Inmecin

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Inmecin is an immediate-release oral capsule containing indomethacin, a powerful non-selective NSAID developed in 1963. Indomethacin is on the WHO Essential Medicines List and remains the gold-standard oral NSAID for several specific indications where its unusually strong anti-inflammatory effect outweighs its relatively higher side-effect burden compared to newer NSAIDs.

Two capsule strengths are available:

• Inmecin 25 mg — starting and maintenance dose, especially in older patients
• Inmecin 50 mg — for more severe inflammatory pain; acute gout and pericarditis commonly need this strength

What Is Inmecin Used For?

• Acute gout — gold-standard oral NSAID for a gout flare; higher-dose 50 mg TID for 2–3 days then taper
• Rheumatoid arthritis and osteoarthritis — when other NSAIDs are inadequate
• Ankylosing spondylitis — first-line NSAID in many guidelines
• Pericarditis — a first-line oral NSAID, usually combined with colchicine
• Reactive arthritis, psoriatic arthritis — inflammatory spondyloarthritides
• Pseudogout (calcium pyrophosphate deposition) — acute flare
• Patent ductus arteriosus (PDA) closure in neonates — hospital setting only
• Bartter syndrome and Gitelman syndrome — to reduce renal prostaglandin overproduction
• Primary dysmenorrhoea — second-line

How Does Indomethacin Work?

Indomethacin is a non-selective NSAID — it blocks both COX-1 (which maintains stomach lining, platelet function, and kidney perfusion) and COX-2 (which is upregulated at sites of inflammation). This broad action explains both its strong anti-inflammatory effect and its well-known gastrointestinal and renal side-effect profile.

The therapeutic chain of events is the same for every NSAID:

1. Tissue injury or inflammation releases phospholipids from cell membranes
2. Phospholipase A₂ converts them to arachidonic acid
3. Cyclooxygenase (COX-1/COX-2) converts arachidonic acid to prostaglandins — the molecules responsible for pain, swelling, and fever
4. Indomethacin blocks the COX enzymes, so less prostaglandin is produced, so there is less pain and inflammation

Because prostaglandins also protect the stomach lining, regulate kidney blood flow, and influence platelet function, the same mechanism that relieves pain is also responsible for the main NSAID side effects: stomach irritation, fluid retention, high blood pressure, and (in some individuals) kidney stress.

Inmecin Dosing

• Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis: 25 mg two or three times daily; may increase to 50 mg TID if needed. Maximum 200 mg/day (rarely justified).
• Acute gout: 50 mg three times daily for 2 days, then 25 mg TID for a further 2–3 days, then stop.
• Pericarditis: 25–50 mg three times daily for 2 weeks, tapering thereafter, alongside colchicine.
• Primary dysmenorrhoea: 25 mg three times daily from onset of pain for 2–3 days.

Always take with food or an antacid to reduce gastric irritation. Swallow capsules whole with a full glass of water. Do not lie down for at least 15 minutes after a dose (reduces oesophageal irritation).

Because indomethacin has a 4-hour half-life, three-times-daily dosing is standard. For a simpler once-daily or twice-daily schedule, a sustained-release formulation such as Inmecin-R 75 mg is available.

Who Should Not Take Inmecin?

• Known hypersensitivity to Indomethacin or any NSAID
• Active or recurrent peptic ulcer, GI bleed, or GI perforation
• Asthma, urticaria, or rhinitis precipitated by aspirin or another NSAID (“aspirin-exacerbated respiratory disease”)
• Severe heart failure (NYHA class IV)
• Severe hepatic impairment (Child–Pugh C)
• Severe renal impairment (CrCl < 30 mL/min)
• Third trimester of pregnancy (risk of premature ductus arteriosus closure and oligohydramnios)
• Recent coronary artery bypass graft surgery (CABG) — absolute contraindication for all NSAIDs

Indomethacin-specific cautions:

• History of seizures or epilepsy — indomethacin can lower seizure threshold
• Psychiatric disorders — can cause confusion, depression, hallucinations (more than other NSAIDs)
• Parkinson’s disease — may worsen symptoms
• Elderly patients — higher risk of CNS side effects; consider a lower dose or alternative NSAID

Cardiovasculair risico

All NSAIDs (except low-dose aspirin) carry some increase in the risk of heart attack and stroke, and can worsen heart failure. The risk is dose- and duration-dependent and is generally highest with COX-2 selective agents and with diclofenac. Patients with established ischaemic heart disease, peripheral arterial disease, stroke, or uncontrolled hypertension should use non-selective NSAIDs (ibuprofen or naproxen) at the lowest effective dose, or use paracetamol instead where possible.

