Indomethacin (Rectal)

Overview

Like most nonsteroidal anti-inflammatory drugs (NSAIDs), Indomethacin helps to relieve swelling, inflammation, fever and/or pain. Whilst NSAIDs can be used to treat short-term or chronic conditions, Indomethacin is predominantly prescribed to patients with gout, arthritis, tendonitis, bursitis and ankylosing spondylitis.

As these conditions are all associated with joint pain and stiffness, Indomethacin can be used to relieve the discomfort caused by these conditions. As Indomethacin reduces swelling and inflammation, as well as pain, it can also help patients to regain mobility in their joints. If inflammation around a joint is causing severe pain, stiffness and subsequent mobility issues, for example, Indomethacin can be used to relieve the inflammation and, therefore, the pain. As a result, the patient is often able to regain movement in the affected joint.

Indomethacin is effective in treating these symptoms because it inhibits the cyclooxygenase enzymes. As these enzymes are involved in the production of prostaglandins, Indomethacin effectively limits production of prostaglandins in the patient's body. Known to be mediators of pain, swelling and inflammation, fewer prostaglandins means that the patient's symptoms should be reduced.

Although Indomethacin can be administered in a variety of ways, it is commonly used as an oral medication, topical cream, an intravenous injection or as a rectal suppository. When prescribed in suppository form, the medication can be used to treat patients who are unable to tolerate oral forms of Indomethacin but who require on-going treatment with NSAIDs.

Conditions Treated

Type Of Medicine

  • Nonsteroidal anti-inflammatory drug (NSAID)

Side Effects

When patients use any type of medication, there is the risk of adverse effects occurring and there are a number of side-effects associated with the use of NSAIDs. Often, patients will experience mild side-effects when they first start using a new medication but these will be relieved as the patient's body becomes accustomed to the treatment.

When patients first start using Indomethacin, they may notice the following side-effects:

  • Continuing buzzing or ringing or other unexplained noise in the ears
  • Mild headache
  • Difficulty having a bowel movement (stool)
  • Trouble sleeping
  • Discouragement
  • Feeling empty or sad
  • Trouble with speaking
  • General feeling of illness or discomfort
  • Tiredness
  • Hearing loss
  • Sensation of spinning
  • Irritability
  • Passing gas
  • Loss of pleasure or interest
  • Lightheadedness
  • Involuntary muscle movements
  • Sleepiness
  • Feeling of constant movement of surroundings or self
  • Trouble with concentrating
  • Excess gas or air in the intestines or stomach
  • Anxiety
  • Changes in rhythms and patterns of speech
  • Full, bloated feeling

If the above side-effects are not severe and are not troublesome to the patient, they may not need medical attention. However, if the above side-effects are bothersome or if they persist for some time, patients should access medical advice.

Patients will also need to access immediate medical assistance if they experience the following adverse effects when using Indomethacin suppositories:

