Alcohol
Contraindicated
Textbook-cited
Increased risk of gastric bleeding
Concurrent use is contraindicated
Source: KDT 7e · p950
Drug reference
Indomethacin
Non-selective NSAID (indole acetic acid) · Analgesic
Also known as Indometacin, Indocin
START
25–50 mg PO TID with food (acute gout 50 mg TID, taper)
TYPICAL MAX
200 mg/day short term
STOP IF
GI bleeding, AKI, uncontrolled hypertension/HF, severe CNS effects
WATCH
GI symptoms, renal function/BP, fluid status; gastroprotection if at risk
CDSCO approvedSchedule HJan AushadhiATC M01AB01
KDIGO 2024 + manufacturer label
- ONSET
- 30min · analgesia onset
- PEAK
- 1.5h · Cmax IR
- t½
- 4.5h · plasma t½
- DURATION
- 6h · IR effect
EXCRETION
~60% renal, ~33% biliary; enterohepatic recycling
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid 3rd trimester (premature ductus closure, oligohydramnios); cautious short use earlier only if needed
FDA category + note
Top interactionssee all 12 →
- AlcoholContraindicatedTextbook-citedKDT 7e · p950
- MethylprednisoloneContraindicatedTextbook-citedKDT 7e · p950
- CiprofloxacinSevereTextbook-citedKDT 7e · p949
- DexamethasoneSevereTextbook-citedKDT 7e · p950
Available in India
56 branded formulations and 2 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Potent non-selective inhibition of COX-1/COX-2, reducing prostaglandin synthesis — anti-inflammatory, analgesic, antipyretic; promotes ductus arteriosus closure via prostaglandin suppression.
Indications
Acute gout and acute musculoskeletal/inflammatory painAnkylosing spondylitis, rheumatoid/osteoarthritis flaresPatent ductus arteriosus closure (neonates)Acute pericarditis; tocolysis (off-label)
Dosing
- Adult
- 25–50 mg PO 2–3 times daily with food; acute gout up to 50 mg TID then taper; SR 75 mg once–twice daily.
- Pediatric
- PDA (neonatal IV): 0.2 mg/kg then 0.1–0.25 mg/kg ×2 at 12–24 h intervals (specialist).
- Renal adjustment
- Avoid if eGFR <30; use lowest dose/short course if 30–60.
- Hepatic adjustment
- Avoid in severe hepatic impairment; reduce dose and monitor in mild–moderate.
- Geriatric
- Higher GI/renal/CNS toxicity; avoid or lowest effective dose, shortest duration (Beers).
- Max dose
- 200 mg/day (acute, short term); 150–200 mg/day usual ceiling
Pharmacokinetics
Onset
~30 min (analgesia)
Peak effect
1–2 h (IR)
Duration
4–6 h IR; ~12 h SR
Half-life
~4.5 h (range 2.6–11.2)
Bioavailability
~90–100%
Protein binding
~90%
Metabolism
Hepatic (O-demethylation, conjugation; enterohepatic recirculation)
Excretion
Renal ~60% and biliary ~33%
Contraindications
- Active GI bleeding/peptic ulcer
- CABG perioperative period
- Severe heart failure
- Third-trimester pregnancy
- Severe renal impairment
- Aspirin/NSAID hypersensitivity (asthma/urticaria)
Side effects
Common
Frontal headache, dizzinessDyspepsia, nausea, GI upsetFluid retention/oedemaRaised BP
Serious
- GI bleeding/perforation
- Acute kidney injury, papillary necrosis
- CV thrombotic events / heart failure
- Severe skin reactions; CNS confusion (esp. elderly)
Pregnancy & lactation
Pregnancy
Avoid 3rd trimester (premature ductus closure, oligohydramnios); cautious short use earlier only if needed
Lactation
Small amounts in milk; short-term use generally considered acceptable — monitor infant
Drug interactions
Methylprednisolone
Contraindicated
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Ciprofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity including seizures.
Avoid concurrent use
Source: KDT 7e · p949
Dexamethasone
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Glibenclamide
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Gliclazide
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glimepiride
Severe
Textbook-cited
Hypoglycemia
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Glipizide
Severe
Textbook-cited
Hypoglycemia.
Avoid concurrent use; substitute with paracetamol if analgesic needed
Source: KDT 7e · p949
Heparin
Severe
Textbook-cited
Increased bleeding risk.
Avoid concurrent use
Source: KDT 7e · p949
Hydrocortisone
Severe
Textbook-cited
Significantly increased GI bleeding risk.
Concurrent use is contraindicated; if unavoidable, add PPI
Source: KDT 7e · p950
Levofloxacin
Severe
Textbook-cited
Enhanced CNS toxicity, seizure risk.
Avoid concurrent use
Source: KDT 7e · p949
Moxifloxacin
Severe
Textbook-cited
Enhanced CNS toxicity, seizure risk
Avoid concurrent use
Source: KDT 7e · p949
Related guidelines
Ask House about Indomethacin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19