--> pain medication management --> indocin


Indomethacin is an analgesic (pain reliever), anti-pyretic (fever reducer) of the NSAID (non-steroidal anti-inflammatory) class which exerts its pharmacological effect by non specific prostaglandin inhibition in peripheral tissues which mediate inflammation and desensitizes afferent nerves (nerves providing information to the brain) thus preventing the potential effect of bradykinin (a chemical that conveys pain) to induce pain. The drug is indicated for long-term use in rheumatoid arthritis (RA), ankylosing spondylitis, and osteoarthritis (DJD).

The response in RA is manifested by pain relief, reduction of fever, swelling, joint tenderness, and morning stiffness. The benefit of adding indomethacin to the RA regiment is reduction in steroid usage in some cases.

Its anti-inflammatory and analgesic effects provide relief for the acute gout patient during attack. Gout, the precipitation of uric acid crystals in the joints, usually of the lower extremity especially the large toe and ankle joints, is a very painful ‘overnight ,waking up to morning pain’ usual presentation. It is characterized by swelling, erythema (heat), very guarded rom (range of motion) on exam, compensated gait.)

As with all pain medication, the lowest possible effective dose should be started, and adjusted to both subjective(patient response) and objective(observed in examination) for the shortest time necessary.


Indomethacin is indicated for:

-moderate to severe RA including acute flare-ups of chronic stages

-moderate to severe ankylosing spondylitis

-moderate to severe DJD

-acute should pain (bursitis, tendonitis)

-acute gouty arthritis


The initial dose of 25-50mg orally is absorbed achieving blood levels in two hours. The drug crosses the blood/brain barrier and placenta, and is NOT RECOMMENDED IN PREGNANT OR BREAST FEEDING WOMEN.

The drug should be avoided in patients with history of easily precipitated severe asthmatic attacks, urticaria( significant rash with itching), or those patients with aspirin or allergy to any other NSAID. It is NOT for use in post-operative patients, especially in those who have undergone coronary artery bypass grafts(CABG) due to its anti-platelet activity and increased bleeding time. The suppository form of the drug should be avoided in patients with rectal bleeding or proctitis.


Indomethacin along with many NSAIDs, even the COX-2 inhibitors (celebrex), may increase the risk of severe cardiovascular events such as stroke(CVA), myocardial infarction(MI-heart attack), worsened hypertension(high blood pressure) or may precipitate high blood pressure. Patients on loop (furosemide) or thiazide (hydrochlorothiazide, chlorothiazide) diuretics may experience a reduced effect in urinary excretion due to the concomitant use of indomethacin.

Through its mechanism of prostaglandin inhibition, necessary for cardiovascular compensation mechanisms, the drug may aggravate congestive heart failure or induce hyponatremia (reduced plasma sodium level concentrations). With the non specific inhibition(COX 1&2), there is increased risk of gastrointestinal problems, such as bleeding, ulceration, perforation, which is additive when aspirin , corticosteroids are used along with patients who smoke and drink alcohol. The risk is elevated in the elderly, debilitated patient and is also a function of duration of the drug. IT SHOULD BE AVOIDED IN PATIENTS ON ANTICOAGULANT MEDICATION.

Long term use may lead to renal(kidney) disease especially in those patients with established reduced renal clearance, heart failure, liver dysfunction, and dehydration. Serum potassium (K+) may be elevated in the hyponatremia (low sodium) patient. Anaphylactic (sudden) and fatal allergic reactions may occur in patients a history of rhinitis(significant nasal inflammation) nasal polyps, and bronchospasms, skin reactions such as exfoliate dermatitis(severe shedding of skin),Stevens-Johnson Syndrome(SJS) with severe redness of the skin, edema) may occur and the medication should be immediately discontinued and proper supportive therapy initiated. Corneal, retinal, and macula changes with blurred vision may occur with prolonged therapy of indomethacin., CNS-central nervous system depression and various psychiatric problems, epilepsy and Parkinson’s may be aggravated by the drug, headaches and drowsiness may occur.

