Drug reference

Indometacin

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1228, 1229

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Pain and moderate to severe inflammation in rheumatic disease and other musculoskeletal disorders ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: 50–200 mg daily in divided doses ▶BY RECTUM ▶Adult: 100 mg twice daily if required, dose to be administered at night and in the morning, combined oral and rectal treatment, maximum total daily dose 150–200 mg ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 75 mg 1–2 times a day Acute gout ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: 150–200 mg daily in divided doses ▶BY RECTUM ▶Adult: 100 mg twice daily if required, dose to be administered at night and in the morning, combined oral and rectal treatment, maximum total daily dose 150–200 mg ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 75 mg 1–2 times a day Dysmenorrhoea ▶BY MOUTH USING IMMEDIATE-RELEASE MEDICINES ▶Adult: Up to 75 mg daily ▶BY RECTUM ▶Adult: 100 mg twice daily if required, dose to be administered at night and in the morning, combined oral and rectal treatment, maximum total daily dose 150–200 mg ▶BY MOUTH USING MODIFIED-RELEASE MEDICINES ▶Adult: 75 mg daily

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Contra Indications

Active gastro-intestinal bleeding. active gastro-intestinal ulceration. history of gastro- intestinal bleeding related to previous NSAID therapy. history of gastro-intestinal perforation related to previous NSAID therapy. history of recurrent gastro-intestinal haemorrhage (two or more distinct episodes). history of recurrent gastro-intestinal ulceration (two or more distinct episodes). severe heart failure

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Cautions

GENERAL CAUTIONS Allergic disorders. cardiac impairment (NSAIDs may impair renal function). cerebrovascular disease. coagulation defects. connective-tissue disorders. dehydration (risk of renal impairment). elderly (risk of serious side-effects and fatalities). epilepsy. heart failure. history of gastro-intestinal disorders (e.g. ulcerative colitis, Crohn’s disease). ischaemic heart disease. parkinsonism. peripheral arterial disease. psychiatric disturbances. risk factors for cardiovascular events. uncontrolled hypertension SPECIFIC CAUTIONS ▶With rectal use Avoid rectal administration in proctitis. avoid rectal administration in recent rectal bleeding

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Allergy And Cross Sensitivity

Contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID—which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID.

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Safety

Interactions

→Appendix 1: NSAIDs

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Side Effects

GENERAL SIDE-EFFECTS Agranulocytosis. alopecia. anaphylactic reaction. angioedema. anxiety. appetite decreased. arrhythmias. asthma. blood disorder. bone marrow disorders. breast abnormalities. chest pain. coma . confusion. congestive heart failure. constipation. corneal deposits. depression. diarrhoea. disseminated intravascular coagulation. dizziness. drowsiness. dysarthria. erythema nodosum. eye disorder. eye pain. fatigue. ﬂuid retention. ﬂushing. gastrointestinal discomfort. gastrointestinal disorders. gynaecomastia. haemolytic anaemia. haemorrhage. hallucination. headache. hearing impairment. hepatic disorders. hyperglycaemia. hyperhidrosis. hyperkalaemia. hypotension. inﬂammatory bowel disease. insomnia. leucopenia. movement disorders. muscle weakness. nausea. nephritis tubulointerstitial. nephrotic syndrome. oedema. oral disorders. palpitations. pancreatitis. paraesthesia. peripheral neuropathy. photosensitivity reaction. platelet aggregation inhibition. psychiatric disorders. renal failure (more common in patients with pre-existing renal impairment). respiratory disorders. seizures. severe cutaneous adverse reactions (SCARs). skin reactions. syncope. thrombocytopenia. tinnitus. urine abnormalities. vasculitis. vertigo. vision disorders. vomiting SPECIFIC SIDE-EFFECTS ▶With oral use Dyspnoea. malaise. pulmonary oedema. sigmoid lesion perforation SIDE-EFFECTS, FURTHER INFORMATION For information about cardiovascular and gastrointestinal side-effects, and a possible exacerbation of symptoms in asthma, see Non- steroidal anti-inﬂammatory drugs. p. 1193

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Conception And Contraception

Caution—long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment.

