Cautions With Other Medicines
Some medicines and allopurinol can interfere with each other and increase the chances of you having side effects.
Tell a doctor or pharmacist if you’re taking any of these medicines before you start taking allopurinol:
- aspirin or medicines used to thin your blood , such as warfarin
- any antibiotics
- medicines used to reduce your immune response
- tablets that make you pee more such as furosemide or ACE inhibitors to treat high blood pressure such as enalapril and ramipril
If you take aluminium hydroxide , leave a 3 hour gap between the aluminium hydroxide and your allopurinol dose.
What Is The Most Important Information I Should Know About Indomethacin
Indomethacin can increase your risk of fatal heart attack or stroke, even if you don’t have any risk factors. Do not use this medicine just before or after heart bypass surgery .
Indomethacin may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using indomethacin, especially in older adults.
You should not use indomethacin if you are allergic to it, or if you have ever had an asthma attack or severe allergic reaction after taking aspirin or an NSAID.
Tell your doctor if you have ever had:
- heart disease, high blood pressure
- a heart attack, stroke, or blood clot
- fluid retention
- liver or kidney disease or
- if you smoke.
If you are pregnant, you should not take indomethacin unless your doctor tells you to. Taking an NSAID during the last 20 weeks of pregnancy can cause serious heart or kidney problems in the unborn baby and possible complications with your pregnancy.
This medicine may temporarily affect fertility in women.
It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.
Indomethacin is not approved for use by anyone younger than 14 years old.
What Other Drugs Could Interact With This Medication
There may be an interaction between indomethacin and any of the following:
- ASA
- alpha agonists
- aminoglycoside antibiotics
- angiotensin converting enzyme inhibitors
- angiotensin receptor blockers
- apixaban
- beta-adrenergic blockers
- bisphosphonates
- calcium channel blockers
- celecoxib
- corticosteroids
- cyclosporine
- diuretics
- drospirenone
- 5-ASA medications
- glucagon
- low molecular weight heparins
- metformin
- other non-steroidal anti-inflammatory medications
- obinutuzumab
- prostaglandin eye drops
- quinolone antibiotics
- rivaroxaban
- selective serotonin reuptake inhibitors
- serotonin/norepinephrine reuptake inhibitors
- sodium phosphates
- tricyclic antidepressants
- vancomycin
- Vitamin E
- warfarin
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.
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Dosage For Moderate To Severe Osteoarthritis
Adult dosage
- Immediate-release capsule: Indomethacin is usually dosed 2 to 3 times per day and starts at a dose of 25 mg. Your doctor may increase your dose by 25 mg or 50 mg per day. The maximum dose is 200 mg per day.
- Extended-release capsule: The dose is 75 mg once or twice per day. The maximum dose is 150 mg per day.
Child dosage
- Immediate-release capsule:
- Indomethacin dosing for children is based on weight. Your doctor will determine the right dose for your child.
- A starting dose may be 1 to 2 mg/kg per day divided into 2 to 4 doses.
- The maximum dose is 3 mg/kg per day or 200 mg per day, whichever is less.
Efficacy And Safety Evaluations
At baseline and 4 hours after the daily dose of study medication , patients assessed the level of pain in the joint identified as the primary study joint. Pain intensity in the study joint was rated by all patients on a 5-point Likert scale ranging from 0 = no pain to 4 = extreme pain. The primary efficacy end point was the patient’s assessment of study joint pain over days 2â5 of treatment.
The secondary efficacy end points over the entire treatment period included the patient’s assessment of pain in the primary study joint, the patient’s global assessment of response to therapy, the investigator’s global assessment of response to therapy, and the investigator’s assessment of tenderness and swelling of the study joint, as well as the proportion of patients who discontinued treatment because of a lack of efficacy. Prespecified exploratory analyses included the proportion of patients exhibiting erythema of the study joint and the onset of efficacy in terms of the pain score at 4 hours after the initial dose of study medication. The patient’s and investigator’s global assessments of response to therapy and the investigator’s assessments of study joint tenderness , swelling , and erythema were conducted on days 2, 5, and 8 during clinic visits.
Safety was monitored throughout the treatment period and for 14 days after study completion. Patients were instructed to report AEs at any time during the study and were queried about AEs during office visits on days 2, 5, and 8.
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What Side Effects Are Possible With This Medication
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- constipation
- general feeling of being unwell
- headache
- vomiting
- vertigo
A common side effect of nonsteroidal anti-inflammatory drugs is stomach upset. This can be minimized by taking the medication immediately after a meal, or with food or milk.
