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Tivorbex, Indocin

Indomethacin, Indomethacin SR, Indomethacin ER

Indomethacin (in doe METH a sin) is prescribed to relieve pain and inflammation (swelling and damage) from certain conditions. It’s also prescribed to treat a heart problem in certain babies. Indomethacin belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs).

Medically reviewed by Alex Brewer, PharmD, MBA on May 8, 2023
Written by Helen Marshall, BPharm, MRPharmS

Specifically, the Food and Drug Administration (FDA) has approved indomethacin for:

These approved uses differ based on the form of indomethacin your doctor prescribes.

This article describes indomethacin’s uses, side effects, and more. Below you’ll also find some coupon options to help save on the cost of indomethacin.

This article doesn’t provide coupons for all forms of indomethacin. To find out more about the other forms of indomethacin, see the following articles:

Boxed warnings

Indomethacin oral capsule, extended-release (ER)* oral capsule, and suppository have boxed warnings about the risks of serious heart and blood vessel problems and serious digestive problems. Boxed warnings are serious warnings from the FDA.

For details, see the “Interactions and warnings for indomethacin” section below.

* ER means the drug is slowly released into your body over a long period of time.

Uses of indomethacin

The Food and Drug Administration (FDA) approves prescription drugs such as indomethacin for certain conditions. Approved uses for indomethacin are described below. These uses differ based on the form of indomethacin prescribed.

Use for certain kinds of inflammation, including gout

Doctors may prescribe indomethacin oral capsule, extended-release (ER)* oral capsule, and suppository for reducing pain and inflammation (swelling and damage) from certain conditions. It’s used for this purpose in adults and children over 14 years old. It may be prescribed as a long-term or short-term treatment.

Specifically, indomethacin oral capsule, ER oral capsule, and suppository may be prescribed for:

Indomethacin oral capsule and suppository may also be prescribed for acute attacks of gout (a form of arthritis that mainly affects the big toe).

With all these conditions, you have inflammation in or around certain joints in your body. This makes the joints stiff and painful to move. Indomethacin helps reduce the inflammation and pain, which makes the joints easier to use.

* ER means the drug is slowly released into your body over a long period of time.

Use for patent ductus arteriosus (PDA)

Doctors may prescribe indomethacin intravenous (IV) infusion* to treat PDA. PDA is a kind of heart problem that can occur in babies born prematurely (early, before 37 weeks of pregnancy).

It’s used for this purpose in premature babies weighing 500 grams (g) to 1,750 g. It’s usually prescribed as a short-term treatment.

With PDA, a blood vessel in the baby’s heart, called the ductus arteriosus, stays open instead of closing soon after the baby is born. This causes extra blood to be pumped through the baby’s lungs. As a result, the baby may have breathing problems and fluid buildup in their lungs. If not treated, the condition can lead to heart failure.

Indomethacin helps to close the ductus arteriosus. It may be prescribed for PDA that hasn’t got better after 48 hours of other treatment.

* An IV infusion is an injection given into a vein over time.

Side effects of indomethacin

Indomethacin may cause mild or serious side effects. More common mild side effects of indomethacin and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about indomethacin’s side effects, ask your doctor or pharmacist. You can also read the prescribing information* for indomethacin.

* To view indomethacin’s prescribing information, see the “Article resources” section below.

Mild side effects

More common mild side effects reported with some forms of indomethacin are listed below. These side effects may differ based on the form of indomethacin you take.

This article doesn’t include all possible mild side effects of the drug. To learn more about indomethacin’s side effects based on the form, see the prescribing information* for indomethacin.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of indomethacin oral capsule, extended-release (ER)† oral capsule, and suppository include:

* To view indomethacin’s prescribing information, see the “Article resources” section below.
† ER means the drug is slowly released into your body over a long period of time.
‡ For details about this side effect, see the “Interactions and warnings for indomethacin” section below.

Serious side effects

Serious side effects of indomethacin are listed below. These side effects may differ based on the form of indomethacin you take.

This article doesn’t include all possible serious side effects of the drug. To learn more about indomethacin’s side effects based on the form, see the prescribing information* for indomethacin.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, indomethacin’s serious side effects include:

* To view indomethacin’s prescribing information, see the “Article resources” section below.
† For details about this side effect, see the “Interactions and warnings for indomethacin” section below.

Common questions about indomethacin

Below you’ll find answers to a few commonly asked questions about indomethacin.

How does indomethacin compare with other similar drugs, such as ibuprofen, naproxen, or colchicine?

Indomethacin is a kind of pain reliever called a nonsteroidal anti-inflammatory drug (NSAID). Other NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and diclofenac (Cataflam, Voltaren gel).

