Indomethacin dosage, forms, and strengths

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID). Indomethacin is the generic name for the brand names Indocin, Indocin SR, and Tivorbex. It is considered one of the most potent NSAIDs and works by reversibly blocking the cyclo-oxygenase (COX) enzyme or prostaglandin synthesis. It has anti-inflammatory, pain relieving, and fever-reducing properties.

Indomethacin is indicated for the use of moderate to severe arthritis such as rheumatoid arthritis, osteoarthritis, acute gouty arthritis, and ankylosing spondylitis by the United States Food and Drug Administration (FDA). Occasionally it will also be used for acute inflammatory conditions such as tendinitis or bursitis. Indomethacin is a prescription drug that must be given by your healthcare provider and cannot be found over-the-counter due to several potential adverse events that may occur with its use. 

RELATED: Arthritis treatments | Types of arthritis

Indomethacin forms and strengths

Indomethacin is found in capsule form, oral suspension, rectal suppositories, or as an injectable. Here are the various forms and dosages available:

• Capsule: 20 mg, 25 mg, 40 mg, or 50 mg

• Extended release capsule: 75 mg

• Oral suspension: 25 mg/5mL

• Rectal Suppository: 50 mg

• Injectable: 1 mg

Indomethacin dosage for adults

While using indomethacin, it is recommended that the lowest effective dose for the shortest duration of time be used when indicated to help reduce any potential gastrointestinal or kidney problems, adverse effects, or allergic reactions. If switching between indomethacin and Tivorbex, please make sure to follow the instructions as they are not interchangeable in mg form and cannot be substituted.

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* There are off-label treatments for other health conditions that are not listed.

Indomethacin dosage for ankylosing spondylitis

Indomethacin is approved for the treatment of ankylosing spondylitis.

• Immediate release: Take 25 mg capsule two or three times per day

  • Max dosage: Do not exceed 200 mg per day

• Extended release: Take 75 mg extended release (ER) capsule daily

  • Max dosage: Do not exceed 150 mg per day

Indomethacin dosage for acute bursitis/tendinitis

Indomethacin is approved for the treatment of acute bursitis or tendinitis.

• Immediate release: Take 75-150 mg capsule three or four times per day

• Extended release: Take 75-150 mg extended release (ER) capsule daily

Indomethacin dosage for acute gout

Indomethacin is approved for the treatment of acute gout.

• Take 50 mg capsule three time per day for 3-5 days

• Reduce amount taking once pain is under control

• Extended release formula is not recommended for the treatment in gout

Indomethacin dosage for osteoarthritis

Indomethacin is approved for the treatment of osteoarthritis.

• Immediate release: Take 25 mg capsule two or three times per day

  • Max dosage: Do not exceed 200 mg per day

• Extended release: Take 75 mg extended release (ER) capsule daily

  • Max dosage: Do not exceed 150 mg per day

Indomethacin dosage for rheumatoid arthritis

Indomethacin is approved for the treatment of rheumatoid arthritis.

• Immediate release: Take 25 mg capsule two or three times per day

  • Max dosage: Do not exceed 200 mg per day

• Extended release: Take 75 mg extended release (ER) capsule daily

  • Max dosage: Do not exceed 150 mg per day

Indomethacin dosage for children

Indomethacin may be used in infants as young as 48 hours old for patent ductus arteriosus as well as children and adolescents who are at least 2 years old for rheumatoid arthritis.

Indomethacin dosage for pediatric patent ductus arteriosus

Indomethacin is approved for the use of pediatric patent ductus arteriosus. Patent ductus arteriosus is an extra blood vessel found in babies. In most cases, the PDA closes on its own within the first few days after birth. However, if it stays open, it may cause extra blood  flow to the lungs.

• Younger than 48 hours old:

  • Dose 1: 0.2 mg/kg/dose IV once

  • Dose 2: 0.1 mg/kg/dose q12-24h

  • Dose 3: 0.1 mg/kg/dose q12-24h 

• 2-7 days old:

  • Dose 1: 0.2 mg/kg/dose IV once

  • Dose 2: 0.2 mg/kg/dose q12-24h

  • Dose 3: 0.2 mg/kg/dose q12-24h 

• Older than 7 days old:

  • Dose 1: 0.2 mg/kg/dose IV once

  • Dose 2: 0.25 mg/kg/dose q12-24h

  • Dose 3: 0.25 mg/kg/dose q12-24h 

Indomethacin dosage for pediatric rheumatoid arthritis

Indomethacin is approved for pediatric rheumatoid arthritis. 

• 2-14 years old:

  • Take 1-2 mg/kg per day orally divided two to four times per day (Max dosage: Do not exceed 200 mg per day or 4 mg/kg per day)

  • Extended release: 4 mg/kg per day and DO NOT exceed 150 mg per day

  • Give with food if gastrointestinal discomfort occurs

• Older than 14 years old:

  • Take 1-2 mg/kg per day orally divided two to four times per day (Max dosage: Do not exceed 200 mg per day or 4 mg/kg per day)

  • Extended release: 4 mg/kg per day and DO NOT exceed 150 mg per day

  • Give with food if gastrointestinal discomfort occurs

Indomethacin dosage restrictions

Close monitoring by a healthcare professional is always recommended while using indomethacin, specifically if the patient has known renal failure. Patients with a creatinine clearance less than 30 mL/min, are on dialysis, or have severe renal disease are contraindications for use of indomethacin as supplements will not be helpful.