  • Sour or acid stomach
  • Leg or back pains
  • Belching
  • Loosening, peeling or blistering of the skin
  • Diarrhea
  • Nausea
  • Heartburn
  • Stomach pain, upset or discomfort
  • Indigestion
  • Stomach or abdominal burning, tenderness or cramping
  • Bleeding gums
  • Tarry, black or bloody stools
  • Fever, with or without chills
  • Blue fingernails or lips
  • Dry, flushed skin
  • Blurred vision
  • Fruit-like breath odor
  • Breast tenderness and enlargement
  • Numbness, burning, itching, crawling, prickling, tingling or "pins and needles" feelings
  • Dry mouth
  • Burning stomach or upper abdominal pain
  • Extreme fatigue
  • Canker sores
  • Fall sense of well-being
  • Change in consciousness
  • Double vision
  • Change in hearing
  • Fainting, lightheadedness or dizziness when getting up suddenly from a sitting or lying position
  • Chest discomfort, pain or burning
  • Feeling of unreality
  • Clay-colored stools
  • Cloudy or bloody urine
  • Heavier menstrual periods
  • Confusion
  • Headache
  • Continuing diarrhea
  • Greatly decreased amount of urine or frequency of urination
  • Hoarseness or cough
  • Hair loss
  • Coughing that sometimes produces a frothy, pink sputum
  • General body swelling
  • Cracks in the skin
  • Feeling of warmth
  • Dark urine
  • Large, purplish or blue, flat patches in the skin
  • Decreased appetite
  • Any change in vision or decreased vision
  • Joint pain
  • Depression
  • Labored or difficult breathing
  • Jerky movements of the face, neck, mouth or head
  • Difficulty with swallowing
  • Swelling or irritation of the eye
  • Dilated neck veins
  • Welts, hives, rash on the skin or itching
  • Large, hive-like swelling on the eyelids, tongue, lips, face, hands, throat, feet, legs or sex organs
  • Mask-like face
  • Increased hunger
  • Loss of balance control
  • Increased sweating
  • Loss of hearing
  • Increased thirst
  • Loss of heat from the body
  • Increased urination
  • Loss of bladder control
  • Irregular breathing
  • Loss of consciousness
  • Pain in lower back or side
  • Mental confusion
  • Sense of detachment from body or self
  • Mood swings
  • Seizures
  • Muscle pains, weakness or aches
  • Hearing, feeling or seeing things that are not there
  • Muscle spasm or jerking of all extremities
  • Seeing double
  • Nervousness
  • Scaly skin
  • Pain in the knees or ankles
  • Rattling, noisy breathing
  • Pale skin
  • Redness of the arms, neck, face and, occasionally, upper chest
  • Nosebleeds
  • Severe constipation
  • Swollen, red skin
  • Tingling or numbness in the feet, lips or hands
  • Discomfort or pain in the throat or upper stomach
  • Irritated, red eyes
  • Pain with swallowing
  • Sore throat
  • Difficulty or painful urination
  • Ulcers, white spots or sores in the mouth, on the lips or on the tongue
  • Red skin lesions, sometimes with a purple center
  • Small purple or red spots on the skin
  • Red, painful lumps under the skin, mostly on the legs
  • Yellow skin or eyes
  • Persistent oozing or bleeding from puncture sites, nose or mouth
  • Stiffness of the legs and arms
  • Personality changes
  • Slurred speech
  • Purple or red pinpoint spots on the skin
  • Slowed movements
  • Pounding in the ears
  • Swelling or puffiness around the eyes or of the eyelids, lips, face or tongue
  • Irregular, fast, slow, racing or pounding pulse or heartbeat
  • Severe mental changes
  • Unexplained weight loss
  • Continuing or severe stomach pain
  • Awkwardness or unsteadiness
  • Shuffling walk
  • Unpleasant breath odor
  • Sudden loss of consciousness
  • Unusual bruising or bleeding
  • Swelling of the fingers, feet, lower legs or face
  • Vaginal bleeding
  • Breast soreness or swelling of the breasts in both males and females
  • Painful or swollen glands
  • Unusual weakness or tiredness
  • Tightness in the chest
  • Vomiting of material that looks like coffee grounds
  • Shaking and trembling of the hands or the fingers
  • Vomiting of blood
  • Troubled breathing at rest
  • Weight gain
  • Troubled breathing with exertion
  • Weakness in the hands, legs, feet and arms
  • Rectal burning, bleeding, itching, dryness or pain
  • Frequent urge to defecate
  • Straining while passing stool

Whilst the above side-effects are not particularly common, they do require medical attention. Furthermore, patients should seek medical help if they experience any adverse effects which are not listed above when using Indomethacin suppositories. Patients can also inform the Food and Drug Administration if they experience any unlisted side-effects by calling 1-800-FDA-1088.

When using this medication, patients should be aware of the symptoms of an overdose. If too much Indomethacin is used or if the medication is used too often, patients may experience a life-threatening overdose. The symptoms of an overdose can include:

  • Severe headache
  • Confusion about place time and/or identity
  • Unusual dullness, drowsiness and/or a feeling of sluggishness

If patients experience these symptoms after using Indomethacin, they will require emergency medical treatment. If patients think they have used too much Indomethacin, they should obtain medical help immediately and not wait for the symptoms of an overdose to occur.

Dosage

When patients are prescribed Indomethacin suppositories, their doctor will tell them how often to use the medication. As every patient is assessed individually, they should adhere to their physician's instructions when using this medication.

