Indomethacin (Indometacin)

How it works

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

Prescribing in practice

• Gastrointestinal toxicity, including ulceration and bleeding, is a major risk and gastroprotection should be considered, especially in older or higher-risk patients.
• Central nervous system effects such as headache, dizziness and confusion are more prominent than with many other NSAIDs and limit tolerability in the elderly.
• It carries the NSAID cardiovascular and renal cautions and should be avoided or used with care in heart failure, renal impairment and with other nephrotoxic or anticoagulant drugs.

Monitoring

Monitor renal function, blood pressure and for gastrointestinal and CNS adverse effects, particularly in older patients and with prolonged use, as advised in the SPC.

Counselling the patient

• Take with or after food and report black stools, abdominal pain or indigestion.
• Report headache, dizziness or confusion, especially when starting.
• Use the lowest effective dose for the shortest time.

Evidence & guidelines

Long-standing trial and clinical experience supports indometacin's efficacy in acute gout and inflammatory arthritis, with its side-effect profile shaping cautious use.