Use of NSAIDs, such as indomethacin, may also place patients at increased risk for fatal heart attack or stroke, especially with long-term use. Patients with a history of hypertension or known heart disease should avoid these medications when possible.

This medication also has the potential for many gastrointestinal problems. Symptoms include intestinal bleeding, ulcers, and stomach or intestinal perforation. These complications can occur at any time while using indomethacin. There is an increased chance of these complications occurring if there is a history of previous gastrointestinal bleeding or with senior populations.

Other contraindications or risk factors associated with use of indomethacin includes:

• History of hypersensitivity reactions or side effects from previous use of indomethacin or NSAIDs

• Aspirin or NSAID-induced asthma or urticaria

• Pregnancy starting at 30 weeks gestation

• Heart bypass (CABG) surgery (do not use just before or after procedure)

• History of proctitis or rectal bleeding

• Neonates with renal impairment, untreated infection, necrotizing enterocolitis, active bleeding, thrombocytopenia, or congenital cardiovascular disease 

How to take indomethacin

Here are some helpful tips when needing to take indomethacin to ensure no adverse reactions occur:

• Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Do not freeze the oral liquid.

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.

• It is best to take this medicine with food, milk, or antacids so it does not upset your stomach.

• Swallow the capsule whole. Do not open, crush, break, or chew it.

• Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup. Shake well before using.

• This medicine should come with a medication guide. Ask your pharmacist for a copy if you do not have one.

Indomethacin dosage FAQs

Indomethacin vs. indomethacin ER: What’s the difference in doses? 

Indomethacin has both the immediate-release and extended-release formulas to many arthritic conditions. Indomethacin ER is offered in 75 mg capsules that are taken once or twice daily.

What happens if I miss a dose of indomethacin?

It is important that this medication is taken as directed by your healthcare professional. Please follow the instructions closely to avoid any negative side effects of indomethacin. If a dose is missed, take it as soon as possible. You may skip the dose if the next dose will need to be taken soon. Never take two doses at the same time.

How long can you take indomethacin?

Indomethacin is to be taken under the direction of your healthcare provider. They will let you know how long you can take this medication based on your medical history and needs.

What is the maximum dosage for indomethacin?

The maximum dosage of indomethacin is 200 mg per day. For extended-release indomethacin, the maximum dosage is 150 mg per day.

Can you overdose on indomethacin?

If too much indomethacin is taken, emergent medical advice is recommended. Serious side effects seen with indomethacin usage includes liver and kidney toxicity; heart failure; GI bleeding, perforation, and ulcer; and allergic reaction. Some common but less serious reactions to indomethacin include:

• Headache

• Nausea

• Indigestion

• Dizziness

• Vomiting

• Diarrhea

• Stomach pain

• Constipation

• Rectal irritation (suppository form)

• Vertigo

• Drowsiness

• Ringing of ears

• Bruising

• Chest pain

• Shortness of breath

• Corneal deposits (prolonged use)

• Rash/skin reactions

• Blisters

• Liver enzymes elevated

• Fluid retention

• Sensitivity to sunlight

• Delayed ovulation

• Yellowing of eyes and skin

• Unexplained weight gain

What interacts with indomethacin?

There are many things that can interact with indomethacin. It is vital that you discuss all medications and health conditions you have with your healthcare provider. Medical conditions to review with your specialist that is important when taking indomethacin include:

• History of cardiovascular disease or high blood pressure

• History of heart attack, stroke, or blood clots

• History of fluid retention (use of diuretics) 

• History of bleeding problems, stomach ulcers, or active bleeding

• History of asthma

• History of kidney or liver disease

• Active smoker

Avoid taking aspirin or any other NSAIDS such as ibuprofen, diclofenac, naproxen, or ketoprofen while taking indomethacin as they may have similar ingredients.

Other drug interactions to be aware of while using indomethacin includes:

• Anticoagulants (warfarin, Plavix)

• Lithium

• Methotrexate

• Corticosteroids

• Cyclosporine 

• Probenecid 

What happens when you mix indomethacin and alcohol?

It is important that alcohol is not used while taking indomethacin. This can increase the side effects of stomach bleeding seen with use of this medication.

Is it safe to take indomethacin during pregnancy?

Indothematcin is not recommended for use during pregancy especially after 30 weeks. When using indomethacin during pregnancy, there is increased risk for cardiovascular and kidney complications to the unborn child, renal dysfunction, not enough amniotic fluid for the unborn child, and premature ductus arteriosus closure may occur.

Although it is not recommended to use this NSAID while pregnant, there is no contraindication for its use while breastfeeding.

Related resources for indomethacin dosages:

• Indomethacin capsules, FDA

• Adult dosing, Epocrates

• Tivorbex dosing, Epocrates

• Indocin IV, FDA

• Pediatric dosing, Epocrates

• Patent ductus arteriosus, KidsHealth

• Contraindications, Epocrates

• Side effects, Epocrates

• Drug interactions, Epocrates