemia risk.
- For prolonged rheumatoid arthritis treatment, consider periodic ophthalmological assessment and stop if treatment-related eye changes occur.
- Monitor lithium, digoxin or vancomycin concentrations when clinically indicated.
Clinical pharmacology
An indole-acetic-acid NSAID that inhibits prostaglandin synthetase, producing anti-inflammatory, analgesic and antipyretic effects. Renal elimination and enterohepatic cycling contribute to important renal and pharmacokinetic interactions.
Formulation and product differences
- The selected licensed product is a polyethylene glycol rectal suppository.
- Rectal use can cause local burning, itching, discomfort, tenesmus, proctitis or bleeding.
- It must not be swallowed and is unsuitable with proctitis or recent rectal bleeding.
indometacin preparations and strengths
Suppository
Route: Rectal
Strengths: 100 mg
indometacin interactions
Check prescribed, over-the-counter and herbal products with a pharmacist or prescriber. Important interactions include:
Aspirin, diflunisal and other NSAIDs
Combining them increases gastrointestinal toxicity. Diflunisal must not be used with indometacin.
Anticoagulants
Bleeding risk may increase, requiring close clinical and coagulation monitoring.
Methotrexate
Indometacin may reduce methotrexate elimination and increase toxicity.
Lithium
Lithium concentrations and toxicity can increase, so additional monitoring may be required.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.