This page about Indomethacin for gout was last reviewed, or updated, on 11 May 2013.
NSAIDs, which include indomethacin, are the first choice gout treatment for relieving immediate gout pain. They work by blocking the Cox -1 and Cox -2 enzymes which are vital for producing prostaglandins. One kind of prostaglandin causes enlargement of blood vessels, an enlargement which causes pain and inflammation. NSAIDs may be given as part of long term gout treatment too. Indomethacin and other NSAIDs do not affect uric acid levels, and so don't dissolve the MSU gout crystals.
INDOMETHACIN FOR GOUT (AKA INDOCIN, INDOMETACIN)
Indomethacin is an NSAID but is discussed separately from the others (below). Indomethacin for gout treatment has been around for over 40 years, which indicates its effectiveness. It is gout medicine's most widely used drug for immediate pain relief. Indomethacin is among the NSAID first choices for patients with no other medical conditions.
Two to seven days of indomethacin usually halts or alleviates gout pain and some pain relief should occur after two to four hours. So indomethacin acts faster than colchicine - colchicine works for a majority of its users usually after around 12 hours, and comes with potentially heavier side effects.
Dosage Prescription (RX) required in most countries. Found as capsules, sustained release capsules, suppositories. (Suppositories are forms of a drug for people who cannot take a drug orally. They can be placed in the rectum and vagina). Amount: 100 – 200 mg two or three times daily. Less as the attack subsides. Take with food to prevent stomach irritation.
Possible side effects include Lethargy; dizziness; mental confusion, nausea; vomiting; diarrhoea (diarrhea); stomach pains; ulcers; gastrointestinal bleeding.
SODIUM DICLOFENAC (VOLTAREN,VOLTAREN-RX,VOLTAROL,DICLOFENAC SODIUM)
Sodium diclofenac is another NSAID used for treating gout pain. Like Indomethacin, but unlike OTC (over-the-counter) NSAIDS (see below), this is an RX (prescription) medicine. But, as one doctor put it to this writer, "it's like Ibuprofen, only better." In other words, it's stronger than the OTC NSAIDs. If OTC NSAIDs don't give you relief from gout pain, you can suggest this one to your doctor or health care professional.
Dosage Prescription (RX) required. A 50 mg tablet taken three times daily for a total of 150 mg daily. Perhaps more if this amount doesn't work. Tablets are also manufactured at 25 mg and 100 mg strength.
Possible side effects include Headache, nausea, vomiting, diarrhoea, (diarrhea), mild skin reactions. These are all common side effects of NSAIDs in some people.
There's a very slight risk of heart attack and stroke with higher doses for a lengthy period. Discuss with your physician if you are at risk - all medical conditions should be discussed with your doctor, and other medicines you take. Some other medicines can interact with sodium diclofenac.eg. Other NSAIDs, diabetes medicines, cyclosporine, diuretics and others.
OTC NSAIDS - NO RX (PRESCRIPTION) REQUIRED
Everyone has heard of the NSAIDs you buy in your local pharmacy. They include aspirin (which should NOT be taken at low dose during a gout attack - it will worsen it), ibuprofen, naproxen and others. Note that aminacetophin, aka paracetamol, (panadol, tylenol and others) is not an effective gout attack reliever because it has no anti inflammatory effect.
If you’ve had a gout attack, keeping an OTC NSAID is a good idea for an emergency. Carry your emergency treatment at all times. But most likely you'll be taking a prescription NSAID such as indomethacin for gout treatment. Carry that too of course.
NSAIDs are usually prescribed as a gout treament for otherwise generally healthy people. But as with many other gout medications they may not be for the elderly and those with other medical conditions such as kidney disease and heart disease.
DosageTake orally during the attack and for a few days after it. Dosages vary according to which NSAID is prescribed.
eg. Naproxen (Naprosyn, Anaprox, Aleve, Artagen, Xenobid) 750 mg first tablet, then 250 mg subsequent tablets. Or 500 mg three times daily. Ibuprofen (Motrin) 800mg three or four times daily. If you are taking a non prescription NSAID make sure you follow the instructions on the packaging. They are there for good reasons.
Possible side effects include OTC NSAIDs are generally well tolerated. But upset stomach, kidney damage, diarrhea, headaches, elevated blood pressure, ulcers, gastrointestinal bleeding, and others are possible side effects. High dosages over longer periods can carry risk (possibly three people in 1,000 in one account) of heart attack and stroke.
Two NSAIDs, Valdecoxib (Bextra) and Rofecoxib (Vioxx), both Cox -2 inhibitors, were taken off the market a few years ago because of concern about their side effects which included cardiovascular, high blood pressure and allergic reaction problems. Because they inhibited Cox -2 enzymes only, it was thought they would avoid the side effects of Cox 1 and -2 blocking NSAIDs.
Etoricoxib (brand name in most countries Arcoxia) has demonstrated that it can be more effective than Indomethacin for gout pain relief and it may have fewer side effects. It is mainly a Cox-2 inhibitor only, and therefore more selective than inhibitors such as indomethacin that inhibit both Cox-1 and -2. It is currently approved in over 60 countries, including those European countries that are members of the EU, (not all are).
However, the European Medicines Agency (the EU version of the US FDA) and Britain's Medicine Safety Committee, issued new contraindications and cautions about its use 2005, as well as about other Cox-2 inhibitors. They were concerned about its potential for heart attacks, strokes and serious or even fatal skin reactions. But they did not request its withdrawl, judging that the benefits still outweighed the risks.
In the U.S. the FDA, in April 2007, asked its manufacturers for more test results before any possibility of approval.
Celecoxib (Celebrex) is also a Cox-2 only inhibitor, used to treat pain and inflammation. It is widely available. You can visit the Celebrex website to read what its manufacturers advise.
Good places to carry gout medicines For men, the back pocket of trousers - it's easy to check you still have them with a quick touch; the security pocket of trousers or shorts (if there is one); inside a credit card envelope in a wallet. Keep medicines in a pocket without any other item. Another good place is in the crown of a hat you wear frequently - if there's a lining pocket. Ideal during outdoor pursuits. Buy a hat with a chin strap so it doesn't blow off in windy weather.
For women, in a medicines-only purse in a handbag; skirts with pockets or security pockets; in the lining pocket of a hat.
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