Drug interactions may occur in those patients also taking various medications-

Anti-hypertensive-reducing the blood pressure effect

ACE- inhibitors, angiotensin II antagonists, Beta-blockers

Aspirin- reduces the effects of indomethacin due to common protein binding sites

Diflunisal, another anti-inflammatory similar to aspirin, will reduce the clearance of indomethacin, and thus increasing plasma levels.

Digoxin, a cardio tonic medication, will have increased half –life, thus providing enhanced reactions possibly harmful

Diuretics efficacy are reduced with indomethacin

Lithium, a medication used in various psychiatric conditions, (whose blood concentration must be closely monitored,) clearance is reduced, thus elevating plasma concentration to possible toxic levels.

Indomethacin is contraindicated in patients less than 14 years of age, and in those patients, especially aging with comorbidities of the renal, gastric or hepatic system should be monitored closely with possible reduction in dosage.


Indomethacin is available in oral capsular form in 25 and 50mg and oral suspension of 25mg/5cc (teaspoonful) or rectal suppository of 75mg. The usual dosage prescribed is 25-50mg po(orally) tid(3 times daily) pc (after meals) for moderate to severe pain relief of RA, DJD, ankylosing spondylitis up to 150-200mg/day. For painful acute bursitis/tendonitis , doses of 75-150mg daily in 3-4 divided doses is beneficial. The drug is also available for injection.


PDR, Physicians’ Desk Reference, 61st edition, 2005

MPR, Monthly Physician Reference

‘Conquering Pain’, Institute for Natural Resources, First edition (02-11)


As a physician, my patient population usually presents with tendonitis, bursitis, and acute gout. It is my drug of choice, for those not taking anticoagulants (blood thinners) or history of gastric disease (ulcers, gastritis). For acute gout and dosed at 50mg by mouth three times per day x 3 days then 25mg by mouth three times per day for 7-10days it provides excellent relief and is usually tolerated very well. Similar favorable responses occur for acute painful ankle sprains and lower extremity tendon problems.



Mayo Clinic


See our other pain medication discussions.

ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis. Jennifer

Hunterville, NC
….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!


I am really, really impressed with your plain-speak explanations for the various conditions.


This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..


A well organized site containing much information written in a manner that the average reader can comprehend.


Ontario, Canada
I found your website and articles most interesting.


Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.


(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.


New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.


Memphis, TN
Thanks again so much for the information in the article. Very interesting.


Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Thanks for the Response, you hit it on the head.


Redondo Beach, CA
Thank you for your time and expertise in answering my question…..


(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….


(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....


Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,


West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....


Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624

Thanks for a most interesting website, which has helped a lot.



Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.


Dragica W.


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!


South Africa

You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT

First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.


Placentia, California

First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)


Unknown location

I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location

I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA

I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,


Alameda, California

By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!


Thank you for your very interesting and informative site!


Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN

Thanks very much for the wonderful informative site.


New Zealand

Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!



Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

I searched the internet everywhere for a clear description and illustration of my symptoms/problem. https://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

1st of all THANKS A LOT for your great site......


Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!


South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....


unknown location

...Thanks for your fantastic service.


Arlington, VA

Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA

Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!


location unknown

Great insights! Thanks Doc, you're the best.


location unknown

I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.


location unknown

Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.


Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!


Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.



Thanks for taking time to read and answer so many questions. It is truly a public service!


Seattle, WA

I just wanted to say that I am very greatful for this website!!


location unknown

Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.


New Jersey

Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.


location unknown

Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.


location unknown

Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!


Evansville, IA

Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown

Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.


location unknown

Thank you very much for the information, I will consider it. Excellent web site.


San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!


Albany, NY

Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown



Whichita, KS

thanks again, this site is very helpful.


Boston, MA

Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.



Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.



Wonderful advice

by: Anonymous

This is the best site for foot problem info.

Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......


location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!


Thank you for your response. You have provided some great insight (to my question)....


location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!


North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...


location unknown

Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.


New Jersey

Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown

I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!


Lenoir, NC

Thank you so much Doc for a quick and thorough response!


Bellevue, WA

I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!


location unknown