$Unique_ID{BRK03191} $Pretitle{} $Title{indomethacin} $Subject{Indocin Merck Sharp Dohme SR Nonsteroidal anti-inflammatory analgesic indomethacin inflammation pain swelling stiffness arthritis gout bursitis tendinitis prostaglandins} $Volume{} $Log{ Indocin 25 mg*0319101.scf Indocin 50 mg*0319102.scf Indocin SR*0319103.scf} Copyright (C) 1993 Publications International, Ltd. indomethacin ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) Indocin (Merck Sharp & Dohme) Indocin SR (Merck Sharp & Dohme) indomethacin (various manufacturers) TYPE OF DRUG Nonsteroidal anti-inflammatory analgesic INGREDIENT indomethacin DOSAGE FORMS Capsules (25 mg and 50 mg) Extended-release capsules (75 mg) Oral suspension (25 mg per 5-ml spoonful, with 1% alcohol) Rectal suppositories (50 mg) STORAGE Indomethacin capsules, oral suspension, and rectal suppositories should be stored in closed containers at room temperature away from heat and direct sunlight. The rectal suppositories can also be stored in the refrigerator. USES Indomethacin is used to treat the inflammation (pain, swelling, and stiffness) of certain types of arthritis, gout, bursitis, and tendinitis. Indomethacin has been shown to block the production of certain body chemicals, called prostaglandins, that may trigger pain. However, it is not yet fully understood how indomethacin works. TREATMENT You should take this drug immediately after meals or with food, in order to reduce stomach irritation. Ask your doctor if you can take indomethacin with an antacid. Do not chew or crush the extended-release capsules; they should be swallowed whole. Breaking the capsule would release the medication all at once--defeating the purpose of the extended-release dosage form. The suspension form of this medication should be shaken well just before measuring each dose. The contents tend to settle on the bottom of the bottle, so it is necessary to shake the container to distribute the ingredients evenly and equalize the doses. Each dose should be measured carefully with a specially designed 5-ml measuring spoon. An ordinary kitchen teaspoon is not accurate enough. To use the rectal suppository form of this medication, remove the foil wrapper, and moisten the suppository with water. If the suppository is too soft to insert, refrigerate it for 30 minutes or run cold water over it before removing the foil wrapper. Lie on your left side with your right knee bent. Push the suppository into the rectum, pointed end first. Lie still for a few minutes. Try to avoid having a bowel movement for at least one hour. It is important to take indomethacin on schedule and not to miss any doses. If you do miss a dose, take the missed dose as soon as possible, unless more than an hour has passed. In that case, do not take the missed dose at all; just return to your regular dosing schedule. Do not double the next dose. This drug does not cure arthritis, but will help to control the condition as long as you continue to take it. It may take up to four weeks before you feel the full benefits of this medication. SIDE EFFECTS Minor. Bloating, constipation, diarrhea, difficulty in sleeping, dizziness, drowsiness, headache, heartburn, indigestion, light-headedness, loss of appetite, nausea, nervousness, soreness of the mouth, unusual sweating, or vomiting. As you adjust to the drug, the side effects should disappear. To relieve constipation, increase the amount of fiber in your diet (fresh fruits and vegetables, salads, bran, and whole-grain breads), exercise, and drink more water (unless your doctor directs you to do otherwise). If you become dizzy, sit or lie down for a while; get up slowly from a sitting or reclining position, and be careful on stairs. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about bloody or black, tarry stools; blurred vision; confusion; depression; difficult or painful urination; palpitations; a problem with hearing; ringing or buzzing in the ears; skin rash, hives, or itching; stomach pain; swelling of the feet; rectal irritation; tightness in the chest; unexplained sore throat and fever; unusual bleeding or bruising; unusual fatigue or weakness; unusual weight gain; wheezing or difficulty in breathing; or yellowing of the eyes or skin. INTERACTIONS Indomethacin interacts with several other types of drugs: 1. Use of anticoagulants (blood thinners, such as warfarin) can lead to an increase in bleeding complications. 2. Anti-inflammatory medications such as aspirin, salicylates, and diflunisal can cause increased stomach irritation when used while taking this drug. 3. Indomethacin can decrease the elimination of lithium from the body, possibly resulting in lithium toxicity. 4. Indomethacin may interfere with the blood-pressure-lowering effects of captopril, enalapril, or beta-blocking medications (acebutolol, atenolol, betaxolol, carteolol, esmolol, labetalol, metoprolol, nadolol, penbutolol, pindolol, propranolol, timolol). 5. Indomethacin can interfere with the diuretic effects of furosemide and thiazide-type diuretics (water pills). 6. Indomethacin can alter the effects of the potassium-sparing diuretics (such as amiloride, spironolactone, or triamterene). 7. The concurrent use of triamterene and indomethacin can result in kidney problems. 8. Probenecid can increase the amount of indomethacin in the bloodstream when both drugs are being taken. BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially those listed above. WARNINGS * Tell your doctor if you have ever had unusual or allergic reactions to any medications, especially to indomethacin or any chemically related drugs. * Before taking indomethacin, tell your doctor if you now have or if you have ever had bleeding problems, colitis, stomach ulcers or other stomach problems, epilepsy, heart disease, high blood pressure, asthma, kidney disease, liver disease, mental illness, or Parkinson's disease. * If indomethacin makes you dizzy or drowsy, do not take part in any activity that requires alertness, such as driving a car or operating potentially dangerous machinery. * If you will be taking this medication for a long period of time, your doctor may want to have your eyes examined periodically by an ophthalmologist. Some visual problems have been known to occur with long-term indomethacin use. Your doctor might want to keep a careful watch for these. * Stomach problems are more likely to occur if you take aspirin regularly or drink alcohol while being treated with this medication. These should therefore be avoided (unless your doctor directs you to do otherwise). * The elderly may be at increased risk for experiencing side effects of this drug. * Be sure to tell your doctor if you are pregnant. Studies in animals have shown that indomethacin can cause unwanted effects in offspring, including lower birth weights, slower development of bones, nerve damage, and heart damage. If taken late in pregnancy, the drug can also prolong labor. Studies in humans have not been conducted. Also, tell your doctor if you are breast-feeding. Small amounts of indomethacin can pass into breast milk, so caution is warranted. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.