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Pregnancy

Avoid unless the potential beneﬁt outweighs the risk. Avoid during the third trimester (risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn); onset of labour may be delayed and duration may be increased.

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Breast Feeding

Amount probably too small to be harmful—manufacturers advise avoid. Use with caution during breast-feeding.

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Hepatic Impairment

Use with caution; there is an increased risk of gastro-intestinal bleeding and ﬂuid retention. Avoid in severe liver disease.

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Renal Impairment

Avoid if possible or use with caution. Avoid in severe impairment. Dose adjustments The lowest effective dose should be used for the shortest possible duration. Monitoring In renal impairment monitor renal function; sodium and water retention may occur and renal function may deteriorate, possibly leading to renal failure.

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Monitoring Requirements

During prolonged therapy ophthalmic and blood examinations particularly advisable.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Suppository ▶Indocid (Aspen Pharma Trading Ltd) Indometacin 100 mg Indocid 100mg suppositories | 10 suppository P £17.61 DT = £17.61 Modified-release capsule CAUTIONARY AND ADVISORY LABELS 21, 25 ▶Berlind Retard (Tillomed Laboratories Ltd) Indometacin 75 mg Berlind 75 Retard capsules | 100 capsule P £8.65 DT = £8.65 Capsule CAUTIONARY AND ADVISORY LABELS 21 ▶Indometacin (Non-proprietary) Musculoskeletal system Indometacin 25 mg Indometacin 25mg capsules | 28 capsule P £1.32 DT = £1.29 Indometacin 50 mg Indometacin 50mg capsules | 28 capsule P £1.93 DT = £1.59

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Clinical care

Patient And Carer Advice

Driving and skilled tasks Dizziness may affect performance of skilled tasks (e.g. driving).

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Dose text by age group

Adult

50–200 mg daily in divided doses

First-line fragment. Read the complete Indications and Dose section above.

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Adult

100 mg twice daily if required, dose to be

First-line fragment. Read the complete Indications and Dose section above.

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Adult

75 mg 1–2 times a day

First-line fragment. Read the complete Indications and Dose section above.

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Adult

150–200 mg daily in divided doses

First-line fragment. Read the complete Indications and Dose section above.

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Adult

100 mg twice daily if required, dose to be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

75 mg 1–2 times a day

First-line fragment. Read the complete Indications and Dose section above.

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Adult

Up to 75 mg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

100 mg twice daily if required, dose to be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

75 mg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Indometacin

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 1228, 1229

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 1228

Contra Indications

PDF page 1228

Cautions

PDF pages 1228, 1229

Allergy And Cross Sensitivity

PDF page 1229

Safety

Interactions

→Appendix 1: NSAIDs

PDF page 1229

Side Effects

PDF page 1229

Conception And Contraception

Caution—long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment.

PDF page 1229

Pregnancy

PDF page 1229

Breast Feeding

Amount probably too small to be harmful—manufacturers advise avoid. Use with caution during breast-feeding.

PDF page 1229

Hepatic Impairment

Use with caution; there is an increased risk of gastro-intestinal bleeding and ﬂuid retention. Avoid in severe liver disease.

PDF page 1229

Renal Impairment

PDF page 1229

Monitoring Requirements

During prolonged therapy ophthalmic and blood examinations particularly advisable.

PDF page 1229

Dose and formulations

Medicinal Forms

PDF page 1229

Clinical care

Patient And Carer Advice

Driving and skilled tasks Dizziness may affect performance of skilled tasks (e.g. driving).

PDF page 1229

Dose text by age group

Adult

50–200 mg daily in divided doses

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

100 mg twice daily if required, dose to be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

75 mg 1–2 times a day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

150–200 mg daily in divided doses

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

100 mg twice daily if required, dose to be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

75 mg 1–2 times a day

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

Up to 75 mg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

100 mg twice daily if required, dose to be

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Adult

75 mg daily

First-line fragment. Read the complete Indications and Dose section above.

PDF page 1228

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.