INDOMETHACIN Drug Interactions
Also known as: Indomethacin
INDOMETHACIN (brand name: Indomethacin) is a NSAIDs. INDICATIONS AND USAGE Carefully consider the potential benefits and risks of indomethacin capsules and other treatment options before deciding to use indomethacin. Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals (see WARNINGS ).…INDOMETHACIN has 16 documented drug interactions in our database, including 0 contraindicated, 16 major, 0 moderate, and 0 minor interactions.
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Combining indomethacin with aspirin 81 mg significantly increases your risk of bleeding, particularly in the stomach and intestines. This combination should generally be avoided.
Mechanism
Both indomethacin (an NSAID) and aspirin (an antiplatelet) inhibit platelet aggregation, though through different mechanisms. Indomethacin reversibly inhibits cyclooxygenase (COX) enzymes, reducing thromboxane A2 production, while aspirin irreversibly inhibits COX-1. Their combined antiplatelet effects are additive, leading to a synergistic increase in bleeding tendency.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), which can be severe and life-threatening. The risk of serious upper gastrointestinal bleeding can be increased by 3 to 15 times compared to using either drug alone. Other bleeding events like epistaxis or bruising may also be more common. This combination should generally be avoided due to the high bleeding risk. If both anti-inflammatory and antiplatelet effects are absolutely necessary, consider alternative NSAIDs with lower GI risk (e.g., celecoxib if cardiovascular risk allows) or alternative pain management strategies. Close monitoring for signs of bleeding (e.g., black tarry stools, coffee-ground vomit, unexplained bruising) is crucial if co-administration is unavoidable.
Combining indomethacin with apixaban significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal defense and inhibit platelet aggregation. Apixaban is a direct oral anticoagulant that directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use leads to additive antiplatelet and anticoagulant effects, alongside increased gastrointestinal mucosal damage from the NSAID.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other systemic bleeding events. Studies show that combining NSAIDs with anticoagulants can increase the risk of GI bleeding by 3 to 15 times compared to anticoagulants alone. This combination should generally be avoided due to the high bleeding risk. If pain management is necessary, consider alternative analgesics such as acetaminophen or opioids. If an NSAID is absolutely essential and no other alternative exists, use the lowest effective dose for the shortest duration, and consider gastroprotective agents (e.g., proton pump inhibitors). Closely monitor for signs of bleeding.
Combining indomethacin with rivaroxaban significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase enzymes, leading to reduced prostaglandin synthesis. This results in impaired platelet aggregation and can cause direct irritation and damage to the gastrointestinal mucosa. Rivaroxaban is a direct oral anticoagulant (DOAC) that directly inhibits Factor Xa, preventing thrombin generation and clot formation. The concurrent use of these agents leads to an additive antiplatelet and anticoagulant effect, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding (e.g., ulcers, hemorrhage), but also epistaxis, hematuria, and bruising. Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by 2-3 fold compared to DOAC monotherapy. Gastrointestinal bleeding can be severe and life-threatening. This combination should generally be avoided due to the high bleeding risk. If an NSAID is absolutely necessary, consider alternative pain management strategies or a short course of a COX-2 selective NSAID (though still with caution). Close monitoring for signs of bleeding (e.g., black/tarry stools, unusual bruising, blood in urine) is essential if co-administration cannot be avoided. Proton pump inhibitors (PPIs) may be considered for gastroprotection.
Combining indomethacin with argatroban significantly increases your risk of serious bleeding, including stomach bleeding. This combination should generally be avoided.
Mechanism
Indomethacin, a non-selective NSAID, inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to reduced prostaglandin synthesis. This impairs platelet aggregation and damages the gastrointestinal mucosal barrier. Argatroban is a direct thrombin inhibitor, which directly interferes with the coagulation cascade, prolonging clotting times. The combined antiplatelet effect of indomethacin and the anticoagulant effect of argatroban lead to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding (e.g., ulcers, hemorrhage), but also bleeding at other sites like the brain or urinary tract. Symptoms may include black, tarry stools, vomiting blood, unusual bruising, or prolonged bleeding from cuts. The risk of serious GI bleeding can be several-fold higher compared to either drug alone. This combination should generally be avoided due to the high risk of serious bleeding. If co-administration is unavoidable, close monitoring for signs and symptoms of bleeding is essential, along with frequent checks of coagulation parameters (e.g., aPTT, INR, ACT, depending on argatroban use). Consider alternative pain management strategies that do not involve NSAIDs, or use a gastroprotective agent (e.g., PPI) if an NSAID is absolutely necessary and the bleeding risk is deemed acceptable by the prescriber.