Renal (kidney) safety

NSAIDs reduce renal prostaglandin production, which can cause salt and water retention, raise blood pressure, and — in vulnerable patients — cause acute kidney injury. High-risk groups are the elderly, patients on ACE inhibitors/ARBs plus diuretics (the “triple whammy”), anyone dehydrated (vomiting, diarrhoea, heat, heavy exercise), and those with pre-existing CKD. Stop the NSAID and seek medical review if you develop reduced urine output, swelling, or unexplained weight gain.

Common Side Effects of Inmecin

Indomethacin has a stronger side-effect profile than ibuprofen or diclofenac, particularly in the central nervous system.

Very common (>10%):

• Headache (up to 25% of users; often “frontal pressure” type)
• Dizziness, vertigo
• Dyspepsia, nausea

Common (1–10%):

• Abdominal pain, diarrhoea or constipation
• Drowsiness, confusion (especially in elderly)
• Tinnitus
• Skin rash, pruritus
• Fluid retention, high blood pressure

Zeldzaam maar ernstig:

• Peptic ulcer, GI bleed, perforation
• Depression, psychosis, hallucinations (rare but reported)
• Acute kidney injury
• Hepatotoxicity
• Blood dyscrasias (rare)

Indomethacin headache is the single most common reason patients discontinue therapy. If it is intolerable, your doctor may switch to naproxen, diclofenac, or a COX-2 selective agent.

Inmecin vs Inmecin-R vs Other Gout NSAIDs

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Veelgestelde vragen

What is Inmecin used for?

Inmecin (indomethacin) is a potent non-selective NSAID used for acute gout, ankylosing spondylitis, pericarditis, rheumatoid arthritis, osteoarthritis flare, and primary dysmenorrhoea.

Why does indomethacin cause headaches?

Indomethacin crosses the blood-brain barrier more than most other NSAIDs, which is why it can cause headaches, dizziness, and occasionally confusion. Up to 1 in 4 users experience this. Taking with food and starting at 25 mg BID can reduce the effect; if persistent, switching to a different NSAID is reasonable.

How is Inmecin different from Inmecin-R?

Both contain indomethacin. Inmecin is an immediate-release 25 or 50 mg capsule given three times daily. Inmecin-R is a 75 mg sustained-release capsule dosed once or twice daily — more convenient for chronic conditions.

Is Inmecin good for gout?

Yes — indomethacin is a gold-standard oral NSAID for an acute gout flare. Typical regimen: 50 mg three times daily for 2 days, then 25 mg TID for 2–3 more days, then stop. Combine with colchicine in severe flares if there are no contraindications.

Can I take Inmecin long-term?

Long-term use is possible in inflammatory arthritis but is not usually the preferred NSAID for prolonged therapy because of its CNS and GI burden. If needed, combine with a proton pump inhibitor for GI protection and review at least every 3 months.

Can I drink alcohol with Inmecin?

Avoid alcohol — it increases GI bleed risk and adds to drowsiness and dizziness. Social light drinking is best avoided while on treatment.

Is Inmecin safe in pregnancy?

No — particularly in the third trimester (risk of premature closure of the fetal ductus arteriosus). Indomethacin is sometimes used under specialist supervision in tocolysis (to stop preterm labour) for short periods, but this is a hospital decision.

Can I drive while taking Inmecin?

Because dizziness and drowsiness are common, assess your own response first. Do not drive on your first day of therapy and avoid driving if you feel any CNS symptoms.

Does Inmecin interact with other medications?

Yes — particularly lithium (raises lithium levels), methotrexate (raises methotrexate toxicity), ACE inhibitors/ARBs plus diuretics (“triple whammy” renal injury), anticoagulants (bleed risk), and SSRIs (bleed risk). Always share your full medication list with your doctor.

What if I miss a dose of Inmecin?

Take it when you remember, unless the next dose is due within 2 hours. Never double up.

Is Inmecin stronger than ibuprofen?

Yes. Milligram-for-milligram indomethacin is one of the most potent NSAIDs. It is also more prone to CNS and GI side effects, which is why it is usually reserved for conditions where its extra strength is needed.

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