In a study of patients with severe heart failure and hyponatremia, indomethacin was associated with significant deterioration of circulatory hemodynamics, presumably due to inhibition of prostaglandin dependent compensatory mechanisms. All nonsteroidal anti-inflammatory drugs (NSAIDs) may cause fluid retention, may cause new or worsening hypertension, may exacerbate congestive heart failure and may cause an increased risk of serious cardiovascular thromboembolism, myocardial infarction, and stroke, which can be fatal. Indomethacin should be used with caution in patients with hypertension or cardiac disease. Consider alternative therapies to NSAIDs for high risk patients.Īcute myocardial infarction, angina, cardiac arrhythmias, cardiac disease, cardiomyopathy, cerebrovascular disease, coronary artery disease, heart failure, hypertension, myocardial infarction, peripheral vascular disease, stroke, thromboembolism Indomethacin may aggravate active conditions or reactivate latent conditions. Patients at increased risk for NSAID-induced GI bleeding include those receiving concurrent myelosuppressive chemotherapy, corticosteroid therapy, or anticoagulant therapy, tobacco smoking patients, the elderly, and patients with alcoholism. All patients receiving prolonged treatment should be routinely monitored for potential GI ulceration and bleeding. It is recommended not to initiate therapy with maximum doses in these patients due to the likely increase frequency of adverse reactions. Patients with a prior history of peptic ulcer disease or GI bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients with neither of these risk factors. Therefore, use all forms of indomethacin with caution in patients with a history of or active GI disease including peptic ulcer disease, ulcerative colitis, or GI bleeding. Chronic use of indomethacin can result in gastritis, ulceration with or without GI perforation, and/or GI bleeds, which can occur at any time, often without preceding symptoms. The use of intravenous indomethacin is contraindicated in neonates with gastrointestinal bleeding. Rectally administered indomethacin should be used with caution in patients with hemorrhoids, anal, or rectal inflammation. Indomethacin suppositories are contraindicated in patients with a history of proctitis or recent rectal bleeding. Nonsteroidal anti-inflammatory drugs (NSAIDs) are well known to cause gastrointestinal injury. Alcoholism, anticoagulant therapy, chemotherapy, corticosteroid therapy, GI bleeding, GI disease, GI perforation, hemorrhoids, peptic ulcer disease, tobacco smoking, ulcerative colitis

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