Indomethacin: a clear, practical guide

Need a strong anti-inflammatory that doctors still reach for when milder painkillers fail? Indomethacin is a potent NSAID used for painful flares like gout, certain arthritis types, and some inflammatory conditions. It works by blocking prostaglandins—the chemicals that cause pain and swelling—but that power means you need to respect the risks.

What people use indomethacin for

Indomethacin commonly treats acute gout attacks, ankylosing spondylitis, and other inflammatory joint problems. It’s also used in hospitals to help close a patent ductus arteriosus (PDA) in premature babies under specialist care. Doctors may pick indomethacin when ibuprofen or naproxen don’t control symptoms, because it is often more effective for severe inflammation.

How to take it, and key dosing notes

Typical adult dosing is 25–50 mg two or three times a day, adjusted by your doctor. For acute gout, doctors often use 50 mg three times daily until symptoms ease, then taper down. Don’t mix indomethacin with other NSAIDs or high-dose aspirin. Take each dose with food or milk to lower stomach upset. Older adults should start at lower doses and monitor closely for side effects.

Important: exact doses vary by condition and product (immediate vs extended release). Always follow your prescriber’s instructions. If you’re unsure how to stop or reduce the drug, ask your doctor—don’t stop abruptly without advice.

Wondering about safety checks? Your clinician may order blood work to watch kidney function and liver enzymes, and check blood pressure periodically while you’re on indomethacin.

Watch closely for warning signs: black or tarry stools, severe belly pain, unexplained bruising, yellowing eyes or skin, sudden shortness of breath, or severe headaches and neck stiffness. Any of these require immediate medical attention.

Common side effects include stomach upset, heartburn, headache, dizziness, and drowsiness. More serious problems can be gastrointestinal bleeding, kidney damage, high blood pressure, and rare central nervous system reactions like aseptic meningitis.

Drug interactions matter. Avoid using indomethacin with blood thinners (warfarin), lithium, methotrexate, ACE inhibitors or ARBs without doctor guidance, and certain antidepressants (SSRIs) that raise bleeding risk. Combining with diuretics can reduce effectiveness and increase kidney strain.

Pregnancy and breastfeeding: don’t use indomethacin in the third trimester. If you’re pregnant or nursing, discuss safer options with your provider.

Looking for alternatives? Naproxen or ibuprofen are milder NSAIDs; celecoxib targets COX-2 and may be easier on the stomach for some people. For gout specifically, colchicine or corticosteroids are alternatives depending on your situation.

Buying online? Only use reputable pharmacies that require a prescription, show a verifiable address, and carry recognized approval seals. Cheap, no-prescription offers are risky—fake or low-quality meds can harm you.

If indomethacin has been suggested, ask your doctor about benefits vs risks for your exact condition. With careful use and monitoring, it can be a strong tool for pain and inflammation—but it’s not a casual choice.