Taking indomethacin, an anti-inflammatory pain reliever, with bivalirudin, a blood thinner, significantly increases your risk of serious bleeding. This combination should generally be avoided.
Mechanism
Indomethacin inhibits cyclooxygenase enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation, thereby increasing bleeding risk. Bivalirudin is a direct thrombin inhibitor, which prevents clot formation. The concurrent use of these agents results in additive antiplatelet and anticoagulant effects, leading to a synergistic increase in bleeding potential.
Clinical Management
The primary clinical effect is an increased risk of bleeding, which can range from minor (e.g., bruising, nosebleeds) to severe and life-threatening (e.g., gastrointestinal bleeding, intracranial hemorrhage). The risk of gastrointestinal bleeding with NSAIDs combined with anticoagulants can be 3 to 15 times higher than with anticoagulants alone. This combination should be avoided if possible. If concomitant use is absolutely necessary, patients must be closely monitored for signs of bleeding, and the lowest effective doses of both medications should be used for the shortest duration. Consider alternative pain management strategies or alternative anticoagulants if feasible. Proton pump inhibitors may be considered to reduce GI bleeding risk.
Combining indomethacin with warfarin significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor will likely avoid this combination or monitor you very closely.
Mechanism
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis. This leads to impaired platelet aggregation and can cause gastric mucosal damage, increasing the risk of gastrointestinal bleeding. Warfarin is an anticoagulant that inhibits vitamin K-dependent clotting factors, leading to a reduced clotting ability. The concurrent use of these drugs results in additive antiplatelet and anticoagulant effects, alongside increased GI mucosal vulnerability.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, particularly gastrointestinal bleeding, which can be severe or fatal. Studies indicate a 3-15 times higher risk of serious GI bleeding when NSAIDs are co-administered with warfarin. Other bleeding manifestations like epistaxis, hematuria, and ecchymosis may also occur, along with potential for increased INR. This combination should generally be avoided due to the high risk of serious bleeding. If concurrent use is unavoidable, patients require extremely close monitoring of INR, signs of bleeding (e.g., melena, hematemesis, unusual bruising), and hemoglobin levels. Lower doses of indomethacin for the shortest possible duration may be considered, but alternative analgesics or anti-inflammatory agents with less bleeding risk (e.g., acetaminophen, selective COX-2 inhibitors with caution) should be preferred.
Combining indomethacin with dabigatran significantly increases your risk of serious bleeding, including bleeding in the stomach or intestines. This combination should generally be avoided due to the heightened danger.
Mechanism
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Dabigatran is a direct thrombin inhibitor, preventing clot formation by interfering with the coagulation cascade. The concurrent use results in additive antiplatelet and anticoagulant effects, severely compromising hemostasis.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, which can manifest as gastrointestinal bleeding (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, hematuria, or other forms of internal or external bleeding. This combined risk is significantly higher than with either drug alone, potentially leading to severe, life-threatening hemorrhagic events. This combination should generally be avoided. If an NSAID is absolutely necessary, consider alternative pain management strategies or a different type of analgesic with a lower bleeding risk. If concurrent use is unavoidable, close monitoring for signs and symptoms of bleeding is imperative, and the lowest effective doses for the shortest duration should be used. Proton pump inhibitor co-therapy may be considered to reduce GI bleeding risk.
Combining Indomethacin with Edoxaban significantly increases your risk of bleeding, including serious internal bleeding. You should avoid taking these medications together unless specifically directed and closely monitored by your doctor.
