Indomethacin

Indomethacin is a non-steroidal anti-inflammatory drug (nsaid) medicine available in Bangladesh under many brand names. Below are its uses, dosage, side effects and precautions — and all brands with their current prices.

• Rheumatoid arthritis, including acute flare-ups.
• Osteoarthritis with pain and inflammation.
• Ankylosing spondylitis.
• Acute painful shoulder conditions such as bursitis or tendinitis.
• Acute gouty arthritis.

Use the lowest effective dose for the shortest possible time. Adult dosing depends on the condition being treated, severity of symptoms, age, other diseases, and the dosage form. Capsules are usually taken by mouth with food or milk to reduce stomach upset. Suppositories are used rectally as directed and should not be swallowed. Do not change the dose, combine dosage forms, or continue treatment longer than prescribed without medical advice.

• Common effects include indigestion, stomach pain, nausea, vomiting, diarrhoea or constipation, headache, dizziness, drowsiness, and fluid retention.
• Can cause stomach ulceration, bleeding, or perforation, sometimes without warning symptoms.
• May increase blood pressure and the risk of heart attack or stroke, particularly with prolonged use or in high-risk patients.
• May worsen kidney function, cause reduced urine output, swelling, or electrolyte imbalance.
• Rare but serious effects include severe allergic reactions, bronchospasm in sensitive patients, liver injury, severe skin reactions, confusion, depression, or vision changes.
• Suppositories may cause rectal irritation, discomfort, or bleeding.

Use with extra caution in people with a history of stomach ulcer or bleeding, heart disease, stroke, high blood pressure, kidney or liver disease, asthma, bleeding disorders, dehydration, older age, or those taking blood thinners or steroids. Avoid alcohol and other NSAIDs unless specifically advised. Use under a registered doctor's or pharmacist's guidance, and seek urgent care for black stools, vomiting blood, chest pain, severe shortness of breath, facial swelling, severe rash, or reduced urination.

• Other NSAIDs, including aspirin used for pain relief, increase the risk of side effects and bleeding.
• Anticoagulants and antiplatelet medicines such as warfarin, heparin, apixaban, rivaroxaban, clopidogrel, or low-dose aspirin may increase bleeding risk.
• Corticosteroids and selective serotonin reuptake inhibitors may increase gastrointestinal bleeding risk.
• ACE inhibitors, ARBs, beta-blockers, and diuretics may have reduced blood pressure effect and may increase kidney risk.
• Lithium, methotrexate, digoxin, and ciclosporin or tacrolimus may have increased toxicity.
• Probenecid may increase indomethacin levels.
• Alcohol increases the risk of stomach irritation and bleeding.

• Known allergy to indomethacin or any NSAID.
• History of asthma, urticaria, or allergic-type reaction after aspirin or another NSAID.
• Active stomach or intestinal ulcer, active gastrointestinal bleeding, or history of recurrent ulcer or bleeding related to NSAIDs.
• Use for pain around the time of coronary artery bypass graft (CABG) surgery.
• Severe heart failure, severe kidney disease, or severe liver disease unless a specialist decides otherwise.
• Third trimester of pregnancy.
• Suppositories should not be used in people with proctitis, recent rectal bleeding, or significant rectal lesions.

Indomethacin should be avoided in pregnancy unless a doctor decides it is clearly necessary. It is generally avoided from 20 weeks of pregnancy because NSAIDs can affect the baby’s kidneys and amniotic fluid, and it must not be used in the third trimester because it may prematurely close the fetal ductus arteriosus and increase bleeding or delivery complications. It passes into breast milk in small amounts; breastfeeding mothers should use it only on medical advice, and safer alternatives may be preferred.

Store at room temperature, away from excess heat, moisture, and direct sunlight. Keep capsules and suppositories in their original packaging and out of the reach of children. Do not use after the expiry date, and do not use suppositories that have melted or become damaged.