Indomethacin side effects
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Indomethacin Side Effects: Overview and Key Risks
Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is widely used for pain and inflammation but is associated with a range of side effects affecting multiple organ systems and patient groups 14510.
Central Nervous System and Psychiatric Side Effects
Indomethacin is known for causing central nervous system (CNS) side effects more frequently than other NSAIDs. These can include dizziness, anxiety, agitation, affective lability, depersonalization, paranoia, hallucinations, and even psychosis. Such psychiatric reactions have been observed in postpartum women, elderly patients, and those receiving high doses, and can occur even after a single dose. These symptoms are generally reversible upon stopping the drug 123689. Rarely, indomethacin can also cause myoclonus (involuntary muscle jerks) .
Gastrointestinal and Colonic Side Effects
Gastrointestinal side effects are common and can be severe. Patients may experience nausea, upset stomach, diarrhea, constipation, stomach pain, and, in some cases, gastrointestinal bleeding or colitis. Indomethacin can damage the mucosal lining of the gastrointestinal tract, leading to inflammation, ulceration, and even colonic shrinkage and edema. These effects have been observed in both human and animal studies 1410.
Renal, Hepatic, and Hematological Effects
Indomethacin can negatively impact kidney and liver function. It may cause increased blood urea nitrogen, serum creatinine, and reduce urine output, indicating renal toxicity. There can also be a reduction in platelet count, which increases the risk of bleeding. These side effects are particularly concerning in vulnerable populations such as preterm neonates, where indomethacin has been shown to have more adverse effects on renal function and platelet count compared to alternatives like paracetamol 510.
Skin and Allergic Reactions
Skin-related side effects include rashes, urticaria (hives), and purpura (small blood spots under the skin). These reactions are less common but can occur as part of the drug’s side effect profile .
Headache as a Side Effect
While indomethacin is often used to treat headaches, it can paradoxically cause headaches in some patients. This has been documented in cases where indomethacin treatment for one type of headache led to the development of a different headache, which resolved after stopping the drug .
Mechanisms and Risk Factors
The severity and frequency of indomethacin side effects can be influenced by factors such as dose, patient age, postpartum status, and pre-existing health conditions. Some CNS effects may be related to peak drug levels in sensitive individuals, and the risk of psychiatric symptoms may be higher in certain populations 2389.
Conclusion
Indomethacin is effective for treating pain and inflammation but carries significant risks of side effects, especially affecting the central nervous system, gastrointestinal tract, kidneys, liver, and skin. Psychiatric and neurological side effects, while less common, can be severe and require prompt recognition and management. Alternative medications may be preferable in high-risk groups or when side effects occur.
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