Mechanism
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis and impairing platelet aggregation, which prolongs bleeding time. Edoxaban is a direct oral anticoagulant (DOAC) that directly inhibits factor Xa, preventing thrombin generation and fibrin formation. The concurrent use of these agents results in an additive pharmacodynamic effect, profoundly impairing hemostasis.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including gastrointestinal, intracranial, and other major hemorrhages. Studies show that combining NSAIDs with DOACs can increase the risk of major bleeding by 2 to 3-fold compared to DOACs alone, with gastrointestinal bleeding being a particular concern. Symptoms can include unusual bruising, nosebleeds, blood in urine or stool, or severe headaches. Concurrent use of Indomethacin and Edoxaban should generally be avoided due to the high risk of bleeding. If an NSAID is absolutely necessary, consider alternatives with lower systemic absorption (e.g., topical NSAIDs) or alternative pain management strategies. If co-administration is unavoidable, patients require very close monitoring for signs and symptoms of bleeding, and the lowest effective doses for the shortest duration should be used. Proton pump inhibitors may be considered to mitigate gastrointestinal bleeding risk.
Combining indomethacin with heparin significantly increases your risk of bleeding, which can be severe. This interaction can lead to internal bleeding, especially in the stomach or intestines.
Mechanism
Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase enzymes, leading to reduced prostaglandin synthesis. This results in impaired platelet aggregation and direct irritation to the gastrointestinal mucosa. Heparin is an anticoagulant that inhibits the coagulation cascade, reducing the formation of fibrin clots. The additive antiplatelet effect of indomethacin combined with the anticoagulant effect of heparin leads to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding. This includes gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and bleeding from other sites. The risk of serious GI bleeding can be 3-15 times higher when NSAIDs are combined with anticoagulants. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is absolutely necessary, it should be done with extreme caution, close monitoring for signs of bleeding (e.g., black tarry stools, easy bruising, nosebleeds), and potentially with gastroprotective agents (e.g., PPIs). Consider alternative pain management strategies that do not increase bleeding risk, or alternative anti-inflammatory agents if appropriate.
Combining indomethacin with enoxaparin significantly increases your risk of serious bleeding, including stomach bleeding. Your doctor will likely avoid this combination or monitor you very closely.
Mechanism
Indomethacin, an NSAID, inhibits prostaglandin synthesis, which reduces platelet aggregation and can damage the gastrointestinal mucosa, increasing bleeding risk. Enoxaparin is a low molecular weight heparin that directly inhibits Factor Xa, preventing clot formation. The additive antiplatelet effect of indomethacin and the anticoagulant effect of enoxaparin lead to a synergistic increase in bleeding risk.
Clinical Management
This combination significantly elevates the risk of major bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other site-specific bleeding. The risk of serious GI bleeding can be 3 to 15 times higher compared to anticoagulant monotherapy. This combination should generally be avoided due to the high bleeding risk. If concurrent use is unavoidable, patients require very close monitoring for signs of bleeding (e.g., black stools, easy bruising, nosebleeds). Consider alternative pain management strategies that do not increase bleeding risk, or use a gastroprotective agent if an NSAID is absolutely necessary.
Combining indomethacin with fondaparinux significantly increases your risk of serious bleeding, including internal bleeding. Your doctor will likely avoid this combination.
Mechanism
Indomethacin, a non-selective NSAID, inhibits cyclooxygenase (COX-1 and COX-2) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Fondaparinux is a selective factor Xa inhibitor, which prevents thrombin generation and clot formation. The concomitant use results in additive antihemostatic effects, primarily through impaired platelet function from the NSAID and direct anticoagulant action from fondaparinux.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding, intracranial hemorrhage, and other major bleeding events. Studies show that combining NSAIDs with anticoagulants can increase the risk of major bleeding by 3 to 15 times compared to anticoagulant monotherapy. This combination should generally be avoided due to the high risk of serious bleeding. If an anti-inflammatory or analgesic is absolutely necessary, consider alternative therapies with lower bleeding risk, such as acetaminophen. Close monitoring for signs and symptoms of bleeding (e.g., melena, hematemesis, epistaxis, bruising) is crucial if co-administration cannot be avoided.
Combining indomethacin with dipyridamole significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided.
Mechanism
Indomethacin, an NSAID, inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Dipyridamole is an antiplatelet agent that inhibits phosphodiesterase, leading to increased cyclic AMP and reduced platelet aggregation. The concurrent use of these agents results in additive antiplatelet effects, significantly prolonging bleeding time.