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Stop taking this medication and seek immediate medical attention if any of the following occur:
- signs of bleeding in the stomach or digestive system
- signs of a heart attack
- signs of stroke
- symptoms of a serious allergic reaction
How Indocin And Ibuprofen Are Different
One of the primary differences is how widely available Indocin and ibuprofen are. While anyone can purchase and take ibuprofen, your practitioner will need to write you a prescription for Indocin. Your healthcare provider may also recommend a high dose of ibuprofenmore than 400 mgwhich is available by prescription only.
Another major difference is in how often the medications have to be taken. Indocin is a long-acting medication that only needs to be taken once or twice per day. Many people like the convenience of only needing to remember one pill.
Ibuprofen, on the other hand, has to be taken three to four times per day, and your dose might involve multiple pills. However, some people like using an OTC medication to manage occasional flare-ups, without committing to taking a prescription medication daily.
While both Indocin and ibuprofen are used to treat osteoarthritisthe most common type of arthritisIndocin can also be used to treat gout, a form of arthritis characterized by acute episodes of intense swelling and pain in one or a few joints.
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Who Should Not Take This Medication
Do not take indomethacin if you:
- are or may be allergic to indomethacin or any ingredients of the medication
- have a history of asthma, itchy skin rash, or allergic reactions after taking ASA or other nonsteroidal anti-inflammatory drugs
- currently have or recently had inflammatory diseases of the stomach and intestines such as stomach or intestinal ulcer or ulcerative colitis
- have bleeding in the brain or other bleeding disorders
- have severe liver or kidney disease
- have severe uncontrolled heart failure
- have high blood levels of potassium
- have recently had heart bypass surgery
- are currently taking other NSAIDs
- are in the third trimester of pregnancy
- are breast-feeding
Do not use indomethacin suppositories if you:
The Protocol 049 Study Group
The following investigators are members of the Protocol 049 Study Group and enrolled patients: Robert Burton, MD , Michael Kohen, MD , Keith G. Pryhuber, MD , Vickie G. Parrish, MD , Ronald Rapoport, MD , Bernard R. Rubin, MD , Jerry L. Miller, MD , J. Scott Toder, MD , Albert J. Razzetti, MD , Shelly P. Kafka, MD , Maria Greenwald, MD , H. Malin Prupas, MD , Philip J. Molloy, MD , Jean Higashida, MD , Jerry Green, MD , Michael A. Borofsky, MD , Charles Birbara, MD , Peter J. Winkle, MD , Craig W. Wiesenhutter, MD , William Julius Shergy, MD , Maren L. Mahowald, MD , Douglas Lain, MD , Gail Kerr, MD , Peter A. Holt, MD , Philip Giordano, MD , Chester L. Fisher, MD , Walter F. Chase, MD , Guillermo Tate, MD , Sandra Navarra, MD , Joseph Antigua, MD , John Londoño, MD , Javier Basualdo, MD , Evelyn Osio-Salido, MD , Ricardo Fuller, MD , Diego Saaibi, MD , Louis Van Zyl, MD , Branca Dias Souza, MD , Philippe Chalem, MD , Helmuth Reuter, MD , Janitzia Vazquez-Mellado, MD , Andre Lubbe, MD , and Cesar Ramos Remus, MD .
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Who Can And Cannot Take Allopurinol
Allopurinol can be taken by adults and sometimes children.
Allopurinol is not suitable for certain people.
Talk to a doctor or pharmacist if you:
- have ever had an allergic reaction to allopurinol or any other medicine
- are of Han Chinese, Thai or Korean origin
- have problems with your liver or kidneys
- currently have an attack of gout
- have thyroid problems
Medication Options For Uric Acid Lowering
It is important to note that whenever starting a uric acid lowering treatment, there is a risk of precipitating a gout flare. A plan should be in place for management if this occurs. This generally can be avoided with the co-administration of prophylactic medications along with the uric acid lowering therapy.
Probenecid
Probenecid may be given to patients with decreased clearance of uric acid by the kidney and normal renal function. In general its use should be limited to patients under the age of 60. Probenecid acts by inhibiting reabsorption of uric acid in the proximal tubules of the kidney. Starting dose is at 500 mg to 1000 mg daily and increased to 1500 mg to 2000 mg as needed. Occasionally higher doses are needed. Probenecid may precipitate renal stone formation and good oral hydration should be encouraged. Probenecid is contraindicated in patients with renal stones and in patients with urate nephropathy. Probenecid given inappropriately to patients with hyperuricemia due to overproduction of uric acid can cause renal stones and urate nephropathy.
- uricosuric
- useful in patients with decreased renal clearance of uric acid
- can only be used if creatinine clearance > 40 cc/min
- must have 24 hour urine for uric acid < 800 mg/dl
- can be used in renal failure
- increased risk of renal stones
Allopurinol
Pegloticase
- pegylated porcine uricase
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Indomethacin May Interact With Other Medications
Indomethacin can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.