NSAIDs help relieve pain and inflammation (swelling and damage) related to many different causes. Colchicine (Colcrys) is a different kind of pain reliever that’s only used for gout attacks.

Indomethacin is stronger than most other NSAIDs, especially ibuprofen. But it also has a higher risk of side effects than other NSAIDs. It’s only available with a prescription. However, ibuprofen and some forms of naproxen and diclofenac can be bought over the counter.

To learn more about how indomethacin compares with other similar drugs, talk with your doctor. They can recommend the drug that’s best for you.

Can indomethacin be used for preterm labor?

Yes, doctors sometimes give indomethacin for preterm labor (early labor, when contractions start before 37 weeks of pregnancy). The drug helps to stop labor contractions.

This is an off-label use for indomethacin. With off-label use, a drug is prescribed for a use that’s not been approved by the Food and Drug Administration (FDA).

To learn more about this use for indomethacin, talk with your doctor.

Is it safe to take indomethacin for a long time?

It might not be. Taking indomethacin for a long time can raise your risk of certain side effects. These include kidney problems and serious digestive problems,* such as stomach ulcers (small sores).

Depending on the condition you’re taking it for, your doctor may prescribe indomethacin for long-term or short-term treatment. Your doctor will prescribe indomethacin for the shortest possible time needed to relieve your symptoms. However, with long-term conditions, such as rheumatoid arthritis, the benefits of taking indomethacin long term may outweigh the risk of its side effects.

If you’re concerned about the safety of taking indomethacin for a long time, talk with your doctor. They can advise on how to lower your risk of side effects. For example, they may prescribe medication to help prevent digestive side effects while you’re taking indomethacin.

* Indomethacin has a boxed warning for this side effect. Boxed warnings are serious warnings from the FDA. For details, see the “Interactions and warnings for indomethacin” section below.

Would it be safe to take indomethacin and Tylenol together?

Yes, it’s usually safe to take indomethacin and acetaminophen (Tylenol) together. Tylenol is a pain reliever that works in a different way than indomethacin. It’s commonly taken with indomethacin.

It’s important to note that indomethacin belongs to a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). It’s not safe to take indomethacin with other NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn, others). Taking indomethacin with other NSAIDs can raise your risk of serious side effects.

If you’re unsure whether you can take indomethacin with another medication, ask your doctor or pharmacist.

How does indomethacin work? And how long does it take to start working?

Indomethacin works by stopping your body from making substances called prostaglandins.

Some prostaglandins cause inflammation (swelling and damage). Indomethacin is prescribed to help relieve inflammation and pain from various forms of arthritis and other inflammatory conditions. With conditions such as arthritis, reducing prostaglandins can help reduce inflammation and pain.

Indomethacin also treats patent ductus arteriosus (PDA), which is a heart problem that can occur in babies born prematurely (early). Babies with PDA have a ductus arteriosus (a blood vessel in the heart) that stays open after birth, instead of closing as it should. Some prostaglandins function to keep the ductus arteriosus open. Reducing prostaglandins can allow the ductus arteriosus to close.

Indomethacin starts working to relieve pain about 1 to 2 hours after taking a dose. But it can take up to 3 weeks to significantly reduce inflammation. It usually takes a few days for indomethacin to work for PDA.

Your doctor can provide more information about what to expect with indomethacin treatment.

Dosage of indomethacin

The dosage of indomethacin your doctor prescribes may vary based on your condition and certain other factors. Talk with your doctor about the dose you should take.

Taking, inserting, and receiving indomethacin

Indomethacin oral capsule and extended-release (ER)* oral capsule are swallowed with or without food.

Indomethacin suppository is inserted into the rectum.

Your doctor will talk with you about how to take indomethacin. They’ll explain how much to take and how often. Always follow your doctor’s recommendation.

Indomethacin liquid solution is given by a healthcare professional as an intravenous (IV) infusion. This is an injection into a vein given over time. Your child’s doctor will explain how an indomethacin infusion will be given and where it’ll be injected. They’ll also tell you how much your child will receive and how often.

* ER means the drug is slowly released into your body over a long period of time.

Overdose of indomethacin

You should not take more indomethacin than your doctor prescribes. For some drugs, doing so may lead to serious side effects or overdose.

If you think you’ve taken too much indomethacin, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Interactions and warnings for indomethacin

Below, you’ll find information about indomethacin’s possible interactions and warnings.

Interactions of indomethacin

For some medications, certain things may affect how the drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take indomethacin, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

  • prescription drugs
  • over-the-counter medications
  • vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for indomethacin” section just below.

Warnings for indomethacin

Indomethacin should not be taken by certain people and should be taken cautiously by certain other people.

