Indomethacin
In brief
- In our pharmacy, you can buy indomethacin without a prescription, with delivery in 9–21 days throughout the United Kingdom. Discreet and anonymous packaging.
- Indomethacin is used to treat pain and inflammation in conditions such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gout and some headache disorders; it is a non‑steroidal anti‑inflammatory drug (an indoleacetic acid derivative) that non‑selectively inhibits cyclooxygenase (COX‑1 and COX‑2) to reduce prostaglandin synthesis.
- The usual dose is 25 mg two to three times daily for arthritis (up to a typical maximum of 200 mg/day for immediate‑release formulations); for acute gout an initial 50 mg three times daily is commonly used then reduced as symptoms improve; sustained‑release 75 mg once daily is available and suppositories are often 100 mg; neonatal IV dosing for patent ductus arteriosus is given as 0.2 mg/kg per protocol.
- Forms of administration include oral tablets/capsules (25 mg, 50 mg, sustained‑release), rectal suppositories (100 mg) and intravenous indomethacin sodium (used mainly for PDA in neonates).
- Onset time: oral analgesic effect typically begins within 30–60 minutes (peak 1–2 hours); topical effects may begin within about 30 minutes; IV effects occur within minutes.
- Duration of action: immediate‑release preparations typically last about 4–6 hours; sustained‑release formulations can provide effect for up to 12–24 hours; anti‑inflammatory benefits may require regular dosing and review.
- Alcohol warning: avoid alcohol while taking indomethacin as it increases the risk of gastrointestinal bleeding and may worsen side effects such as dizziness or liver-related issues.
- The most common side effect is dyspepsia (indigestion); other frequent adverse effects include nausea, headache, dizziness, gastrointestinal ulceration or bleeding, oedema and raised blood pressure.
- Would you like to try indomethacin without a prescription?
Basic indomethacin information
- INN (international nonproprietary name): Indometacin (indomethacin)
- Brand names available in the United Kingdom: Indocid; generic indometacin
- ATC code: M01AB01
- Forms and dosages: Capsules 25 mg and 50 mg; modified-release capsules 75 mg; suppositories 100 mg; solution for injection (hospital use, neonatal patent ductus arteriosus)
- Manufacturers in the United Kingdom: Generic manufacturers such as Mylan
- Registration status in the United Kingdom: Licensed by the MHRA
- OTC / Rx classification: Prescription-only medicine (POM)
What indomethacin is — INN, class and ATC codes
INN and naming variants
Indometacin is the International Nonproprietary Name (INN); the US spelling is indomethacin.
Pharmacological class and ATC
Indometacin belongs to the NSAID family, specifically the indoleacetic acid subclass.
Its ATC code for systemic use is M01AB01; C01EB03 is used for ductus arteriosus closure in neonates.
- INN
- International nonproprietary name of the active substance; here: Indometacin.
- NSAID
- Non‑steroidal anti‑inflammatory drug that reduces inflammation and pain by inhibiting prostaglandin synthesis.
- COX inhibition
- Mechanism whereby NSAIDs reduce prostaglandin formation by blocking cyclo‑oxygenase enzymes.
| Route | ATC code | Typical use |
|---|---|---|
| Systemic (oral/IV) | M01AB01 | Anti‑inflammatory and analgesic; systemic therapy |
| Cardiac (neonatal) | C01EB03 | Ductus arteriosus closure in neonates |
Licensed indications and typical dosing
Common adult indications and usual regimens
Osteoarthritis and rheumatoid arthritis are common long‑term indications where the usual adult dose is 25mg two to three times daily by mouth, with a reported maximum around 200mg per day.
For acute gout attacks an initial regime commonly used is 50mg three times daily by mouth, then reducing the dose as symptoms improve over several days.
Ankylosing spondylitis often uses 25–50mg two to three times daily depending on response and tolerability.
Some headache syndromes are treated off‑label with single doses of 25–50mg at onset.