In general, however, patients who are prescribed Indomethacin suppositories for the treatment of gout are usually advised to administer one suppository, three times per day. If patients are using Indomethacin suppositories for the treatment of tendonitis or bursitis, however, they may be advised to use one suppository, three or four times per day.

When patients are prescribed Indomethacin suppositories for the treatment of rheumatoid arthritis, osteoarthritis and/or ankylosing spondylitis, they may be advised to use the medication on a long-term basis. If so, patients will usually be instructed to administer one 50mg Indomethacin suppository, up to three times per day.

If patients are prescribed Indomethacin in suppository form, they should only be inserted into the rectum and should never be placed into the mouth and/or vagina. Prior to using the suppository, patients may want to place the foil-wrapped suppository in the refrigerator or run it under cold water as this can make it easier to insert.

Following this, patients will need to remove the foil wrapper and soften the suppository by running cold water over it. Patients should lie on their side and use their finger to gently insert the Indomethacin suppository in their rectum. In order to keep the suppository in place, patients should stay lying down on their side for approximately fifteen minutes.

When administering Indomethacin suppositories, patients should only use the medicine as instructed by their doctor. If patients use too much Indomethacin or use the medicine too often, it could have harmful side-effects and may become ineffective at relieving pain, swelling and inflammation.

If patients are prescribed Indomethacin to treat a long-term condition, such as arthritis, it may take some time for the medication to take its full effect. The medication may begin to have some effect within one week but, in many cases, it will take a few weeks until the patient gets the full benefit of the medicine.

If patients forget to administer a dose of Indomethacin, they should do so as soon as they remember to. However, if their next dose of medicine is due in the near future, patients should skip the missed dose and continue with the normal dosing schedule. Patients should not attempt to administer a double dose of Indomethacin, even if an earlier dose has been missed.

Before using Indomethacin suppositories, patients should ensure they know how to administer the medication and when each dose is due. If they are unsure, they should seek advice from their physician or pharmacist.

Potential Drug Interactions

Although some drugs can be used in conjunction with one another, others may produce an interaction if they are used at the same time. Due to this, it may not be appropriate for patients to use Indomethacin suppositories if they are already taking certain other medications.

Indomethacin should not be prescribed if the patient is already taking the following medicine, for example:

  • Ketorolac

In addition to this, the use of Indomethacin suppositories is not recommended if patients are using any of the following medications:

