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Indomethacin is a highly potent inhibitor of prostaglandin synthesis and suppresses neutrophil motility.

The common side effects reported with Indocin are nausea, dyspepsia, diarrhea, abdominal distress, constipation, anorexia, bloating, flatulence, peptic ulcer, gastroenteritis, head ache, dizziness, vertigo, somnolence, depression, fatigue, anxiety, muscle weakness, insomnia, mental confusion, drowsiness, tinnitus, hypertension, hypotension, tachycardia, chest pain, edema, weight gain, fluid retention, leukopenia, anemia, acute anaphylaxis and gynecomastia. Indomethacin can cause skin side effects like exfoliative dermatitis, which can be fatal.

Indomethacin decreases antihypertensive effect of Angiotensin Converting Enzyme (ACE) inhibitors, beta blockers and angiotensin II receptor antagonists. This medicine should be used with caution in patients taking cyclosporine due to decreased synthesis of renal prostacyclin and renal function should be carefully monitored. The concomitant administration of Indocin and diflunisal can cause fatal gastrointestinal hemorrhage. There should be continous monitoring of digoxin levels when digoxin is given along with this medicine. Indocin can reduce the diuretic and antihypertensive effects of loop, potassium-sparing, and thiazide diuretics. The use of Indocin with other NSAIDs can cause increased gastrointestinal toxicity. The use of Indomethacin causes an increased risk of cardiovascular thrombotic events, myocardial infarction, and stroke. This medicine can cause serious gastrointestinal events including bleeding, ulceration, and perforation of the stomach, small intestine or large intestine. Patients should be informed of incidence of hepatotoxicity, which can occur during Indocin treatment. Indocin is not recommended for pediatric patients under the age of 14. Indocin is not used as an alternative to corticosteroids or to treat corticosteroid insufficiency. It can cause anemia due to fluid retention and GI blood loss.

The recommended dosage of Indocin in rheumatoid arthritis and ankylosing spondylitis is 25-50mg bid or tid. The goal of the treatment should be the lowest effective dose for the shortest duration. The patients who are not tolerating the oral administration of Indocin may be given a nightly suppository. In acute painful shoulder the dose of Indocin is 75-150 mg daily in 3 or 4 divided doses for 7-14 days. In acute gouty arthritis the dose of Indomethacin is 50 mg t.i.d. until pain is tolerable.