Special indications (neonatal PDA)
Patent ductus arteriosus closure in neonates is an intravenous, specialist procedure using indomethacin sodium at typical concentrations of 0.2mg/mL with weight‑based dosing (about 0.2mg/kg), given under neonatal protocol.
| Indication | Typical dose | Typical duration |
|---|---|---|
| Osteoarthritis / rheumatoid arthritis | 25mg two–three times daily PO (max ~200mg/day) | Lowest effective dose, reviewed frequently |
| Gout (acute) | 50mg PO three times daily initial, then taper | Short course, typically 3–7 days |
| Ankylosing spondylitis | 25–50mg two–three times daily PO | As required or continuous with review |
| Neonatal PDA (hospital use) | 0.2mg/kg IV per neonatal protocol | Specialist setting |
| Suppository use | 100mg rectal suppository | Short courses or when oral route unsuitable |
Formulations, pack sizes and brands
Oral, rectal and IV forms
Oral capsules (and tablets) are the usual formats in 25mg and 50mg strengths, commonly in blisters of 10–30 units.
Rectal suppositories of 100mg are supplied in strips of 5–10 units.
Intravenous indomethacin sodium for neonatal PDA is supplied to hospitals in specific concentrations and packaging rather than community supply.
Key brands and manufacturers
Brands and generics include Indocid and indometacin generics from several manufacturers.
Pack sizes vary: standard blister packs for capsules and strips for suppositories.
| Formulation | Strength | Common pack sizes | Brand / supplier |
|---|---|---|---|
| Oral tablet / capsule | 25mg, 50mg | Blisters of 10–30 | Indocid; generics |
| Rectal Suppository | 100mg | Strips of 5–10 | Indometacin suppositories |
| IV Injection | Indomethacin sodium (0.2mg/mL) | Hospital vials | Hospital supply manufacturers |
| Modified-release capsule | 75mg | Blister packs | Brand or generic |
How indomethacin is prescribed and dispensed in the UK
NHS and private prescriptions
Indometacin is a Prescription Only Medicine (POM) under MHRA rules and is prescribed on NHS FP10 forms or as electronic prescriptions in primary care.
Private prescriptions are accepted by pharmacies once a valid private prescription is presented.
Indometacin is a prescription-only medicine (POM) in the UK.
In our online pharmacy, indomethacin is available without a prescription, with discreet delivery to the United Kingdom in 9–21 days.
Counselling and practical advice for patients
Key counselling points
Emphasise that indometacin is a prescription medicine and explain the reason for pharmacist checks: safety with stomach, heart and kidneys.
Advise taking doses with food to reduce dyspepsia and warn about possible dizziness; recommend avoiding driving until the effect is known.
Ask specifically about a history of peptic ulcer, heart failure, high blood pressure, reduced kidney function and concurrent anticoagulant or diuretic therapy.
For elderly patients recommend starting at a lower dose, such as 25mg twice daily, and arranging monitoring of renal function if used long term.
Missed dose guidance: take as soon as remembered, but skip if the next dose is near; do not double up.
Overdose actions: urgent hospital assessment for severe gastrointestinal, central nervous system or metabolic symptoms.
Contraindications and precautions
Absolute contraindications
- Hypersensitivity to indometacin or other NSAIDs, including previous anaphylaxis.
- Active gastrointestinal bleeding or ulceration and inflammatory bowel disease.
- Severe hepatic, renal or cardiac failure.
- Third trimester of pregnancy.
- History of NSAID‑induced asthma, urticaria or severe skin reactions.
Relative risks needing GP review
Use caution and liaise with the prescriber for patients with controlled hypertension, heart failure, anticoagulant therapy, mild to moderate renal or hepatic impairment, prior peptic ulcer disease and elderly patients.
Points to check:
- Current blood pressure and antihypertensive therapy.
- Anticoagulant or antiplatelet medication records.
- History of stomach ulcers or gastrointestinal bleeding.
- Renal or liver impairment and recent blood test results.
- Severe renal impairment
- Marked reduction in kidney function where NSAIDs are generally contraindicated.
- Controlled hypertension
- High blood pressure kept within targets but at risk of worsening with NSAIDs.
Side effects, monitoring and red‑flag symptoms
Common transient effects to warn patients about
Mild effects reported include dyspepsia, nausea, diarrhoea, headache, dizziness and occasional tinnitus.
Advise patients these are typically dose related and often resolve after dose reduction or stopping the drug.
Serious adverse events and escalation steps
Serious risks include gastrointestinal ulceration or bleeding, fluid retention and oedema, raised blood pressure, renal impairment and rare severe skin reactions.
