Indomethacin Suppositories: Formula, Presentation, Indications, Action Mechanism, Dosage and Side Effects

It is used to relieve pain, hypersensitivity, and swelling caused by various conditions.

They belong to the group of non-steroidal anti-inflammatory drugs.

Indomethacin can cause severe cardiovascular and gastrointestinal problems.

Indomethacin in suppositories can cause an increased risk of severe and sometimes fatal problems of the heart and blood vessels.

This risk can be even greater if you already have heart problems or have taken it for a long time.

Indomethacin suppositories should not be used just before or after heart bypass surgery.

Chemical formula

  • C19H16ClNO4.


  • This medicine comes in oral suspension, extended-release capsule, and rectal suppository forms.


Indomethacin suppositories are a prescribed medication that is most commonly used to relieve moderate to severe pain, tenderness, and swelling caused by various conditions.


Indomethacin treats moderate to severe rheumatoid arthritisosteoarthritis, and ankylosing spondylitis.

It is also used to treat gout or certain bursitis and tendonitis.

Mechanism of action

Indomethacin belongs to a group of medications called nonsteroidal anti-inflammatory drugs.

Indomethacin exerts its mechanism by peripheral action since it inhibits the synthesis of prostaglandins; it can also inhibit leukocyte migration to inflamed areas.

This action that exerts against inflammation can contribute to the analgesic effect.

This drug works by stopping the symptoms of fever, pain, and inflammation.


In your presentation of rectal suppositories, this medicine and the dose will depend on the disease for which the treatment and the patient’s response are recommended.

The recommended dose for indomethacin treatment is:

  • For moderate to severe rheumatoid arthritis treatment, 25 to 50 mg should be used every eight to twelve hours a day.
  • The recommended dose for shoulder bursitis and tendonitis treatment is 75 to 150 mg per day, dividing the treatment every eight or six hours a day. This therapy should generally be extended from 7 to 14 days.
  • For the treatment of acute gouty arthritis, the recommended dose is 50 mg every eight hours.

These doses are recommended for adults and children over 14 years of age; in children under 14 years of age, their use and dosage must be supervised by a doctor.

The use of indomethacin suppositories should be done as directed by your doctor.

To place the indomethacin suppositories, you must:

  • Wash hands before and after using indomethacin suppositories.
  • If the suppository is too soft to use, it should be placed in the refrigerator for approximately 15 minutes. It can also be placed in cold water or ice.
  • The wrap is removed, the suppository is moistened with cold water, and lying on its side, the pointed end of the suppository is inserted into the rectum. I am using my finger to push it ultimately.
  • If a dose of indomethacin suppositories is missed and this is taken regularly, the amount should be placed as soon as possible. If when it is remembered that a dose has not been taken, only one hour is missing, the missed dose must be omitted, and the regular dosing schedule returned.

Side effects

Along with the necessary effects, a medication can cause some unwanted effects.

Serious side effects have been reported with the treatment of indomethacin suppositories, which include the following:

The less common symptoms are:

  • Stomach acidity
  • Belching
  • Diarrhea
  • Indigestion.
  • Nausea
  • Stomach discomfort or pain
  • Upset and vomiting.

The rare symptoms are:

  • Abdominal or stomach cramps.
  • Burning or sensitivity
  • The pains in the back.
  • The bleeding of the gums.
  • Blisters
  • Flaking or loosening of the skin.
  • Presence of stools with blood or black.
  • Lips and cyanotic nails.
  • Blurry vision.
  • Ardor.
  • Tingling sensation.
  • Canker sores.
  • Changes in consciousness and hearing.
  • Urine is cloudy or bloody.
  • Diarrhea.
  • Cough is sometimes accompanied by foamy pink sputum.
  • Hoarseness
  • Dry mouth.
  • Decreased appetite.
  • Decreased vision
  • Depression .
  • Difficult breathing
  • Difficulty in swallowing.
  • The vein of the neck dilated.
  • Dizziness
  • Fainting or stunning when suddenly rising from a lying or sitting position.
  • Double vision.
  • Extreme fatigue
  • False sense of well-being and feeling of unreality.
  • Fever with or without chills.
  • General swelling of the body.
  • Decrease in the frequency of urination or amount of urine.
  • Hair loss.
  • Headache.
  • Rochas
  • Itchy skin or rash.
  • Increased sweating and thirst
  • Irregular breathing
  • Irritation and swelling of the eye.
  • Sudden movements of the head, face, mouth, and neck.
  • Pain in the joints.
  • The face, eyelids, lips, tongue, throat, hands, legs, feet, or sexual organs are swelling.
  • Loss of balance control.
  • I heard loss.
  • Loss of body heat.
  • Mental confusion and mood swings
  • Muscle aches or weakness.
  • Muscle spasm or jerking of all limbs, nervousness.
  • Nasal hemorrhages.
  • Numbness or tingling in the hands, feet, or lips.
  • Pain in the ankles or knees.
  • Pain or discomfort in the upper part of the stomach or throat.
  • Convulsions
  • Severe constipation
  • The rigidity of arms and legs.
  • Swollen or painful glands
  • Unusual bleeding or bruising
  • Vaginal bleeding
  • Black vomiting
  • Frequent urge to defecate.
  • Rectal bleeding.

