Drug Information

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.

Common brand names:

Indocin, Indocin SR

Summary of Interactions with Vitamins, Herbs, & Foods

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Iron

    NSAIDs cause gastrointestinal (GI) irritation, bleeding, and iron loss.1 Iron supplements can cause GI irritation.2 However, iron supplementation is sometimes needed in people taking NSAIDs if those drugs have caused enough blood loss to lead to iron deficiency. If both iron and nabumetone are prescribed, they should be taken with food to reduce GI irritation and bleeding risk.

  • Vitamin C

    Indomethacin has been reported to decrease absorption of folic acid and vitamin C.3 Under certain circumstances, indomethacin may interfere with the actions of vitamin C.4 Calcium and phosphate levels may also be reduced with indomethacin therapy.5 It remains unclear whether people taking this drug need to supplement any of these nutrients.

  • Calcium

    Indomethacin has been reported to decrease absorption of folic acid and vitamin C.6 Under certain circumstances, indomethacin may interfere with the actions of vitamin C. Calcium and phosphate levels may also be reduced with indomethacin therapy.7 It remains unclear whether people taking this drug need to supplement any of these nutrients.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • Licorice

    The flavonoids found in the extract of licorice (Glycyrrhiza glabra) known as DGL (deglycyrrhizinated licorice) are helpful for avoiding the irritating actions NSAIDs have on the stomach and intestines. One study found that 350 mg of chewable DGL taken together with each dose of aspirin reduced gastrointestinal bleeding caused by the aspirin.8 DGL has been shown in controlled human research to be as effective as drug therapy (cimetidine) in healing stomach ulcers.9

Support Medicine

  • Stinging Nettle

    In a controlled human study, people who took stinging nettle with diclofenac obtained similar pain relief compared to people taking twice as much diclofenac with no stinging nettle.10 More research is needed to determine whether people taking diclofenac might benefit from also taking stinging nettle.

Reduces Effectiveness

  • none

Potential Negative Interaction

  • Iron

    Iron supplements can cause stomach irritation. Use of iron supplements with indomethacin increases the risk of stomach irritation and bleeding.11 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.

  • Potassium

    Indomethacin may cause elevated blood potassium levels in people with normal and abnormal kidney function.12 , 13 , 14 , 15 Until more is known, people taking indomethacin should not supplement potassium without medical supervision.

  • Sodium

    Indomethacin may cause sodium and water retention.16 It is healthful to reduce dietary salt intake by decreasing the use of table salt and avoiding heavily salted foods.

  • White Willow

    White willow bark (Salix alba) 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.17 Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Explanation Required 

  • Food

    Indomethacin should be taken with food to prevent stomach irritation.18 However, applesauce, high-protein foods, and high-fat foods have been reported to interfere with indomethacin absorption and/or activity.19

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a new supplement with your doctor or pharmacist.

References

1. Bjarnason I, Macpherson AJ. Intestinal toxicity of non-steroidal anti-inflammatory drugs. Pharmacol Ther 1994;62:145-57.

2. Threlkeld DS, ed. Blood Modifiers, Iron-Containing Products. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Jun 1998, 62-9a.

3. Hodges R. Nutrition in Medical Practice. Philadelphia: W. B. Saunders, 1980, 323-31 [review].

4. 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.

5. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 138,140.

6. Hodges R. Nutrition in Medical Practice. Philadelphia: W. B. Saunders, 1980, 323-31 [review].

7. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 138,140.

8. Rees WDW, Rhodes J, Wright JE, et al. Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin. Scand J Gastroenterol 1979;14:605-7.

9. Morgan AG, McAdam WAF, Pacsoo C, Darnborough A. Comparison between cimetidine and Caved-S in the treatment of gastric ulceration, and subsequent maintenance therapy. Gut 1982;23:545-51.

10. Chrubasik S, Enderlein W, Bauer R, Grabner W. Evidence for antirheumatic effectiveness of Herba Urticae dioicae in acute arthritis: a pilot study. Phytomedicine 1997;4:105-8.

11. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 139-40.

12. Tan SY, Shapiro R, Franco R, et al. Indomethacin-induced prostaglandin inhibition with hyper kalemia. Ann Intern Med 1979;90:783-5.

13. Goldszer RC, Coodley EL, Rosner MJ, et al. Hyperkalemia associated with indomethacin. Arch Intern Med 1981;141:802-4.

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. Perazella MA. Drug-induced hyperkalemia: Old culprits and new offenders. Am J Med 2000;109:307-14 [review].

16. 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.

17. 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.

18. 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.

19. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 138-9.