Indomethacin
Benjamin Clanner-Engelshofen is a freelance writer in the medical department. He studied biochemistry and pharmacy in Munich and Cambridge / Boston (USA) and noticed early on that he particularly enjoyed the interface between medicine and science. That is why he went on to study human medicine.
More about the experts All content is checked by medical journalists.The active ingredient indomethacin is a pain reliever (analgesic) from the group of non-steroidal anti-inflammatory drugs. It is mainly used for the treatment of rheumatic diseases, but also for pain, swelling and inflammation of other causes. Here you can read everything you need to know about the effects and use of indomethacin, side effects and interactions.
This is how indomethacin works
The active ingredient indomethacin inhibits the production of certain tissue hormones (prostaglandins) in the body. These mediate a variety of effects in the human body: Prostaglandins stimulate inflammatory reactions, cause tissue swelling, increase blood circulation locally, intensify pain stimuli, stimulate the uterine muscles to contract (stimulate labor), narrow the bronchi in the lungs and trigger a fever.
If one now inhibits the formation of these tissue hormones, these reactions no longer take place or only take place to a lesser extent. This explains the effect of indomethacin against inflammation, pain and swelling.
Uptake, degradation and excretion of indomethacin
After ingestion, indomethacin is quickly and completely absorbed through the intestinal mucosa into the blood, where it reaches the highest level after half an hour to two hours. Then half of the active ingredient is excreted over about two hours. It is partially converted in the liver to make it more soluble in water, then about two thirds is excreted in the urine and one third in the stool.
When is indomethacin used?
The analgesic indomethacin is used against:
- chronic inflammation, pain, and swelling (such as in rheumatoid arthritis)
In the past, the active ingredient was also used to inhibit labor, but more reliable means are now available.
This is how indomethacin is used
The dose of indomethacin to be taken is selected depending on the severity of the disease. Dosages of 50 to 150 milligrams per day, divided into one to three individual doses, are common. The maximum daily dose reserved for very severe cases is 200 milligrams. It is taken with a glass of water with a meal.
The active ingredient is not only available for oral ingestion, but also in the form of suppositories and eye drops as well as pain gel and pain spray. The pain gel is used two to four times a day, the pain spray three to five times a day. The eye drops are used four to six times a day.
What are the side effects of indomethacin?
Indomethacin side effects such as headache, drowsiness, gastrointestinal complaints, nausea, vomiting, diarrhea and bleeding in the gastrointestinal tract occur in more than one in ten people treated.
In addition, one in ten to one hundred people treated has hypersensitivity reactions (such as itchy skin and rash), depression, dizziness, sleepiness, exhaustion, ringing in the ears (tinnitus), indigestion, abdominal cramps and pain, gastrointestinal ulcers or an increase in liver enzyme levels.
To prevent gastrointestinal complaints when taking indomethacin for a long time, a so-called "stomach protection" can also be taken after a doctor's agreement. Proton pump inhibitors such as omeprazole or prostaglandin analogs such as misoprostol are suitable as such.
What should be considered when taking indomethacin?
Taking other active substances together with indomethacin can increase the risk of interactions.
The additional intake of other non-steroidal anti-inflammatory drugs (NSAIDs) such as ASA / acetylsalicylic acid (as a pain reliever or to inhibit coagulation), naproxen and diclofenac can lead to severe internal bleeding. The same applies to the combination with glucocorticoids (colloquially "cortisone").
The effects of anticoagulants such as phenprocoumon and warfarin can be increased by indomethacin, which is why the coagulation status should be closely monitored.
The blood level of active ingredients with a narrow therapeutic range (i.e. those that are quickly overdosed or underdosed) can change due to indomethacin and should therefore be closely monitored, especially at the start of therapy. Examples of such active substances are digoxin (heart medicine), phenytoin (antispasmodic) and lithium (for mental illness).
In addition, indomethacin can weaken the effect of active substances that drain water (diuretics such as furosemide and hydrochlorothiazide). The same applies to the effects of high blood pressure drugs from the group of ACE inhibitors (such as captopril and enalapril) or from the group of sartans (such as valsartan and candesartan).
Indomethacin can affect labor in the third trimester of pregnancy and have a harmful effect on the unborn child. Therefore, it should not be used throughout pregnancy.
The active ingredient passes into breast milk. If use during breastfeeding is absolutely necessary, breastfeeding should be discontinued beforehand.
There are insufficient data available for use in children and adolescents, which is why it should not be used here.
Elderly patients (65 years and over) should be carefully monitored during treatment because of the risk of increased side effects.
How to get medication with indomethacin
With the exception of the pain spray for use on the skin, all preparations containing indomethacin require a prescription.
How long has indomethacin been known?
Indomethacin was discovered in 1963 when a specific search for a decongestant was being sought. Until then, only glucocorticoids ("cortisone") were known to reduce swelling. Like other non-steroidal anti-inflammatory drugs (e.g. acetylsalicylic acid / ASA), indomethacin also has an analgesic effect. The active ingredient was first approved in the USA in 1965. There are now numerous generic drugs with the active ingredient indomethacin.
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