Clinical Management
Patients are at a substantially increased risk of serious bleeding events, including gastrointestinal bleeding, intracranial hemorrhage, and other forms of hemorrhage. The risk of gastrointestinal bleeding with NSAIDs alone is already elevated, and antiplatelets further amplify this risk. Symptoms may include black, tarry stools, vomiting blood, or unusual bruising. This combination should generally be avoided due to the high bleeding risk. If concurrent use is absolutely necessary, patients require very close monitoring for signs of bleeding, and the lowest effective doses should be used for the shortest possible duration. Consider alternative pain management strategies or alternative antiplatelet therapies if appropriate.
Combining indomethacin with ticagrelor significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Ticagrelor is an antiplatelet agent that directly inhibits the P2Y12 receptor on platelets, preventing their activation and aggregation. The concurrent use of these agents results in additive antiplatelet effects and increased gastrointestinal mucosal damage from the NSAID, synergistically elevating bleeding risk.
Clinical Management
This combination substantially increases the risk of serious bleeding, including gastrointestinal hemorrhage (e.g., ulcers, melena, hematemesis), intracranial hemorrhage, and other systemic bleeding events. Studies show that combining NSAIDs with antiplatelets can increase the risk of major bleeding by several-fold compared to either drug alone, with GI bleeding being the most common and severe complication. This combination should generally be avoided due to the high risk of serious bleeding. If an NSAID is absolutely necessary, consider alternative pain management strategies or a COX-2 selective NSAID (like celecoxib) for the shortest possible duration, along with a proton pump inhibitor (PPI) for gastroprotection. Closely monitor for any signs of bleeding (e.g., black stools, easy bruising, nosebleeds). Consult a physician to discuss safer alternatives.
Combining indomethacin with clopidogrel significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided due to the heightened risk of serious bleeding events.
Mechanism
Both indomethacin (an NSAID) and clopidogrel (an antiplatelet) inhibit platelet aggregation through different mechanisms, leading to an additive antiplatelet effect. Indomethacin also causes direct gastrointestinal mucosal damage and inhibits prostaglandin synthesis, which normally protects the GI lining, further increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other systemic bleeding events. Studies show that combining NSAIDs with antiplatelets can increase the risk of upper GI bleeding by 3 to 15 times compared to either drug alone. This combination should generally be avoided. If concomitant use is unavoidable, patients require very close monitoring for signs of bleeding (e.g., black stools, easy bruising, nosebleeds). Consider alternative pain management strategies or a proton pump inhibitor (PPI) for gastroprotection if the NSAID is absolutely necessary. Re-evaluate the need for both medications frequently.
Combining indomethacin with prasugrel significantly increases your risk of serious bleeding, especially from the stomach or intestines. This combination should generally be avoided.
Mechanism
Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis which impairs gastric mucosal protection and platelet aggregation. Prasugrel is an antiplatelet agent that irreversibly inhibits the P2Y12 ADP receptor on platelets, preventing platelet activation and aggregation. The combined effect of impaired gastric protection and dual antiplatelet activity leads to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding, particularly gastrointestinal bleeding, which can manifest as ulcers, melena, hematemesis, or even life-threatening hemorrhage. Other bleeding events like epistaxis, hematuria, or bruising are also more likely. The risk of major GI bleeding can be several-fold higher compared to either drug alone. This combination should be avoided whenever possible. If indomethacin is absolutely necessary, consider alternative pain management strategies or a COX-2 selective NSAID with concurrent proton pump inhibitor (PPI) therapy, though significant bleeding risk remains. Closely monitor for any signs of bleeding. If co-administration is unavoidable, use the lowest effective dose of indomethacin for the shortest duration.
Combining indomethacin with cilostazol significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Indomethacin, an NSAID, inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that also reduces platelet aggregation and causes vasodilation. The concurrent use of these two drugs results in additive antiplatelet effects, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is an increased risk of bleeding, which can manifest as gastrointestinal bleeding (e.g., ulcers, melena, hematemesis), bruising, epistaxis, or prolonged bleeding from minor cuts. The risk of serious GI bleeding with NSAID plus antiplatelet therapy can be several-fold higher compared to either drug alone. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is absolutely necessary, it should be done with extreme caution, close monitoring for signs of bleeding, and consideration of gastroprotective agents (e.g., PPIs). Alternative pain management strategies or alternative antiplatelet therapies should be explored.
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