Indocin (Indomethacin) Drug Interactions

Indocin (indomethacin) is a prescription drug indicated for arthritis and overuse injuries that cause pain and swelling, such as tendonitis and bursitis. You usually take it by mouth as a capsule or an oral suspension, but it also comes in a suppository form. 

It helps treat swelling, stiffness, and pain caused by conditions like osteoarthritis and rheumatoid arthritis. It’s part of the class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). While it’s an effective treatment option for many types of painful conditions, it may interact with certain medications, causing potentially harmful reactions.

NSAIDs

Because indomethacin is an NSAID itself, taking it with other NSAIDs, such as over-the-counter (OTC) Advil, can increase your risk of side effects. Don’t take indomethacin with the following NSAIDs unless expressly directed to by your healthcare provider:

• Advil, Motrin (ibuprofen)
• Aleve (naproxen)
• Aspirin
• Celebrex (celecoxib)
• Mobic (meloxicam)
• Voltaren, Zorvolex, Zipsor (diclofenac)
• Ketorolac

Antidepressants

Tell your healthcare provider if you’re taking an antidepressant. Some antidepressants may interact with indomethacin and increase your risk of bleeding.

SSRIs

The following selective serotonin reuptake inhibitors (SSRIs) may interact with indomethacin:

• Celexa (citalopram)
• Luvox (fluvoxamine)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

SNRIs

The following selective serotonin and norepinephrine reuptake inhibitors (SNRIs) may interact with indomethacin:

• Cymbalta (duloxetine)
• Effexor XR (venlafaxine)
• Pristiq (desvenlafaxine)

Heart Medicines

Some heart medicines may interact with indomethacin. Combining indomethacin with ACE inhibitors, AR blockers, or beta blockers can diminish their effectiveness. In older adults, combining indomethacin with heart medicines can cause kidney problems and, in some cases, kidney failure.

Indomethacin comes with a black box warning that cautions people to avoid the medication if they have a history of heart disease. Taking it for long periods can increase your risk of heart attack, stroke, and blood clots.

ACE Inhibitors

Your healthcare provider may need to monitor you and adjust the dosage of indomethacin if you take any of the following angiotensin-converting enzyme (ACE) inhibitor drugs:

• Accupril (quinapril)
• Altace (ramipril)
• Captopril
• Fosinopril
• Lisinopril 
• Lotensin (benazepril)
• Mavik (trandolapril)
• Univasc (moexipril)
• Vasotec (enalapril) 

ARBs

Several angiotensin II receptor blockers (ARBs) may interact with indomethacin, including:

• Atacand (candesartan)
• Avapro (irbesartan)
• Benicar (olmesartan)
• Cozaar (losartan)
• Tenormin (telmisartan)
• Teveten (eprosartan)

Beta Blockers

Beta blockers that may interact with indomethacin include:

• Corgard (nadolol)
• InnoPran XL (propranolol)
• Lopressor (metoprolol)
• Tenormin (atenolol)
• Trandate (labetalol)

Others

Other medications that may interact with indomethacin include:

• Cyclosporine, an immunosuppressant used to prevent organ rejection
• Blood thinners
• Digoxin, a drug that treats irregular heartbeat and heart failure
• Diuretics
• Lithium
• Methotrexate, a disease-modifying anti-rheumatic drug (DMARD)
• Phenytoin, an anti-seizure drug

Because blood thinners affect the body’s clotting ability, taking them with indomethacin (which may increase your risk of internal bleeding) can be dangerous. 

Combining lithium with indomethacin increases the blood concentration of lithium. It can cause lithium to take longer to clear the body. This can also happen when taking indomethacin with digoxin, methotrexate, and cyclosporine, increasing the risk of kidney problems.

Supplements

You should always tell your healthcare provider about any OTC vitamins, supplements, or herbal products you’re taking because they may interact with certain medications. 

Iron and potassium supplements can interact with indomethacin. Because iron can irritate the stomach, taking it with indomethacin can increase your risk of gastrointestinal side effects, including bleeding and ulcers. 

Mixing potassium supplements with indomethacin can cause adverse kidney reactions whether or not you have existing kidney problems.

Alcohol

People who drink a lot of alcohol while taking indomethacin may be more likely to experience certain side effects, such as:

• Ulcers
• Internal bleeding
• Perforations in the gastrointestinal tract
• Liver disease

Older adults are more likely to experience dangerous side effects from mixing alcohol with medications like indomethacin.

Most NSAIDs don't mix well with alcohol. If you want to keep enjoying alcohol while taking indomethacin, talk to your healthcare provider to determine whether it’s safe to do so. Until you talk to a healthcare provider, avoid drinking alcohol.