  • Abciximab
  • Dabigatran Etexilate
  • Aceclofenac
  • Dalteparin
  • Acemetacin
  • Desirudin
  • Acenocoumarol
  • Dexamethasone
  • Amiloride
  • Desvenlafaxine
  • Amineptine
  • Dexibuprofen
  • Amitriptyline
  • Danaparoid
  • Amitriptylinoxide
  • Deflazacort
  • Amoxapine
  • Desipramine
  • Amtolmetin Guacil
  • Duloxetine
  • Enoxaparin
  • Anagrelide
  • Edoxaban
  • Apixaban
  • Escitalopram
  • Ardeparin
  • Eptifibatide
  • Argatroban
  • Epoprostenol
  • Aspirin
  • Eplerenone
  • Balsalazide
  • Etodolac
  • Bemiparin
  • Etofenamate
  • Bendroflumethiazide
  • Fenoprofen
  • Benzthiazide
  • Fepradinol
  • Beta Glucan
  • Feverfew
  • Betamethasone
  • Felbinac
  • Bismuth Subsalicylate
  • Flufenamic Acid
  • Bivalirudin
  • Etoricoxib
  • Bromfenac
  • Fluocortolone
  • Budesonide
  • Floctafenine
  • Bufexamac
  • Feprazone
  • Bumetanide
  • Fluvoxamine
  • Cangrelor
  • Fluoxetine
  • Celecoxib
  • Flurbiprofen
  • Certoparin
  • Hydroflumethiazide
  • Chlorothiazide
  • Fondaparinux
  • Chlorthalidone
  • Heparin
  • Choline Magnesium Trisalicylate
  • Hydrocortisone
  • Choline Salicylate
  • Hydrochlorothiazide
  • Cilostazol
  • Protein C
  • Ginkgo
  • Protriptyline
  • Citalopram
  • Gossypol
  • Rivaroxaban
  • Clomipramine
  • Reviparin
  • Lithium
  • Rofecoxib
  • Clonixin
  • Reboxetine
  • Lofepramine
  • Clopamide
  • Magnesium Salicylate
  • Clopidogrel
  • Lumiracoxib
  • Cortisone
  • Loxoprofen
  • Cyclopenthiazide
  • Lornoxicam
  • Cyclosporine
  • Metolazone
  • Dexketoprofen
  • Melitracen
  • Diazoxide
  • Methotrexate
  • Dibenzepin
  • Mesalamine
  • Diflunisal
  • Meloxicam
  • Digoxin
  • Milnacipran
  • Dipyridamole
  • Morniflumate
  • Dipyrone
  • Nadroparin
  • Dothiepin
  • Nefazodone
  • Doxepin
  • Nabumetone
  • Droxicam
  • Naproxen
  • Ibuprofen
  • Oxaprozin
  • Iloprost
  • Oxyphenbutazone
  • Imipramine
  • Paramethasone
  • Indapamide
  • Parecoxib
  • Ketoprofen
  • Lepirudin
  • Parnaparin
  • Levomilnacipran
  • Paroxetine
  • Meadowsweet
  • Tiaprofenic Acid
  • Meclofenamate
  • Tinzaparin
  • Mefenamic Acid
  • Tolmetin
  • Methyclothiazide
  • Tolfenamic Acid
  • Methylprednisolone
  • Ticagrelor
  • Nepafenac
  • Tirofiban
  • Niflumic Acid
  • Ticlopidine
  • Nimesulide
  • Salsalate
  • Nimesulide Beta Cyclodextrin
  • Sulfasalazine
  • Nortriptyline
  • Sibutramine
  • Olsalazine
  • Sodium Salicylate
  • Opipramol
  • Spironolactone
  • Pemetrexed
  • Sulindac
  • Pentosan Polysulfate Sodium
  • Sertraline
  • Pentoxifylline
  • Salicylic Acid
  • Tacrolimus
  • Treprostinil
  • Phenindione
  • Trolamine Salicylate
  • Phenprocoumon
  • Tianeptine
  • Phenylbutazone
  • Valdecoxib
  • Phenyl Salicylate
  • Triamterene
  • Piketoprofen
  • Trichlormethiazide
  • Piroxicam
  • Tenoxicam
  • Polythiazide
  • Trimipramine
  • Potassium
  • Salicylamide
  • Pralatrexate
  • Vasopressin
  • Prasugrel
  • Vorapaxar
  • Prednisolone
  • Warfarin
  • Prednisone
  • Vilazodone
  • Probenecid
  • Venlafaxine
  • Proglumetacin
  • Vortioxetine
  • Propyphenazone
  • Xipamide
  • Proquazone

Whilst the use of Indomethacin alongside the above medications is not usually advisable, doctors may feel that combined treatment would be of benefit to the patient. If so, the patient's dose of medicine may be reduced in order to try and prevent an interaction occurring. Alternatively, the patient may be advised to use their medication at a specific time to prevent any adverse effects.

If patients use Indomethacin in conjunction with any of the following medicines, it may increase their risk of experiencing side-effects:

  • Acebutolol
  • Levobunolol
  • Alacepril
  • Lisinopril
  • Atenolol
  • Metoprolol
  • Azilsartan
  • Imidapril
  • Azilsartan Medoxomil
  • Irbesartan
  • Benazepril
  • Labetalol
  • Betaxolol
  • Metipranolol
  • Bisoprolol
  • Losartan
  • Candesartan
  • Nebivolol
  • Captopril
  • Olmesartan
  • Cilazapril
  • Pentopril
  • Carteolol
  • Nadolol
  • Telmisartan
  • Carvedilol
  • Oxprenolol
  • Timolol
  • Celiprolol
  • Perindopril
  • Temocapril
  • Delapril
  • Penbutolol
  • Enalapril
  • Trandolapril
  • Ramipril
  • Enalaprilat
  • Practolol
  • Eprosartan
  • Propranolol
  • Esmolol
  • Quinapril
  • Fosinopril
  • Pindolol
  • Gentamicin
  • Spirapril
  • Moexipril
  • Sotalol
  • Zofenopril
  • Valsartan

If patients are prescribed Indomethacin suppositories alongside the above medications, they may be given specific advice regarding the reduction of side-effects. Alternatively, their physician may prescribe additional medication to relieve any side-effects they develop.

