Indomethacin is a member of the non-steroidal anti-inflammatory drug (NSAIDs) family of drugs. NSAIDs reduce inflammation
(swelling), pain, and temperature.
Indomethacin is used to reduce pain/swelling involved in osteoarthritis, rheumatoid arthritis, bursitis,
tendinitis, gout, ankylosing spondylitis,
and headaches.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
May Be Beneficial:Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them.
Calcium*
Folic acid
Vitamin C
Avoid:Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
Lithium*
Potassium
Sodium
White willow*
Check:Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
Iron
Side effect reduction/prevention
None known
Supportive interaction
None known
Reduced drug
absorption/bioavailability
None known
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
evidence.
Interactions with Dietary Supplements
Iron
Iron supplements can cause stomach irritation. Use of iron supplements with indomethacin
increases the risk of stomach irritation and bleeding.1 However, stomach bleeding
causes iron loss. If both iron and indomethacin are prescribed, they should be taken with food
to reduce stomach irritation and bleeding risk.
Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts
to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion
of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.2
Since major changes in lithium blood levels can produce unwanted side effects or interfere
with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in
people taking lithium supplements.
Potassium
Indomethacin may cause elevated blood potassium levels in people with normal and abnormal
kidney function.3456 Until more is known,
people taking indomethacin should not supplement potassium without medical supervision.
Vitamins and minerals
Indomethacin has been reported to decrease absorption of folic acid and vitamin C.7 Under certain circumstances,
indomethacin may interfere with the actions of vitamin C.8Calcium and phosphate levels may also be reduced with
indomethacin therapy.9 It remains unclear whether people taking this drug need to
supplement any of these nutrients.
Sodium
Indomethacin may cause sodium and water
retention.10 It is healthful to reduce dietary salt intake by decreasing the use of table
salt and avoiding heavily salted foods.
Interactions with Herbs
White willow bark
(Salix alba)
White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce
anti-inflammatory effects after they have been converted to salicylic acid in the body. The
administration of salicylates like aspirin to individuals taking oral NSAIDs may result in
reduced blood levels of NSAIDs.11 Though no studies have investigated interactions
between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more
information is available.
Interactions with Foods and Other Compounds
Food
Indomethacin should be taken with food to prevent stomach irritation.12 However,
applesauce, high-protein foods, and high-fat foods have been reported to interfere with
indomethacin absorption and/or activity.13
Alcohol
Indomethacin may cause drowsiness or dizziness.14 Alcohol may amplify these
actions. Use of alcohol during indomethacin therapy increases the risk of stomach irritation
and bleeding.15 People taking indomethacin should avoid alcohol.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
2. Olin BR, ed. Central Nervous System Drugs, Analgesics and
Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and
Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.
3. Tan SY, Shapiro R, Franco R, et al. Indomethacin-induced prostaglandin
inhibition with hyper kalemia. Ann Intern Med 1979;90:783–5.
4. Goldszer RC, Coodley EL, Rosner MJ, et al. Hyperkalemia associated
with indomethacin. Arch Intern Med 1981;141:802–4.
5. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal
Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO:
Facts and Comparisons, Mar 1993, 252–a.
6. Perazella MA. Drug-induced hyperkalemia: Old culprits and new
offenders. Am J Med 2000;109:307–14 [review].
7. Hodges R. Nutrition in Medical Practice. Philadelphia: W. B.
Saunders, 1980, 323–31 [review].
8. Ogilvy CS, DuBois AB, Douglas JS. Effects of ascorbic acid and
indomethacin on the airways of healthy male subjects with and without induced
bronchoconstriction. J Allergy Clin Immunol 1981;67:363–9.
10. Somova L, Zaharieva S, Ivanova M. Humoral factors involved in the
regulation of sodium-fluid balance in normal man. II. Effects of indomethacin on sodium
concentration, renal prostaglandins, vasopressin and renin-angiotensin-aldosterone system.
Acta Physiol Pharmacol Bulg 1984;10:29–33.
11. Olin BR, ed. Central Nervous System Drugs, Analgesics and
Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and
Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.
12. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal
Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO:
Facts and Comparisons, Mar 1993, 252–a.
14. Threlkeld DS, ed. Central Nervous System Drugs, Nonsteroidal
Anti-Inflammatory Agents. In Facts and Comparisons Drug Information. St. Louis, MO:
Facts and Comparisons, Mar 1993, 252–a.
The information presented in Aisle7 is for informational purposes only.
It is based on scientific studies (human, animal, or in vitro), clinical experience,
or traditional usage as cited in each article. The results reported may not necessarily occur
in all individuals. For many of the conditions discussed, treatment with prescription or over
the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist
for any health problem and before using any supplements or before making any changes in
prescribed medications.
