Indomethacin ointment (Indocin)

Indomethacin is used to treat pain or inflammation caused by many conditions such as arthritis, gout, ankylosing spondylitis, bursitis, or tendinitis.

Therapeutic actions:
Indomethacin has two additional modes of actions with clinical importance:
- It inhibits motility of polymorphonuclear leukocytes, similar to colchicine.
- It uncouples oxidative phosphorylation in cartilaginous (and hepatic) mitochondria, like salicylates.
These additional effects account as well for the analgesic and the anti-inflammatory properties.
Indomethacin readily crosses the placenta, and can reduce fetal urine production to treat polyhydramnios. It does so by reducing renal blood flow and increasing renal vascular resistance, possibly by enhancing the effects of vasopressin on the fetal kidneys.

What is it used for?:
- moderate to severe rheumatoid arthritis,
- osteoarthritis,
- ankylosing spondylitis,
- gout or certain types of bursitis and tendonitis.

Contraindications and cautions:
- allergy to any ingredient in Indocin;
- known severe allergic reaction (eg, severe rash, hives, trouble breathing, growths in the nose, dizziness) to aspirin or an NSAID (eg, ibuprofen, celecoxib);
- recent or forthcoming heart surgery;
- taking diflunisal, another NSAID (eg, ibuprofen), or triamterene;
- the last 3 months of pregnancy.

Side effects:
Serious side effects: severe allergic reactions (rash; hives; itching; trouble breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody or black, tarry stools; chest pain; confusion; dark urine; depression; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; mental or mood changes; numbness of an arm or leg; one-sided weakness; rectal bleeding; red, swollen, blistered, or peeling skin; unusual tiredness or weakness; ringing in the ears; seizures; severe headache or dizziness; severe or persistent stomach pain or nausea; severe vomiting; shortness of breath; sudden or unexplained weight gain; blood in the urine; swelling of hands, legs, or feet; unusual bruising or bleeding; unusual joint or muscle pain; unusual vaginal bleeding; vision or speech changes; change in the amount of urine produced;vomit that looks like coffee grounds; yellowing of the skin or eyes.
Less serious side effects: Constipation; diarrhea; dizziness; drowsiness; gas; headache; heartburn; nausea; stomach upset.

Interactions:
- Anticoagulants (eg, warfarin), corticosteroids (eg, prednisone), diflunisal, heparin, other NSAIDs (eg, ibuprofen), salicylates (eg, aspirin), or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) may increase the risk of stomach bleeding;
- Potassium-sparing diuretics (eg, spironolactone, triamterene) may increase the risk of kidney problems or increase blood potassium levels;
- Cyclophosphamide may provoke low blood sodium levels;
- the risk of Indocin 's side effects may be increased by probenecid;
- Indocin may increase the risk of side effects of cyclosporine, digoxin, lithium, methotrexate, quinolones (eg, ciprofloxacin), or sulfonylureas (eg, glipizide);
- Indocin may decrease effectiveness of angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), angiotensin receptor blockers (eg, losartan), beta-blockers (eg, propranolol), or diuretics (eg, furosemide, hydrochlorothiazide).