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Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is associated with certain important safety warnings and precautions. It is crucial for patients and healthcare providers to be aware of these risks before starting treatment. Below are the key safety considerations:

• Heart Risks: Indomethacin may increase the risk of heart attack, stroke, and blood clots. This risk can occur at any time during use and is heightened by prolonged use, existing heart disease, or risk factors such as smoking or diabetes. It should not be used immediately before or after heart bypass surgery (CABG). If symptoms such as chest pain, shortness of breath, or sudden weakness occur, seek emergency medical attention.

• Gastrointestinal Risks: This medication can lead to serious, potentially fatal stomach or intestinal bleeding and ulcers, which may occur without warning. The risk is greater for older adults, those with a history of ulcers or bleeding, and those using alcohol or tobacco. Immediate medical care is required if you experience persistent stomach pain, black or bloody stools, or vomit resembling coffee grounds.

• Blood Pressure and Heart Failure: Indomethacin may raise blood pressure and increase the risk of heart failure due to fluid retention. Patients with heart issues or those on blood pressure medications should consult their healthcare provider before use.

• Liver Risks: Rarely, indomethacin can cause severe liver damage. Symptoms of liver problems include abdominal swelling or pain, jaundice, dark urine, or confusion. Immediate medical help is advised if these occur.

• Kidney Risks: The drug may impair kidney function, especially in older adults or those with pre-existing kidney or liver issues, or those taking specific blood pressure medications. Monitoring of kidney function is advised, and any changes in urination should be reported to a healthcare provider.

• Allergic Reactions: Severe allergic responses, including anaphylaxis, could occur. Those with known NSAID or aspirin allergies should avoid indomethacin. Signs of an allergic reaction include hives, swelling, or difficulty breathing, requiring immediate medical intervention.

• Asthma: Indomethacin can exacerbate asthma symptoms. It should be avoided in individuals with asthma related to NSAID use. Medical help should be sought if breathing difficulties arise.

• Nervous System and Mental Health: Indomethacin might worsen conditions like epilepsy, Parkinson's disease, or mental health disorders. Notify your provider if there are any changes in mental health or neurological symptoms during treatment.

• Pregnancy Risks: Use during the second half of pregnancy may harm the unborn child or cause delivery complications. Pregnant individuals should discuss alternative treatments with their healthcare provider.

Contraindications: Indomethacin should not be used by individuals with a history of allergic reactions to NSAIDs or aspirin, nor should it be used following coronary artery bypass surgery (CABG).

Patients should consult their healthcare provider to thoroughly understand the risks and benefits of using indomethacin and to discuss any concerns or pre-existing conditions that might affect its use.

Common side effects:

• Headache
• Nausea
• Upset stomach
• Dizziness
• Diarrhea
• Constipation
• Stomach pain
• Sleepiness

Serious side effects:

• Stomach bleeding
• Heart attack
• Heart failure
• Stroke
• Worsening liver issues
• Serious kidney problems
• Allergic reactions
• Serious skin reactions

Interactions with high risk of serious adverse effects and should be avoided:

• Ketorolac
• Blood thinners such as Dabigatran, Enoxaparin, Warfarin
• Anti-platelet drugs such as Clopidogrel
• Similar NSAIDs or pain relievers like Ibuprofen, ketorolac, Aspirin

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Aliskiren
• ACE inhibitors (e.g., Captopril, Lisinopril)
• Angiotensin II receptor blockers (e.g., Valsartan, Losartan)
• Diuretics such as Furosemide
• Corticosteroids such as Prednisone
• Lithium
• Methotrexate