Drug interactions can occur between over-the-counter medicines, supplements and vitamins, as well as prescription medicines. Due to this, patients will need to tell their physician if they are using any of these substances before they begin treatment with Indomethacin suppositories. In addition to this, patients will need to obtain medical advice before using any new medicines, supplements or vitamins, once they have begun treatment with Indomethacin suppositories.

Warnings

If patients have existing medical conditions or a history of certain conditions, it may affect their treatment with Indomethacin. Patients should disclose their medical history to their physician before using Indomethacin to ensure that the treatment is safe for them. The following conditions can be particularly relevant if treatment with Indomethacin is being considered:

  • Stomach bleeding or ulcers
  • Blood clots
  • Fluid retention and/or body swelling (Edema)
  • Depression or any other mental changes
  • Anemia
  • Heart disease
  • Jaundice or hepatitis
  • Heart surgery
  • Bleeding problems
  • Stroke
  • Heart attack
  • Liver disease
  • Kidney disease
  • High blood pressure (Hypertension)
  • Parkinsonism
  • High levels of potassium in the blood (Hyperkalemia)
  • Epilepsy or seizures
  • Aspirin sensitivity
  • Aspirin sensitive asthma
  • Inflammation of the rectum (Proctitis)
  • Rectal bleeding

Although Indomethacin suppositories may be prescribed to patients over the age of fourteen years, studies have not been carried out on the effects of this medication on patients who are younger than this.

Whilst geriatric patients can be prescribed Indomethacin suppositories, older patients may be more sensitive to the effects of this medicine and may be more likely to suffer from side-effects and/or complications. In addition to this, geriatric patients may have age-related kidney, heart or liver problems with may affect their tolerance levels. Due to this, their dose of Indomethacin may need to be reduced.

If Indomethacin is prescribed on a long-term basis, patients will need to attend regular consultations with their doctor. They may also need to undergo regular urine and blood testing to assess the effects of this medication.

Using Indomethacin can increase the patient's risk of having a stroke and/or heart attack. This may be more likely in patients who use Indomethacin for long periods of time and/or have existing heart disease or a history of heart problems.

Indomethacin can cause bleeding in the intestines or stomach and this side-effect may occur suddenly and without warning. If patients smoke, consume alcohol regularly, are obese, are over the age of sixty years, are in poor health, have had a stomach ulcer before or use certain other medicines, such as steroids or blood thinners, they may be more likely to experience bleeding.

When patients are using Indomethacin, they may experience serious skin conditions. If patients experience the following side-effects, they will need to access immediate medical assistance:

  • Loosening, peeling or blistering of the skin
  • Fever
  • Chills
  • White spots, ulcers or sores in the mouth or on the lips
  • Diarrhea
  • Cough
  • Unusual weakness or tiredness
  • Muscle or joint pain
  • Red skin lesions
  • Itching

When patients are using Indomethacin, they can experience serious complications. The following side-effects may indicate that a serious health problem is occurring and patients should obtain immediate medical help:

  • Tarry, black stools
  • Severe stomach pain
  • Yellowing of the skin or eyes
  • Decreased urination
  • Vomiting of material that looks like coffee grounds
  • Unusual weight gain
  • Swelling of the lower legs, feet, face or hands
  • Vomiting of blood
  • Unusual bleeding or bruising
  • Rash on the skin

The following side-effects can be linked to serious heart problems and patients should stop using Indomethacin and obtain urgent medical assistance if they experience them:

  • Tightness in chest
  • Irregular or fast heartbeat
  • Chest pain
  • Unusual warmth or flushing of the skin
  • Slurring of speech
  • Weakness

Indomethacin can cause patients to become lightheaded, drowsy, dizzy or less alert than normal. Patients should not operate machinery, drive or carry out any tasks which require their full attention whilst they are experiencing these side-effects. Even when Indomethacin is taken before going to bed, side-effects, such as drowsiness and lightheadedness, can still be present when you awaken and may persist throughout the morning.

