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Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug (NSAID) that requires careful consideration due to potential risks and precautions. The following safety information outlines critical warnings and instructions for safe use.

• Heart Risks: Indomethacin may elevate the risk of heart attack or stroke, particularly with prolonged use or in individuals with existing heart conditions or risk factors such as smoking, high blood pressure, or diabetes. It should not be used immediately before or after heart bypass surgery (CABG). If you experience chest pain, shortness of breath, or difficulty speaking, seek emergency help immediately.

• Stomach and Intestinal Bleeding: This medication can cause serious, sometimes fatal, stomach or intestinal bleeding or ulcers without warning. Older adults and those with a history of ulcers or bleeding disorders are at greater risk. Contact a healthcare provider if you experience persistent stomach pain, bloody stools, or vomit resembling coffee grounds.

• High Blood Pressure and Heart Failure: Indomethacin can increase blood pressure and risk heart failure by causing fluid retention. Inform your provider if you have a history of heart problems or are taking blood pressure medications.

• Liver Concerns: Rarely, indomethacin may cause serious liver issues leading to liver failure. Seek immediate medical attention if you notice symptoms such as yellowing of the skin or eyes, dark urine, or severe abdominal pain.

• Kidney Damage and Potassium Levels: This drug can impair kidney function, especially in individuals with pre-existing kidney conditions or those on certain blood pressure medications. Monitor for changes in urination frequency and consult with your healthcare provider about risks and benefits if you have severe kidney issues.

• Allergic Reactions: Severe allergic reactions, including anaphylaxis, can occur. Do not use if you have a known allergy to aspirin or other NSAIDs. Seek emergency help if you experience hives, swelling, or difficulty breathing.

• Asthma Considerations: Indomethacin may provoke severe asthma attacks in individuals with existing asthma or allergies to NSAIDs. Avoid use if you have a history of asthma exacerbations following NSAID use.

• Nervous System and Mental Health: This medication may exacerbate certain neurological or mental health conditions, such as epilepsy or depression. Report any new or worsening symptoms to your healthcare provider.

• Pregnancy Warning: Indomethacin can harm an unborn child and complicate delivery if used during the second half of pregnancy. Discuss potential risks and alternatives with your provider if you are pregnant or plan to become pregnant.

• Contraindications: Do not use indomethacin if you have had allergic reactions to aspirin or other NSAIDs, or if you are recovering from or preparing for coronary artery bypass graft surgery.

Always consult with a healthcare provider to fully understand the risks and benefits of using indomethacin and to ensure it is safe based on your personal health history.

When taking this medication, it's common to experience mild side effects such as headache, nausea, upset stomach, and dizziness. These effects are generally not severe, but if they persist or worsen, consulting your healthcare provider is advisable. Other possible, though less common, side effects include diarrhea, constipation, stomach pain, drowsiness, and tinnitus (ringing in the ears). Monitoring your blood pressure is recommended, as the medication may cause an increase.

Serious side effects, although rare, require immediate medical attention. These include signs of stomach bleeding, such as feeling faint, vomiting blood, or having bloody or dark stools, as well as severe stomach pain. Symptoms of heart attack or heart failure, such as chest pain, breathing difficulties, swelling, or rapid weight gain, also necessitate urgent care. Stroke indicators like sudden confusion, trouble breathing, weakness on one side of the body, or slurred speech are critical signs to watch for.

This medication may also adversely affect the liver or kidneys, potentially leading to severe outcomes like liver failure or significant kidney problems. Signs of liver issues include swelling of the stomach, yellowing of the skin or eyes, confusion, and dark urine. Kidney problems might manifest as tiredness, itchy skin, reduced appetite, decreased urination, foamy or bloody urine, and muscle cramps.

Allergic reactions to this drug are rare but serious, with symptoms such as hives, rash, blisters, swelling of the lips or tongue, and breathing difficulties. Additionally, severe skin reactions like reddening, peeling, and blistering warrant immediate medical help. If you notice any side effects not listed here, contact your healthcare provider for advice.

Indomethacin (Indocin) can interact with various medications, so it's important to inform your doctor and pharmacist about all the medicines you are taking, including prescription, over-the-counter, vitamins, and herbal supplements. Some interactions may require changes in medication or dosage.

1. Bleeding Risk: Indomethacin may increase bleeding risk if taken with anti-platelet drugs like clopidogrel or blood thinners such as dabigatran, enoxaparin, and warfarin. It is vital to monitor for signs of bleeding and consult your doctor for guidance.

2. Similar Medications: Avoid using indomethacin with other pain relievers or fever reducers like aspirin and NSAIDs (e.g., ibuprofen, ketorolac), as they can amplify side effects. However, if you are on low-dose aspirin (81-162 mg/day) for heart protection, continue taking it unless advised otherwise by your doctor.

3. Kidney Impact and Blood Pressure: Medications such as ACE inhibitors (e.g., captopril, lisinopril), angiotensin II receptor blockers (e.g., valsartan, losartan), and diuretics (e.g., furosemide) may interact with indomethacin, potentially affecting kidney function and blood pressure. Your doctor may adjust doses accordingly.

4. Lithium and Methotrexate: Indomethacin can increase the levels of lithium and methotrexate in the blood, leading to toxicity. Regular monitoring and dose adjustments might be necessary.

5. Corticosteroids Interaction: Using indomethacin with corticosteroids such as prednisone may increase the risk of gastrointestinal issues. Discuss any concerns with your healthcare provider.

6. Laboratory Tests: Inform lab personnel that you are taking indomethacin as it may interfere with certain lab tests, causing inaccurate results.

Always consult your healthcare provider before making any changes to your medication regimen to ensure safe and effective treatment.