INDOMETHACIN

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Safetychecker Summary for Indomethacin
(for details about the summarized interactions, read the full article)

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

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.^{3 4 5 6} 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.⁸ Calcium 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.

1. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 139–40.

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.

9. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 138,140.

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.

13. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 138–9.

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.

15. Holt GA. Food & Drug Interactions. Chicago, Precept Press, 1998, 137–8.

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The information presented in Healthnotes 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. Information expires December 2003.

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