Updated: January 25, 2026
What Is Indomethacin? Uses, Dosage, and What You Need to Know in 2026
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Peter Daggett
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Overview
Indomethacin is a potent prescription NSAID used for gout, arthritis, and pain. Learn how it works, what it treats, dosage forms, and important safety information.
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Indomethacin is a prescription nonsteroidal anti-inflammatory drug (NSAID) that has been used in medicine since 1963 — making it one of the oldest and most studied NSAIDs available. Despite its age, it remains a go-to treatment for certain painful conditions, particularly acute gout and ankylosing spondylitis, because of its exceptional potency. This guide covers everything you need to know about indomethacin in 2026.
What Is Indomethacin Used For?
The FDA has approved indomethacin to treat:
Moderate to severe acute pain in adults
Rheumatoid arthritis (though DMARDs are generally preferred for disease modification)
Osteoarthritis (the most common form of arthritis)
Ankylosing spondylitis (inflammatory arthritis of the spine)
Acute gouty arthritis (gout attacks) — one of its most common uses
Bursitis and tendinitis (inflammation of bursa sacs and tendons, especially in the shoulder)
Patent ductus arteriosus (PDA) (IV form only, for premature infants weighing 500-1,750 grams)
Indomethacin is also sometimes used off-label for pericarditis, reactive arthritis, certain headache syndromes (hemicrania continua, paroxysmal hemicrania), and Bartter syndrome.
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Brand Names and Generic
The original brand name Indocin is no longer commercially available in the United States. Tivorbex (a 20 mg and 40 mg formulation specifically for acute pain) remains available. Today, nearly all indomethacin prescriptions are filled with generic versions. Common generic forms are manufactured by Glenmark, Lannett, and other companies.
Dosage Forms and Strengths
Indomethacin is available in several forms:
Oral capsules: 25 mg and 50 mg (immediate-release) — most widely available
Extended-release capsules: 75 mg (Indocin SR formulation; now generic) — once-daily dosing; not recommended for acute gout
Tivorbex capsules: 20 mg and 40 mg — specifically for mild-to-moderate acute pain; taken with food
Oral suspension: 25 mg/5 mL — very limited supply; for patients unable to swallow capsules
Rectal suppository: 50 mg — extremely limited commercial availability; specialty pharmacy may be needed
Intravenous injection: 1 mg — hospital use only for neonatal PDA closure
Typical Dosages
Your dose will depend on your condition and your doctor's assessment. General ranges:
Arthritis / chronic pain: 25-50 mg two to three times daily (max 200 mg/day); or 75 mg ER once daily
Acute gout: 50 mg three times daily for 3-5 days, then reduced once pain is controlled
Ankylosing spondylitis: 75-150 mg/day in divided doses; continuous use often recommended to slow disease progression
Tivorbex (acute pain): 20 mg three times daily or 40 mg two to three times daily
How Should I Take Indomethacin?
Always take with food, milk, or antacids to reduce stomach irritation
Swallow extended-release capsules whole — do not crush, chew, or open
Take the lowest effective dose for the shortest time necessary
Do not take with other NSAIDs (ibuprofen, naproxen, aspirin) unless your doctor specifically directs you to
Avoid alcohol — it increases the risk of stomach bleeding
Who Should NOT Take Indomethacin?
People with a history of aspirin- or NSAID-induced asthma, urticaria, or anaphylaxis
Patients undergoing or recovering from CABG (heart bypass) surgery
Pregnant women at 30 weeks gestation or later (can cause fetal complications)
Patients with active stomach ulcers or recent GI bleeding
For a complete overview of side effects and warnings, see our detailed guide on Indomethacin side effects.
Frequently Asked Questions
Yes — indomethacin is generally considered more potent per milligram than ibuprofen. It has stronger COX inhibition and a more pronounced anti-inflammatory effect, which is why it's preferred for severe conditions like acute gout. However, its greater potency also comes with a higher rate of side effects, particularly GI and CNS effects.
Indomethacin typically begins reducing gout pain within 2-4 hours of the first dose. Most patients experience significant relief within 24 hours. A typical course for acute gout is 3-5 days at 50 mg three times daily, with the dose reduced once acute pain resolves.
Both. Indomethacin is an analgesic (painkiller), anti-inflammatory, and antipyretic (fever reducer). It works by blocking COX enzymes that produce prostaglandins — chemicals responsible for pain, inflammation, and fever. It treats the underlying inflammation rather than just masking pain.
No. Indomethacin is available by prescription only in the United States. Unlike ibuprofen and naproxen, which are available OTC at lower doses, all formulations of indomethacin require a valid prescription from a licensed healthcare provider.
Both are immediate-release oral capsules. The 50 mg capsule delivers twice the dose per capsule. Your doctor will determine the appropriate strength and frequency based on your condition. For many arthritis conditions, 25 mg twice or three times daily is the starting dose, with increases as needed. For acute gout, 50 mg three times daily is the typical regimen.
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