What is it used for?

• Rheumatoid arthritis.
• Osteoarthritis.
• A form of arthritis affecting the joints of the spine (ankylosing spondylitis).
• Acute gout.
• Acute inflammatory disorders of the joints, such as tendon inflammation (tendinitis), bursitis, tenosynovitis, capsulitis.
• Painful disorders of the muscles and skeleton, such as sprains, strains, dislocations, fractures.
• Lower back pain.
• Pain and inflammation following orthopaedic (bone) surgery or other orthopaedic procedures.
• Painful periods (dysmenorrhea).

How does it work?

• Indometacin Capsules contain the active ingredient indometacin, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID).
• Indometacin works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Indometacin blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
• Indometacin is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, muscle sprains and strains, back pain, tendinitis and pain following orthopaedic procedures. It can also be used to relieve period pain.
• The capsules should preferably be taken with food to help avoid irritating the stomach.

Important information:

• This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
• NSAIDs can occasionally cause serious side effects on the gut, such as ulceration, bleeding or perforation of the stomach or intestinal lining. This type of side effect is more likely to occur in elderly people and in people taking high doses of the medicine.
• Non-steroidal anti-inflammatory drugs such as this one may be associated with a small increase in the risk of experiencing a heart attack or stroke. 
• Very rarely, NSAIDS may cause serious blistering or peeling skin reactions.
• During long-term treatment with this medicine you should have regular check-ups with your doctor so that you can be monitored for possible side effects of the medicine. 
• During long-term treatment with this medicine it is also recommended that you have regular eye examinations, as it can sometimes cause eye problems. Consult your doctor if you experience any disturbances in your vision while taking this medicine.

Use with caution in

• Elderly people.
• History of disorders affecting the stomach or intestines.
• Inflammatory bowel disease such as Crohn's disease or ulcerative colitis.
• Decreased kidney function.
• Decreased liver function.
• Heart failure.
• High blood pressure (hypertension).
• Heart disease caused by poor blood flow to the heart (ischaemic heart disease, eg angina).
• History of stroke or mini-stroke (cerebrovascular disease).
• Poor blood circulation in the arteries of the legs (peripheral arterial disease).
• High cholesterol levels.
• Diabetes.
• Smokers.
• People with blood clotting disorders or taking anticoagulant medicines.
• History of asthma.
• History of allergies.
• Epilepsy.
• Parkinson's disease.
• Psychiatric disorders.
• Diseases affecting connective tissue, eg systemic lupus erythematosus.

Not to be used in

• Children.
• People in whom aspirin or other NSAIDs, eg ibuprofen, cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal inflammation (rhinitis) or swelling of the lips, tongue and throat (angioedema).
• Nasal polyps.
• Active peptic ulcer or bleeding in the gut, or a history of this.
• Severe liver failure.
• Severe kidney failure.
• Severe heart failure.
• Third trimester of pregnancy.
• Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

Pregnancy and breastfeeding

• This medicine should not be used during the third trimester of pregnancy. If taken in the third trimester it may delay labour, increase the length of labour and cause complications in the newborn baby, as well as increasing the risk of bleeding in the mother and baby. It should not be used in the first or second trimesters of pregnancy unless considered essential by your doctor. Some evidence suggests that NSAIDs should also be avoided by women attempting to conceive, as they may temporarily reduce female fertility during treatment and may also increase the risk of miscarriage or malformations. Seek medical advice from your doctor.
• This medicine passes into breast milk. Women who are breastfeeding should not use this medicine. Seek medical advice from your doctor.

Side effects

• Headache.
• Dizziness.
• Disturbances of the gut such as indigestion, nausea, vomiting, diarrhoea or abdominal pain.
• Ulceration or bleeding in the stomach or intestines.
• Retention of water in the body tissues (fluid retention), resulting in swelling (oedema).
• Rise in blood pressure.
• Change in heart rate or rhythm.
• Hair loss.
• Balance disorders involving the inner ear (vertigo).
• Sensation of ringing, or other noise in the ears (tinnitus).
• Confusion.
• Depression.
• Anxiety.
• Fatigue.
• Difficulty sleeping (insomnia).
• Pins and needles sensations.
• Eye pain.
• Blurred vision.
• Allergy to active ingredients (hypersensitivity) such as facial flushing, skin rash, itch, narrowing of airways (bronchospasm) or swelling of lips, tongue or throat (angioedema).
• Kidney, liver or blood disorders.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

Indometacin should not be taken in combination with painkilling doses of aspirin or any other oral NSAID, eg ibuprofen, as this increases the risk of side effects on the stomach and intestines. Selective inhibitors of COX-2 such as celecoxib or etoricoxib should also be avoided for the same reason.

There may be an increased risk of ulceration or bleeding in the gut if indometacin is taken with corticosteroids such as prednisolone.

There may also be an increased risk of bleeding in the gut if indometacin is taken with the following medicines:

• anti-blood-clotting (anticoagulant) medicines such as warfarin
• anti-platelet medicines to reduce the risk of blood clots or 'thin the blood', eg low-dose aspirin, clopidogrel, dipyridamole
• SSRI antidepressants, eg fluoxetine, paroxetine, citalopram
• venlafaxine.

Indometacin may enhance the effect of blood-thinning or anti-clotting medicines (anticoagulants) such as warfarin. As this may increase the risk of bleeding, people taking indometacin with an anticoagulant should be closely monitored by their doctor.

Indometacin may reduce the removal of the following medicines from the body and so may increase the blood levels and risk of side effects of these medicines. People taking indometacin with any of these should be closely monitored by their doctor:

• digoxin
• lithium
• methotrexate.

There may be an increased risk of side effects on the kidneys if indometacin is taken with any of the following medicines:

• ACE inhibitors, eg enalapril
• ciclosporin
• diuretics, eg furosemide (the diuretic triamterene should not be taken with indometacin)
• tacrolimus.

Indometacin may oppose the blood pressure lowering effects of certain medicines to treat high blood pressure, such as the following:

• ACE inhibitors such as captopril
• beta-blockers such as propranolol
• diuretics such as furosemide.

The following medicines may increase the blood level of indometacin, which may increase the risk of side effects:

• diflunisal (should not be taken with indometacin)
• probenecid
• ritonavir.

If indometacin is taken with the antipsychotic medicine haloperidol there may be a risk of profound drowsiness and confusion. This combination should be avoided.

Indometacin may enhance the absorption of tiludronic acid (used for Paget's disease) from the gut. If you are taking both these medicines it is recommended the doses are separated by two hours to avoid this.

References:

https://www.drugbank.ca/drugs/DB00328

https://www.netdoctor.co.uk/medicines/aches-pains/a6906/indolar-sr-indometacin/

https://www.medicines.org.uk/emc/product/4552

https://patient.info/medicine/indometacin-for-pain-and-inflammation

https://en.wikipedia.org/wiki/Indometacin

https://www.nice.org.uk/bnf-uk-only