If patients experience a change in their vision, blurred vision or have difficulty reading when using Indomethacin, they should consult their physician. They may be referred to an ophthalmologist so that a more comprehensive assessment of their eyes can be carried out.

If patients are due to undergo any surgeries, medical tests or dental work, they must inform the relevant healthcare practitioners that they are using Indomethacin. It may be unsafe to perform certain procedures whilst patients are using this medication.

When using Indomethacin, female patients may experience a delay in ovulation. This can affect their ability to have children. If the patient plans to have children in the future or is unsure whether they want to have children in the future, they should discuss this with their physician before using Indomethacin.

If patients who are pregnant use Indomethacin, it poses a risk to their unborn baby. Whilst the risk cannot be ruled out at any stage of the pregnancy, it is particularly dangerous to use Indomethacin during the third trimester of pregnancy. Due to this, patients who are pregnant are not normally treated with this medicine, particularly if they are in the late stages of pregnancy.

When using Indomethacin, patients are normally advised to use a reliable form of birth control. If patients become pregnant whilst using Indomethacin, they should inform their physician as soon as possible.

If patients breastfeed whilst using medication, there is a chance that the medicine could be passed on to the infant and it may cause them harm. Due to this, patients are normally advised not to breastfeed whilst using Indomethacin and should obtain medical advice if they are considering doing so.

When using Indomethacin, patients may experience a serious allergic reaction, including anaphylaxis. Before using this medicine, patients should tell their doctor if they have any known allergies, particularly if they have an allergy or sensitivity to aspirin or any other NSAIDs. An allergic reaction may include the following symptoms:

  • Difficulty swallowing
  • Difficulty breathing
  • Irregular or very fast breathing
  • Shortness of breath
  • Gasping for breath
  • Itching, hives or a rash on the skin
  • Fainting
  • Change of color in the skin of the face
  • Irregular or very fast pulse or heartbeat
  • Swelling or puffiness around the eyes or of the eyelids
  • Hive-like swellings on the skin
  • Swelling of the tongue, mouth, lips, throat, face and/or hands

An allergic reaction and anaphylaxis can be life-threatening and patients will need emergency medical treatment if they exhibit the above symptoms.

Storage

When patients are storing Indomethacin suppositories at home, they should follow the manufacturer's instructions or the medication guidelines. Generally, Indomethacin can be kept at room temperature but some manufacturers recommend that Indomethacin suppositories are kept in a refrigerator.

Patients should keep Indomethacin suppositories away from heat, moisture and direct light. In addition to this, Indomethacin suppositories should be stored in their original container and should be left in their individual foil-wrappings until the patient is ready to use them.

If patients are required to keep medicine at home, they should ensure that they have somewhere safe and secure to store it. It is particularly important that children and/or pets cannot gain access to any medications in the home.

If patients are advised to stop using Indomethacin suppositories or if the medicine reaches its use-by date, patients will need to dispose of it. However, medicine should never be thrown out with regular household waste as it could pose a risk to other people.

In order to dispose of Indomethacin safely, patients should contact their physician's office or pharmacist and make use of a designated medicine disposal service.

Summary

Unlike many pain-relieving medications, NSAIDs reduce inflammation and swelling, as well as targeting pain. If the cause of the patient's pain is acute or short-term, using Indomethacin can help to relieve their swelling or inflammation and can help to rid them of pain permanently.

When Indomethacin is used to treat a chronic condition, however, it will not provide a cure for that condition. If patients are prescribed Indomethacin for the treatment of osteoarthritis, rheumatoid arthritis or ankylosing spondylitis, for example, the medicine will not rid them of these conditions. Instead, Indomethacin can be used to manage the symptoms of these conditions and to relieve the joint pain, stiffness, swelling and inflammation which is associated with them.

Before using Indomethacin, it's essential that patients are assessed by their physician. As Indomethacin can cause some serious health complications, it is not suitable for all patients. By seeking advice from their physician, patients can ensure that treatment with Indomethacin is right for them and that they aren't facing a significant risk of developing further health problems.

When used appropriately, Indomethacin can be extremely effective in relieving pain, stiffness and swelling. For patients with long-term chronic pain, in particular, treatment with Indomethacin can be hugely beneficial and may enable them to resume activities they were previously unable to perform due to their symptoms.