Indomethacin

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Also indexed as:

Indocin

Indomethacin is a member of the non-steroidal anti-inflammatory drug (NSAIDs) family of drugs. NSAIDs reduce inflammation (swelling), pain, and temperature. Indomethacin is used to reduce pain/swelling involved in osteoarthritis, rheumatoid arthritis, bursitis, tendinitis, gout, ankylosing spondylitis, and headaches.

Herbs

Summary of Interactions for Indomethacin

Depletion or interference	Calcium* Folic acid Vitamin C
Adverse interaction	Lithium* Potassium Sodium White willow*
Side effect reduction/prevention	None known
Supportive interaction	None known
Reduced drug absorption/bioavailability	None known
Other (see text)	Iron

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Iron

Iron supplements can cause stomach irritation. Use of iron supplements with indomethacin increases the risk of stomach irritation and bleeding.¹ However, stomach bleeding causes iron loss. If both iron and indomethacin are prescribed, they should be taken with food to reduce stomach irritation and bleeding risk.

Lithium

Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.² Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

Potassium

Indomethacin may cause elevated blood potassium levels in people with normal and abnormal kidney function.^{3, 4, 5, 6} Until more is known, people taking indomethacin should not supplement potassium without medical supervision.

Vitamins and minerals

Indomethacin has been reported to decrease absorption of folic acid and vitamin C.⁷ Under certain circumstances, indomethacin may interfere with the actions of vitamin C.⁸ Calcium and phosphate levels may also be reduced with indomethacin therapy.⁹ It remains unclear whether people taking this drug need to supplement any of these nutrients.

Sodium

Indomethacin may cause sodium and water retention.¹⁰ It is healthful to reduce dietary salt intake by decreasing the use of table salt and avoiding heavily salted foods.

Interactions with Herbs

White willow bark (Salix alba)

White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.¹¹ Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

Other Interactions

Food

Indomethacin should be taken with food to prevent stomach irritation.¹² However, applesauce, high-protein foods, and high-fat foods have been reported to interfere with indomethacin absorption and/or activity.¹³

Alcohol

Indomethacin may cause drowsiness or dizziness.¹⁴ Alcohol may amplify these actions. Use of alcohol during indomethacin therapy increases the risk of stomach irritation and bleeding.¹⁵ People taking indomethacin should avoid alcohol.

References

1. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 139-40.
2. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172-90.
3. Tan SY, Shapiro R, Franco R, et al. Indomethacin-induced prostaglandin inhibition with hyper kalemia. Ann Intern Med 1979;90:783-5.
4. Goldszer RC, Coodley EL, Rosner MJ, et al. Hyperkalemia associated with indomethacin. Arch Intern Med 1981;141:802-4.
5. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1993, 252-a.
6. Perazella MA. Drug-induced hyperkalemia: Old culprits and new offenders. Am J Med 2000;109:307-14 [review].
7. Hodges R. Nutrition in Medical Practice. Philadelphia: W. B. Saunders, 1980, 323-31 [review].
8. Ogilvy CS, DuBois AB, Douglas JS. Effects of ascorbic acid and indomethacin on the airways of healthy male subjects with and without induced bronchoconstriction. J Allergy Clin Immunol 1981;67:363-9.
9. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 138,140.
10. Somova L, Zaharieva S, Ivanova M. Humoral factors involved in the regulation of sodium-fluid balance in normal man. II. Effects of indomethacin on sodium concentration, renal prostaglandins, vasopressin and renin-angiotensin-aldosterone system. Acta Physiol Pharmacol Bulg 1984;10:29-33.
11. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172-90.
12. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1993, 252-a.
13. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 138-9.
14. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Mar 1993, 252-a.
15. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 137-8.

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Last Review: 01-21-2009

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires February 2010.

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