Indomethacin

How it works

It is a strong non-selective cyclo-oxygenase inhibitor, markedly reducing prostaglandin synthesis to control inflammation and pain.

Prescribing in practice

• It has a high rate of gastrointestinal and central nervous system adverse effects (notably headache, dizziness and confusion, especially in the elderly), so reserve it and use the lowest effective dose for the shortest time.
• Avoid in active peptic ulceration, significant renal or hepatic impairment, heart failure and the third trimester of pregnancy.
• Caution with anticoagulants, antiplatelets, diuretics, ACE inhibitors and lithium owing to bleeding, renal and drug-level interactions.

Monitoring

Monitor renal function, blood pressure and for gastrointestinal and CNS adverse effects, particularly in older patients.

Counselling the patient

• Take with food; report stomach pain, black stools or vomiting blood.
• Tell your prescriber about headaches, dizziness or confusion.
• Use only for the short course prescribed.

Evidence & guidelines

MHRA advice on NSAIDs supports lowest-effective-dose, shortest-duration use, with indomethacin recognised for a higher adverse-effect burden than many alternatives.