Boxed warnings

Indomethacin oral capsule, extended-release (ER)* oral capsule, and suppository have boxed warnings about the risks of serious heart and blood vessel problems and serious digestive problems. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

To learn more about these warnings, read below. You can also talk with your doctor or pharmacist.

Note: The intravenous (IV) infusion form of indomethacin used to treat the heart condition patent ductus arteriosus (PDA) does not have these boxed warnings. (An IV infusion is an injection into a vein given over time.)

* ER means the drug is slowly released into your body over a long period of time.

Risk of serious digestive problems. Indomethacin capsules and suppository can cause serious digestive problems that may rarely lead to death. These problems include bleeding, ulcers (small sores), and tears in your stomach or intestines. These side effects were rare in studies* of indomethacin.

Symptoms may include abdominal pain, black or tar-like stools, and vomiting blood or a substance that looks like coffee grounds.

If you have symptoms of serious digestive problems, tell your doctor right away. They’ll likely recommend stopping indomethacin and switching to a different treatment for your condition.

* To view indomethacin’s prescribing information, see the “Article resources” section below.

Risk of serious heart and blood vessel problems. Indomethacin capsules and suppository can cause serious heart and blood vessel problems that can be fatal. These problems include heart attack and stroke. These side effects were rare in studies* of indomethacin.

Symptoms may include chest pain, dizziness, shortness of breath, weakness on one side of your body, and slurred speech.

If you have symptoms of serious heart and blood vessel problems, call 911 or a local emergency number right away. Your doctor will likely recommend stopping indomethacin and switching to a different treatment for your condition.

* To view indomethacin’s prescribing information, see the “Article resources” section below.

What to do if you think you’re having a heart attack or stroke

If you think you’re having a heart attack or stroke:

  • Call 911 or your local emergency number
  • Do not drive yourself to the hospital. You may lose consciousness (pass out).
  • Wait for the paramedics to arrive. They can begin lifesaving treatment.

If you think you’re having a heart attack, ask the emergency dispatcher if you should chew an aspirin. This may help break up a blood clot blocking blood flow to the heart muscle. If your doctor has prescribed nitroglycerin for heart-related chest pain, then take a nitroglycerin tablet.

If you think you’re having a stroke, try to remember the time that symptoms began. Tell the emergency dispatcher or paramedics. A clot-busting drug can be given within the first few hours. Try to stay calm and rest until help arrives.

For either a heart attack or stroke, ask that someone stay nearby while you wait for the paramedics. If you lose consciousness (pass out), CPR may be necessary.

Other warnings

Indomethacin could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether indomethacin is a safe option for you. These warnings may differ based on the form of indomethacin you take.

Ask your doctor about specific warnings for indomethacin, and be sure to tell your doctor about your:

  • current health, including any allergies to medications
  • past health conditions or surgeries

Allergic reaction

Indomethacin can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to indomethacin, any of its ingredients, or other nonsteroidal anti-inflammatory drugs, your doctor will likely not prescribe indomethacin. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

A severe allergic reaction may cause the following symptoms:

  • swelling under your skin, usually in your hands, feet, eyelids, or lips
  • swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to indomethacin, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Pregnancy or breastfeeding and indomethacin

Information about indomethacin and pregnancy and breastfeeding is described below.

Indomethacin and pregnancy

Indomethacin should not be taken during the last trimester of pregnancy (from week 30 of pregnancy onward). It’s not known whether indomethacin can be taken earlier during pregnancy.

If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication. Your doctor may suggest birth control options to use during treatment with indomethacin.

Indomethacin and breastfeeding

It’s not known whether indomethacin should be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication.

Indomethacin coupon

You may be able to save money on your prescription for indomethacin by using our Perks discount coupons. They can be found at the end of this article.

If you have questions about how to pay for indomethacin, talk with your doctor or pharmacist.

Note: Optum Perks coupons cannot be used with insurance copays or benefits.

What to ask your doctor

This article describes indomethacin’s uses and dosage, ways to save on cost, and more. Let your doctor know if you have questions about indomethacin or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

  • Does indomethacin make you feel sleepy?
  • How long will I need to take indomethacin?
  • Is indomethacin addictive?
  • Can indomethacin help prevent gout attacks?

Article resources

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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Name

Indomethacin Capsules

Pronunciation

(in doe METH a sin)

Brand Names: US

Tivorbex

Warning

This drug may raise the risk of heart and blood vessel problems like heart attack and stroke. These effects can be deadly. The risk may be greater if you have heart disease or risks for heart disease. However, it can also be raised even if you do not have heart disease or risks for heart disease. The risk can happen within the first weeks of using this drug and may be greater with higher doses or long-term use. Do not use this drug right before or after bypass heart surgery. This drug may raise the chance of severe and sometimes deadly stomach or bowel problems like ulcers or bleeding. The risk is greater in older people, and in people who have had stomach or bowel ulcers or bleeding before. These problems may occur without warning signs.