Below is a list of medications that can interact with indomethacin. This list does not contain all drugs that may interact with indomethacin.
Before taking indomethacin, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Rated For Osteoarthritis Report
Began taking Indocin at bedtime to control severe neck & shoulder pain with chronic muscle spasms. Worked wonders!! First time in over 3 years the pain is manageable, really almost gone!! Has improved my quality of life 100%. Am 65 with an active husband, 4 Gkids and still working. Can keep up with all of them!! So thankful for Indocin.
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What Is Indomethacin
Indomethacin is a medication used to treat various conditions by relieving the pain. It doesnt affect the condition itself, but rather the chemicals that are produced by the body in the joint and cause the inflammation. Less of that substance means less pain!
The medication has been used for treating gout, arthritis in general, tendonitis and many other conditions. It is useful and desirable because it also decreases joint stiffness and swelling besides the pain.
It is known as nonsteroidal anti-inflammatory drug or for those who like acronyms NSAID medication. The medication itself is commonly used by gout sufferers and it is very effective. It isnt a magical potion but it does help.
How To Take It
Swallow the allopurinol tablets with water, ideally after food. You’ll usually take it once a day, but if you’re on a high dose, your doctor may advise you to split the dose and take it twice a day.
If your doctor has recommended you take allopurinol with lots of fluid, try to drink 2 to 3 litres of fluids every day.
You can take allopurinol at any time of the day, however, try to take your doses at the same time of day each day.
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Indomethacin Or Naproxen: Which Is Better For Gout
Gout is a very costly condition. When I said costly, I am referring to the costly medicines that you will be needing to treat the condition. Well, if you will have gout, you will be able to spend a lot of money for the maintenance medicines. It is for a certain that the pain that the condition produces is more than enough. What more if the pain will be added to the pain in the pocket due to the medications?
The truth here is that, it isnt the cost of the medications that really matter here. Its their uselessness or ineffectiveness. Lets get this straight to the point: theres no medication that may help in treating gout. Nevertheless, there are various medications that may mask the pains, as well as the symptoms. Two of such medications are the indomethacin and the naproxen. The question here now is, which of them is really better when it comes to the management of the pain and the inflammation thats caused by gout?
Why Is This Medication Prescribed
Indomethacin is used to relieve moderate to severe pain, tenderness, swelling, and stiffness caused by osteoarthritis , rheumatoid arthritis , and ankylosing spondylitis . Indomethacin is also used to treat pain in the shoulder caused by bursitis and tendinitis . Indomethacin immediate-release capsules and suspension are also used to treat acute gouty arthritis . Indomethacin is in a class of medications called NSAIDs. It works by stopping the body’s production of a substance that causes pain, fever, and inflammation.
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Rated For Rheumatoid Arthritis Report
Ive been taking 50 mg 3x daily for about a year now and up until a couple of months ago I was totally fine taking indometachin. I never had any side effect but then one day while I was at my nightly yoga class I suddenly felt so ill and drowsy. I had to rush home to lie down because I thought I was going to pass out! It makes me feel high but definitely not in a nice way, it makes me feel like I have no control over my body. It does work really well for my joint pain. I notice a huge difference in how stiff I am. I stopped taking it now due to the side effects and am using naproxen, I do believe indometachin works better! So definitely try it and see if it works for you!
Indomethacin May Cause Side Effects Tell Your Doctor If Any Of These Symptoms Are Severe Or Do Not Go Away:
- headache
- difficult or painful urination
- blurred vision or other problems with sight
Indomethacin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s MedWatch Adverse Event Reporting program online or by phone .
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The Mechanism Of Action Of Indomethacin And Naproxen
Now lets delve deeper and analyze these two medications. How do they really work? What causes all of their side effects?
Different from the other medications out there, the side effects of the NSAIDs may be explained through thorough studying of their own mechanisms, not just by staring at the numbers of the patients that fell prey to their own side effects.
NSAIDs hinder the production of the cyclooxygenase enzymes, which are accountable for the conversion of the arachidonic acids into prostaglandins. Meanwhile, since the prostaglandins are the ones accountable for the pain and inflammation as their defense mechanisms, youll not experience any pain and swelling when it isnt produced. Unluckily, this may leave the body susceptible to attacks. For short, taking either of the two medications may cause the suppression of the immune system hence leaving you unprotected against bacteria, viruses and some other foreign entities. This is particularly true when it comes to indomethacin, because indomethacin mutilates the white blood cells so itll not respond to any foreign invasions and will consequently not cause any pain.
Finally, all the NSAIDS cause gastrointestinal bleeding and peptic ulcer because the prostaglandins are also accountable for the mucus lining maintenance of the stomach. If you are going to disable the production of the prostaglandins, you will be disabling the maintenance of the mucus lining finally leading to an ulcer or even in bleeding.