Indomethacin is a potent anti-inflammatory painkiller. It is used for arthritis, gout attacks, ankylosing spondylitis and other inflammatory joint conditions, and comes as 25 mg and 75 mg capsules and as a topical gel. It is one of the stronger NSAIDs, and correspondingly more likely to cause side effects.
What is Indomethacin?
Indomethacin — also spelled indometacin — is available in South Africa in several forms:
| Product | Contains | Schedule |
|---|---|---|
| Arthrexin, Amdocin, Mediflex, Gulf Indomethacin | Indomethacin 25 mg capsule | S3 |
| Sandoz Indomethacin | Indomethacin 75 mg capsule | S3 |
| Adco-Indomethacin | Indomethacin 10 mg/g gel | S1 |
Indomethacin is a non-steroidal anti-inflammatory drug (NSAID). It blocks cyclo-oxygenase (COX) enzymes, which the body uses to make prostaglandins — the messengers driving inflammation, swelling, pain signalling and fever.
What distinguishes indomethacin is potency. It is among the strongest of the traditional NSAIDs at suppressing inflammation, which makes it effective in conditions where milder options are not enough. That potency comes at a cost: it also has one of the higher rates of side effects in the class, particularly headache, dizziness and gastrointestinal problems.
That trade-off shapes how it is used. Indomethacin is not a general-purpose painkiller for everyday aches — ibuprofen or paracetamol are better suited to those. It is chosen when strong anti-inflammatory action is genuinely needed.
The gel is a different proposition. Applied over a painful joint or muscle, it delivers the medicine locally with far less absorbed into the body, so the stomach, kidney and heart risks are substantially lower — though not eliminated.
What is Indomethacin commonly used for?
- Acute gout attacks, where it is a well-established choice and works quickly.
- Rheumatoid arthritis, for pain, swelling and morning stiffness.
- Ankylosing spondylitis, where NSAIDs are a mainstay and indomethacin is often particularly effective.
- Osteoarthritis, especially during flares.
- Acute musculoskeletal pain, including bursitis and tendonitis.
- Low back pain, for short courses.
- Period pain, though gentler options are usually tried first.
- Localised joint and muscle pain, using the gel.
Use the lowest effective dose for the shortest time that works. With indomethacin this matters more than with most NSAIDs, because both effectiveness and side effects are pronounced.
It relieves symptoms. In arthritis it does not slow joint damage, and in gout it treats the attack rather than the underlying uric acid problem — that needs separate long-term treatment such as allopurinol.
How Indomethacin fits into this medicine category
| Group | Examples | What it does |
|---|---|---|
| Simple analgesics | Paracetamol | Pain and fever; minimal anti-inflammatory effect |
| Non-selective NSAIDs | Indomethacin, ibuprofen, diclofenac | Pain and inflammation; stomach and kidney cautions |
| COX-2 selective | Celecoxib, etoricoxib | Anti-inflammatory, gentler on the stomach |
| Topical NSAIDs | Indomethacin gel | Local relief, much less systemic exposure |
| Corticosteroids | Prednisone | Powerful anti-inflammatory, given as courses |
| Gout-specific | Colchicine, allopurinol | Attack treatment and long-term prevention |
Indomethacin sits at the more potent end of the non-selective NSAIDs. See the pain, inflammation and musculoskeletal medicines hub.
What to check before using Indomethacin
Do not take it with another anti-inflammatory. Ibuprofen, diclofenac, naproxen, mefenamic acid and aspirin are all NSAIDs. Combining them multiplies stomach bleeding risk without improving relief, and these hide in combination cold, flu and period-pain products.
Take it with food or immediately after a meal, and do not lie down straight afterwards.
Speak to a pharmacist or doctor first if you:
- Have had a stomach ulcer, gastritis or bleeding in the gut. Indomethacin is among the more irritating NSAIDs, and a stomach-protecting medicine is often prescribed alongside it.
- Have heart disease, heart failure, high blood pressure, or a history of heart attack or stroke.
- Have kidney disease, or are dehydrated.
- Have liver disease.
- Have asthma. A minority of people with asthma wheeze significantly on NSAIDs.
- Have epilepsy or Parkinson’s disease, which indomethacin can aggravate.
- Have depression or psychiatric illness, given its central nervous system effects.
- Are over 65, where stomach and kidney risks rise.
- Are pregnant. NSAIDs are generally avoided, particularly from around 20 weeks and definitely in the third trimester.
- Are breastfeeding.
- Take warfarin or another blood thinner.
- Take an ACE inhibitor or ARB with a diuretic — that trio plus an NSAID is a recognised cause of acute kidney injury.
- Take lithium, methotrexate, low-dose aspirin for your heart, or an SSRI antidepressant.
Do not drive until you know how it affects you — dizziness and drowsiness are common with this particular NSAID.
For the gel: apply only to intact skin, avoid eyes and mucous membranes, wash your hands afterwards, and do not use it under a tight dressing.
Possible cautions and when to ask a pharmacist or doctor
Headache is the most characteristic effect of indomethacin — often frontal, sometimes persistent, and more common than with other NSAIDs. Dizziness, light-headedness and a feeling of mental dullness are also frequent. These are among the main reasons people stop taking it, and they are worth reporting rather than pushing through, since alternatives exist.
Other common effects are indigestion, nausea, abdominal discomfort and diarrhoea.
Stop and seek medical attention urgently if you notice:
- Vomiting blood, or vomit resembling coffee grounds.
- Black, tarry stools.
- Severe stomach pain.
- Chest pain, breathlessness, or sudden one-sided weakness or slurred speech — seek emergency care.
- Swelling of the face, lips or tongue, or difficulty breathing.
- Sudden wheezing, particularly with asthma.
- A spreading rash, blistering or peeling skin.
- Yellowing of the eyes or skin.
- Much less urine than usual, or swollen ankles.
- Confusion, marked drowsiness, or a seizure.
- Blurred vision or a change in vision — report this, as eye effects are recognised with long-term use.
Serious stomach bleeding can develop without warning pain, so the bleeding signs matter even when you otherwise feel well.
See a doctor if pain persists beyond the intended course, if it worsens, or if you find yourself needing an anti-inflammatory continuously. Long-term use should be monitored.
Related medicine guides
- Browse Pain, Inflammation & Musculoskeletal Medicines guides
- Read: Prednisone used for
- Read: Donapan used for
Frequently asked questions
What are indomethacin tablets used for? Inflammatory joint conditions — rheumatoid arthritis, ankylosing spondylitis, osteoarthritis flares — acute gout attacks, and acute musculoskeletal pain.
Is indomethacin strong? It is among the more potent traditional anti-inflammatories, which is why it is used for genuinely inflammatory conditions. It also has a higher rate of side effects.
Why does it give me a headache? Headache is the characteristic effect of indomethacin, more common than with other NSAIDs, along with dizziness. Report it — alternatives exist.
Is it the same as ibuprofen? Both are NSAIDs and work the same way, but indomethacin is more potent and more likely to cause side effects. They are not interchangeable.
Can I take it with paracetamol? They are different medicines and are sometimes used together on advice. Do not combine it with another anti-inflammatory.
Can I use the gel and take the capsules together? Not without advice. Both deliver the same medicine and combining them increases total exposure.
Can I take it for gout? It is an established choice for an acute attack. Long-term uric acid control needs different treatment.
Is it safe in pregnancy? Generally avoided, particularly from around 20 weeks. Paracetamol is usually preferred — confirm with your doctor.