What is this drug used for?

It is used to treat some types of arthritis. It is used to treat ankylosing spondylitis. It is used to ease pain. It may be given to you for other reasons. Talk with the doctor.

What do I need to tell my doctor BEFORE I take this drug?

If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had. If you have an allergy to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If you have ever had asthma caused by a salicylate drug like aspirin or a drug like this one like NSAIDs. If you have any of these health problems: Dehydration, GI (gastrointestinal) bleeding, heart failure (weak heart), kidney disease, or liver disease. If you have had a recent heart attack. If you are having trouble getting pregnant or you are having your fertility checked. If you are pregnant or may be pregnant. Do not take this drug if you are in the third trimester of pregnancy. You may also need to avoid this drug at other times during pregnancy. Talk with your doctor to see when you need to avoid taking this drug during pregnancy. If you are taking any other NSAID, a salicylate drug like aspirin or diflunisal, triamterene, or pemetrexed. This is not a list of all drugs or health problems that interact with this drug. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take this drug?

Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists. Avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you. You may bleed more easily. Be careful and avoid injury. Use a soft toothbrush and an electric razor. This drug may affect certain lab tests. Tell all of your health care providers and lab workers that you take this drug. Talk with your doctor before you drink alcohol. If you smoke, talk with your doctor. Have your blood work checked if you are on this drug for a long time. Talk with your doctor. High blood pressure has happened with drugs like this one. Have your blood pressure checked as you have been told by your doctor. Do not take more than what your doctor told you to take. Taking more than you are told may raise your chance of very bad side effects. Do not take this drug for longer than you were told by your doctor. If you have asthma, talk with your doctor. You may be more sensitive to this drug. The chance of heart failure is raised with the use of drugs like this one. In people who already have heart failure, the chance of heart attack, having to go to the hospital for heart failure, and death is raised. Talk with the doctor. The chance of heart attack and heart-related death is raised in people taking drugs like this one after a recent heart attack. People taking drugs like this one after a first heart attack were also more likely to die in the year after the heart attack compared with people not taking drugs like this one. Talk with the doctor. If you are taking aspirin to help prevent a heart attack, talk with your doctor. Liver problems have happened with drugs like this one. Sometimes, this has been deadly. Call your doctor right away if you have signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes. Depression or other mood problems, seizures, and health problems like Parkinson's disease have gotten worse with this drug. Tell your doctor if you have any of these health problems and your signs get worse. If you are 65 or older, use this drug with care. You could have more side effects. NSAIDs like this drug may affect egg release (ovulation) in women. This may cause you to not be able to get pregnant. This goes back to normal when this drug is stopped. Talk with your doctor. This drug may cause harm to the unborn baby if you take it while you are pregnant. If you are pregnant or you get pregnant while taking this drug, call your doctor right away. Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. Signs of bleeding like throwing up or coughing up blood; vomit that looks like coffee grounds; blood in the urine; black, red, or tarry stools; bleeding from the gums; abnormal vaginal bleeding; bruises without a cause or that get bigger; or bleeding you cannot stop. Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain. Signs of high potassium levels like a heartbeat that does not feel normal; feeling confused; feeling weak, lightheaded, or dizzy; feeling like passing out; numbness or tingling; or shortness of breath. Signs of high blood pressure like very bad headache or dizziness, passing out, or change in eyesight. Shortness of breath, a big weight gain, or swelling in the arms or legs. Chest pain or pressure. Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight. Change in eyesight. Ringing in ears. Low mood (depression). Flu-like signs. A very bad skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis) may happen. It can cause very bad health problems that may not go away, and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: Headache. Constipation, diarrhea, stomach pain, upset stomach, or throwing up. Heartburn. Gas. Feeling dizzy, sleepy, tired, or weak. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch.

How is this drug best taken?

Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely. Take with food to prevent an upset stomach. Take with a full glass of water.

What do I do if I miss a dose?

Take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time. Do not take 2 doses at the same time or extra doses.

How do I store and/or throw out this drug?

Store at room temperature. Do not refrigerate or freeze. Protect from light. Store in a dry place. Do not store in a bathroom. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

If your symptoms or health problems do not get better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else's drugs. This drug comes with an extra patient fact sheet called a Medication Guide. Read it with care. Read it again each time this drug is refilled. If you have any questions about this drug, please talk with the doctor, pharmacist, or other health care provider. If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

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