Some side effects do not require medical attention because they can disappear while the treatment lasts.

As the body adapts to the medication, there are ways to prevent or reduce some of these side effects.

Warnings and contraindications

This medicine may increase your risk of having a heart attack or stroke. This is more likely in people who already have heart disease. People who use this medication for a long time may also have a higher risk.

This medicine can cause bleeding in the stomach or intestines. These problems can occur without warning signs. This is more likely if you have had a stomach ulcer in the past, if you smoke or drink alcohol regularly, are over 60 years of age, or are using certain other medications.

This medicine can also cause a severe type of allergic reaction called anaphylaxis. Although this is rare, it can occur more frequently in patients allergic to aspirin or any non-steroidal anti-inflammatory drugs.

Anaphylaxis is an allergic reaction that requires immediate medical attention because it can endanger the patient’s life.

The most severe signs of this reaction are very rapid or irregular breathing, difficulty breathing, or fainting.

Other signs may include changes in facial skin color, swift but irregular pulse or heartbeat, swelling in the form of a hive on the skin, and swelling of the eyelids or around the eyes.

If these effects occur, emergency help should be obtained.

The use of this medication during pregnancy can harm the unborn baby.

So it may not be administered during pregnancy or when its existence is suspected.

This medicine can also cause a delay in women’s ovulation and can affect a woman’s ability to have children.

This medicine may cause dizziness, lightheadedness, or less alertness than usual.

Even if used at bedtime, it can cause some people to feel drowsy or less alert when getting up.

So you should not drive cars, use machines or equipment, or perform tasks that involve some danger if the patient is not alert.

This medication should not be administered before undergoing surgery or medical exams. The doctor should be informed that this medication is being used.

You may need to stop the treatment or switch to a different non-steroidal anti-inflammatory drug before the procedure.

Indomethacin suppositories are contraindicated in the following cases:

  • If the patient is allergic to indomethacin or any other ingredient present in the suppositories.
  • If the patient has had a severe allergic reaction, such as severe rash, hives, shortness of breath, dizziness, aspirin, or non-steroidal anti-inflammatory drugs such as ibuprofen or celecoxib.
  • If the patient has had or will have bypass surgery recently.
  • If the patient has a history of inflammation of the rectum or anus or recent rectal bleeding.
  • If the patient is taking diflunisal or triamterene.
  • If the patient is pregnant, especially during the last three months of pregnancy.
  • If the patient has a history of kidney or liver disease, diabetes, or stomach or intestinal problems such as bleeding, perforation, ulcers, or inflammation.
  • If the patient has a history of swelling or fluid accumulation, depression, mental or mood problems, seizures, Parkinson’s disease, asthma, growths in nasal polyps, or inflammation of the mouth.
  • If the patient has high blood pressure, a blood disorder, bleeding or clotting problems, heart problems such as heart failure or blood vessel disease, or if you are at risk of any of these diseases.
  • If the patient is not in good health, has dehydration or a low volume of fluids, low sodium levels or high potassium levels in the blood, or has a history of alcohol abuse.
  • Indomethacin suppositories are contraindicated to treat perioperative pain in coronary artery bypass surgery.


Some medications may interact with indomethacin suppositories, such as:

    • Anticoagulants ( Warfarin ), corticosteroids ( Prednisone ), diflunisal, heparin, other non-steroidal anti-inflammatory drugs (Ibuprofen), salicylates (Aspirin) or selective serotonin reuptake inhibitors (Fluoxetine), since stomach bleeding may be increased.
    • Potassium-sparing diuretics (Spironolactone, triamterene) may increase the risk of kidney problems or increase potassium levels in the blood.
    • Cyclophosphamide because low levels of sodium can occur in the blood.
    • Probenecid may increase the risk of side effects of indomethacin suppositories.
    • Angiotensin-converting enzyme (enalapril) inhibitors, angiotensin receptor blockers (Losartan), beta-blockers (Propranolol), or diuretics (for example, furosemide, hydrochlorothiazide), because indomethacin may decrease its effectiveness.