Is Your Indomethacin Dosing Safe for Gout?

I am reviewing indomethacin dosing following my recent review of colchicine.

Though both are used to combat gout pain during acute attacks, they work very differently. They have different effects on pain and different side effects on the rest of the body.

I cover the individual effects in the relevant guidelines, but today I want to focus on common safety issues.

I am using indomethacin as an example of a Non-Steroidal Anti-Inflammatory Drug (NSAID). Everything I say about indomethacin applies to any NSAID, but I have selected indomethacin as one of the most prescribed drugs for gout pain.

Here is a list of NSAIDs. New ones may have been added since this was prepared, so please check the labels of all medicines you are taking.

Alphabetic list of NSAIDs
Generic Name Tradename
Celecoxib Celebrex
Diclofenac Cataflam, Voltaren, Arthrotec (combined with misoprostol)
Diflunisal Dolobid
Etodolac Lodine, Lodine XL
Fenoprofen Nalfon, Nalfon 200
Flurbiprofen Ansaid
Ibuprofen Motrin, Tab-Profen, Vicoprofen* (combined with hydrocodone), Combunox (combined with oxycodone)
Indomethacin Indocin, Indocin SR, Indo-Lemmon, Indomethegan
Ketoprofen Oruvail
Ketorolac Toradol
Mefenamic Acid Ponstel
Meloxicam Mobic
Nabumetone Relafen
Naproxen Naprosyn, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprapac (co-packaged with lansoprazole)
Oxaprozin Daypro
Piroxicam Feldene
Sulindac Clinoril
Tolmetin Tolectin, Tolectin DS, Tolectin 600

If you are taking any of the above NSAIDs to cure gout pain, please take note of the safety issues.

Safe Indomethacin Dosage

The prescribing information for indomethacin dosage is clear:

Do not exceed 50mg three times per day, and stop taking as soon as gout pain is tolerable.

In addition to the daily dose of indomethacin during a gout attack, we must also consider the period of time that you take indomethacin. Why is this important? I can do no more than reproduce the warning that accompanies all NSAIDs:

Cardiovascular Risk

  • NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at a greater risk.
  • Indomethacin is contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery

Gastrointestinal Risk

  • NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events.

Safe Indomethacin Dosing

I’m using the term dosing to describe the entire period of time that you take indomethacin for.

I covered important issues about the inappropriate use of colchicine when I wrote about the high cost of Colcrys. Though the cost issues are important for most gout patients, the health issues are important for everyone.

Whether it is colchicine or NSAIDs such as indomethacin, there are stark warnings against long-term use. Even if there were not, the dangers of not treating high uric acid are extremely serious for gout sufferers. Though pain relief is important, without tackling the underlying cause, excess uric acid, the gout attacks will get worse. Each flare will last longer, be more frequent, and spread to more joints. If that were not bad enough, the uric acid deposits affect bone, cartilage, and tendons so that your joints crumble and you suffer the permanent pain of osteoarthritis.

Some gout patients can identify the cause of excess uric acid early, and make changes to prevent further attacks. In that event, long-term dosing of indomethacin never becomes an issue. However, most gout sufferers cannot control gout so easily. Those that delay treating uric acid are in for the triple whammy of:

  1. Gout flares become longer, more frequent and affect more joints
  2. Uric acid crystals cause permanent joint destruction
  3. Indomethacin or other NSAIDs raise the risk of heart disease, stroke, and stomach ulcers
Which NSAID for Your Gout?

Indomethacin Dosing for Your Gout

Indomethacin dosing, after two or three gout attacks, should be restricted to preventing attacks during the first six months of uric acid lowering therapy.

Set your maximum uric acid target at 5mg/dL, and agree on a treatment plan with your doctor. If you have had gout for more than a year, you should set a starting target below 5mg/dL. This will help dissolve uric acid crystals quicker and shorten the time that you are at risk of gout attacks. You might need indomethacin or other pain relief until most of the old crystals have dissolved, so discuss the pain relief treatment with your doctor at the same time.

If you have arranged an effective indomethacin gout treatment plan with your doctor, please share your experience. You can also ask any questions about indomethacin dosage for gout in the gout forum.

Leave Is Your Indomethacin Dosing Safe to browse the Indomethacin Dosage for Gout guidelines and related information.

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