Monitoring plan for long‑term users should include baseline and periodic blood pressure and renal function checks, especially in the elderly or those on diuretics or ACE inhibitors.
Emergency actions — stop the medicine and seek urgent care for:
- Black, tarry stools or persistent vomiting with blood.
- Severe abdominal pain or vomiting.
- New breathlessness, chest pain or sudden swelling.
- Sudden widespread rash, blistering or jaundice.
Report suspected adverse reactions to the Yellow Card Scheme in the United Kingdom.
| Monitoring | When |
|---|---|
| Blood pressure | Baseline and periodically for long‑term use |
| Renal Function (eGFR/Creatinine) | Baseline and during extended therapy, especially in elderly |
Drug interactions and co‑prescribing guidance
High‑risk interacting medicines
Indometacin increases bleeding risk with anticoagulants and antiplatelets.
It can reduce the blood pressure‑lowering effects of ACE inhibitors, ARBs and diuretics, and may increase nephrotoxicity when combined with other nephrotoxic drugs.
Concurrent use with corticosteroids or SSRIs raises gastrointestinal bleeding risk.
Safe co‑prescribing (gastroprotection)
Consider prophylactic gastroprotection with a proton pump inhibitor for patients taking long‑term NSAIDs or those at high GI risk.
When warfarin or a direct oral anticoagulant is co‑prescribed, ensure closer INR/clinical monitoring and liaise with the prescriber about alternative analgesics where appropriate.
Recommended actions:
| Drug class | Risk | Action |
|---|---|---|
| Anticoagulants / antiplatelets | Increased bleeding | Check indication, advise monitoring, liaise with prescriber |
| ACE inhibitors / ARBs / diuretics | Reduced BP control, renal risk | Recommend BP/renal checks and review therapy |
| Corticosteroids / SSRIs | Higher GI bleeding risk | Consider gastroprotection with PPI |
| Other NSAIDs / COX‑2 inhibitors | Additive toxicity | Avoid combination; suggest safer alternative |
Dosing adjustments: elderly, renal/hepatic impairment and pregnancy
Practical dosing changes and monitoring
Start elderly patients at a lower dose, for example 25mg twice daily, and use the shortest effective course with frequent review.
Avoid sustained high doses and monitor renal function if treatment continues beyond a few days.
In mild to moderate hepatic or renal impairment dose reduction and specialist advice are recommended; in severe impairment indometacin is contraindicated.
Pregnancy and breastfeeding considerations
Indometacin is absolutely contraindicated in the third trimester due to risk of premature closure of the fetal ductus arteriosus.
Use in the first and second trimesters requires specialist discussion and risk/benefit assessment for women of childbearing potential.
For neonates, IV indomethacin sodium is used in hospital protocols for ductus arteriosus closure with typical dosing around 0.2mg/kg.
Dosing adjustment summary:
- Elderly: start low, monitor closely.
- Renal/hepatic impairment: consult specialist and monitor renal function.
- Pregnancy: avoid in third trimester; discuss risks earlier in pregnancy.
Storage and disposal
Storage advice
Tablets and capsules should be stored below 25°C, away from moisture and in original packaging.
Suppositories should be kept in a cool, dry place.
Advise patients not to store medicines in bathrooms.
Return expired or unused indometacin to a pharmacy for safe disposal.
Delivery across the United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | England | 9–21 days |
| Manchester | England | 9–21 days |
| Birmingham | England | 9–21 days |
| Glasgow | Scotland | 9–21 days |
| Leeds | England | 9–21 days |
| Liverpool | England | 9–21 days |
| Edinburgh | Scotland | 9–21 days |
| Bristol | England | 9–21 days |
| Cardiff | Wales | 9–21 days |
| Belfast | Northern Ireland | 9–21 days |
| Newcastle Upon Tyne | England | 9–21 days |
| Nottingham | England | 9–21 days |
| Southampton | England | 9–21 days |
Final practical notes
Ask about gastroprotection if you are likely to need indometacin for more than a few days, and inform the pharmacist about all current medications including blood pressure tablets and anticoagulants.
Keep stored medicines in original packaging below 25°C and return expired or unwanted medicines to a pharmacy for safe disposal.
For suspected adverse reactions report via the UK Yellow Card Scheme and seek urgent care for any red‑flag symptoms.
