Indomethacin -- Is it really that bad?

Factual Questions
1

Inspired by this thread’s question.

I have a tendency to get mild tendinitis in my right hand/wrist, no matter how careful I am WRT posture, so, when I get pain in my wrist, I usually reach for Vantelin brand pads. I had never heard of the active ingredient in them, indomet(h)acin, so I looked it up online and learned that, according to Wikipedia, it is only available by prescription in the US and, apparently, has a huge list of associated side effects including hearing loss, psychosis, life-threatening(!) shock, and hepatitis! They really work wonders for pain, but am I really subjecting myself to danger? Or is this another case of the Internet over-informing and making everything on God’s Green Earth™ seem horrible and deadly?

2

I prescribe indomethacin fairly regularly. And the only problem I see associated with it is GI-related: Stomach upset. If I’ve someone who will be on it regularly long-term, I usually put them on a medication like ranitidine or omeprazole to reduce the risk of GI bleeding. And I insist they take it with food, and report any signs of bleeding into the gut like frank blood or black stools.

All the other side-effects are quite uncommon, and generally shared by other commonly used drugs like ibuprofen and naproxen.

3

Okay, good, that puts me at ease.

The pads I use are strictly topical, 1% (1g per 100g pad), so I imagine the effect on my GI would be less than an oral dosage. Does anybody know why indomethacin is prescription only in the US? The stuff is absolutely amazing.

Is this just a case of the FDA being overly cautious as usual? I find that several things that are prescription-only in the US are fairly common OTC medications in Japan, for better or for worse, and I can only assume it is just that the FDA is strict.

4

Oh, you’re using topical indomethacin! Well, then your risk is far far lower than that of one taking it orally.

Can’t answer the FDA question, other than to say that yes, the FDA is stricter on drugs than many other nations’ drug regulatory agencies.

5

Alright then! I’ll just keep sticking one of these things on whenever my wrist acts up. Thanks for the reassurance, doc!

“Not at all! That’s what I’m here for. Now, is there anything else I can reassure you about?”

6

Qadgop, do you ever prescribe Sulindac? Speaking from a patient’s perspective, it works very well for me- better than Indomethacin, which I had tried previously.

7

I use Indomethacin when my gout acts up, and haven’t noticed any GI problems (although a doctor I know has suggests I use omeprazole.

8

Yes, I prescribe it.

But frankly, there is no good evidence that any one NSAID is better at pain relief or fighting inflammation than any other NSAID.

So I switch people from one subclass of NSAIDS to another to see if one works better for them. But it’s trial and error.

Even the class of COX II NSAIDS (Celebrex) are no better in this regard than the COX I NSAIDS (Indomethacin, sulindac, ibuprofen, etc etc etc). The only advantage to COX IIs is that they are somewhat less likely to cause gastric bleeding. Somewhat.

9

Count me as another Sulindac fan. I’ve been prescribed any number of other NSAIDs. Mobic gave me terrible ringing in my ears, Dolobid stopped working after a year, and Feldene upset my stomach something awful even with Protonix and taking it carefully with food. (though it did work). Hopefully Sulindac will keep working for me.