Non-selective NSAID Pregnancy: Contraindicated during the third trimester (risk of premature closure of the ductus arteriosus, pulmonary hypertension, renal dysfunction, prolonged bleeding time and delayed/prolonged labour). During the first and second trimester give only if clearly necessary, at the lowest dose for the shortest time. Not recommended while breast-feeding (excreted in breast milk).

Indometacin

Indometacin is a non-steroidal anti-inflammatory drug (NSAID) used for pain and inflammation in conditions such as acute gout, rheumatoid arthritis and other musculoskeletal disorders.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One suppository (this SPC is for Indometacin 100 mg suppositories)

Route: Rectal (suppository)

Frequency: Once or twice a day - one at bedtime; if a second is necessary, one in the morning

Dosage should be carefully adjusted to the individual patient. Starting therapy at a low dosage and increasing gradually usually minimises the incidence of headache. Use with particular care in older patients, who are more prone to adverse reactions. Safety and efficacy of indometacin in children has not yet been established.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to indometacin or any excipient
History of, or active, peptic ulcer
Recurrent history of gastro-intestinal lesions
Nasal polyps with angioneurotic oedema, or aspirin/other-NSAID-induced asthma, urticaria or rhinitis
History of proctitis or recent rectal bleeding
Third trimester of pregnancy or during lactation

Side effects

CNS: headache, dizziness, light-headedness, vertigo, fatigue (often early and transient)
GI: nausea, anorexia, vomiting, epigastric distress, abdominal pain, constipation, diarrhoea
GI ulceration, perforation and haemorrhage (occasionally fatal); with suppositories, tenesmus and rectal mucosal irritation
Cardiovascular/renal: oedema, raised blood pressure, tachycardia, arrhythmia, congestive heart failure (infrequent)
Hypersensitivity/skin: pruritus, urticaria, angioedema, rash, photosensitivity, Stevens-Johnson syndrome, toxic epidermal necrolysis

Interactions

Anticoagulants (e.g. warfarin) - synergistic effect on bleeding; increased risk of serious bleeding
Antiplatelet agents / aspirin - increased GI toxicity and bleeding risk (no added therapeutic benefit)
SSRIs and SNRIs - may potentiate the risk of bleeding when combined with an NSAID

Clinical monograph

How it works

It non-selectively inhibits cyclo-oxygenase (COX-1 and COX-2), reducing prostaglandin synthesis to produce analgesic, anti-inflammatory and antipyretic effects.

Prescribing in practice

Like other NSAIDs it carries gastrointestinal bleeding, cardiovascular and renal risks, so use the lowest effective dose for the shortest time and consider gastroprotection in those at risk.
It is relatively poorly tolerated, with a high incidence of central nervous system effects such as headache and dizziness compared with other NSAIDs.
Avoid in active peptic ulceration, severe heart failure and significant renal impairment, and use caution with anticoagulants and other nephrotoxic drugs.

Monitoring

Monitor blood pressure, renal function and for gastrointestinal symptoms, particularly in older or higher-risk patients.

Counselling the patient

Take with or after food and report indigestion, black stools or signs of bleeding.
Report headache, dizziness or visual disturbance, which can occur with this medicine.
Avoid other NSAIDs, including over-the-counter products, unless advised.

Evidence & guidelines

NSAID cardiovascular and gastrointestinal risks are highlighted in MHRA advice and NICE guidance on prescribing.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways