Aspirin vs. Indomethacin

See how Aspirin and Indomethacin compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Aspirin is an over-the-counter NSAID used for pain, fever, and long-term prevention of a repeat heart attack or stroke, while indomethacin is a prescription NSAID reserved for more severe inflammatory conditions.

  • Indomethacin is generally more potent and used short-term for gout flares, arthritis, and bursitis, but it carries an FDA boxed warning for cardiovascular and gastrointestinal risks.

  • Aspirin's low-dose form has a unique FDA-recognized role in secondary cardiovascular prevention, a use indomethacin does not share.

Aspirin vs. Indomethacin Drug Summary

Aspirin

Aspirin is a salicylate NSAID used to relieve minor aches, reduce fever, and lower the risk of another heart attack or stroke in people with known cardiovascular disease. It comes in regular, chewable, and enteric-coated tablets, taken anywhere from once daily at a low dose to every four hours for pain.

Indomethacin

Indomethacin is a prescription NSAID used for moderate to severe arthritis, ankylosing spondylitis, bursitis, tendinitis, and acute gout flares. It's taken as a capsule two to three times a day, starting low and increasing under a doctor's supervision if needed.

Aspirin vs. Indomethacin Side Effects

Aspirin

Most common
Upset stomach (up to 15%)
Heartburn (up to 10%)
Tinnitus (up to 5%)
GI bleeding (up to 3%)

Indomethacin

Most common
Headache (up to 16%)
Dyspepsia (up to 9%)
Nausea (up to 9%)
Dizziness (up to 9%)

Aspirin vs. Indomethacin Dosage

Aspirin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 325-650 mg every 4 hrs At the start
Maximum dose 75-325 mg once daily If needed
Dose changes 2 increases As tolerated

Indomethacin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25 mg 2-3 times daily At the start
Maximum dose 50 mg 3 times daily If needed
Dose changes 3 increases As tolerated

Aspirin vs. Indomethacin Indications

Aspirin

Aspirin relieves minor aches, pains, and fever, and is FDA-approved to reduce the risk of a repeat heart attack or stroke in people with known cardiovascular disease. It's also used to lower risk during unstable angina or a suspected heart attack, and for inflammatory joint conditions like rheumatoid arthritis. Some doctors also use it off-label for primary heart disease prevention or colorectal cancer risk reduction, though these are not FDA-approved uses.

  • Temporary relief of minor aches, pains, and fever

  • Secondary prevention of heart attack and stroke

  • Risk reduction in unstable angina and acute MI

  • Rheumatoid arthritis and ankylosing spondylitis

  • Off-label: primary CV prevention, colorectal cancer risk reduction

Indomethacin

Indomethacin is prescribed for moderate to severe rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis, as well as short-term flares of bursitis, tendinitis, and gout. It works by reducing the inflammation driving joint pain, swelling, and stiffness. Because of its strength, it's meant for short courses rather than everyday long-term use.

  • Moderate to severe rheumatoid arthritis flares

  • Moderate to severe ankylosing spondylitis

  • Moderate to severe osteoarthritis

  • Acute painful shoulder (bursitis or tendinitis)

  • Acute gouty arthritis flares

Aspirin vs. Indomethacin Pros and Cons

Aspirin

Aspirin is the only common over-the-counter pain reliever with an FDA-recognized role in secondary cardiovascular prevention, backed by decades of real-world safety data. It's inexpensive and available without a prescription in multiple forms, but regular use still carries a real bleeding risk, especially in older adults or with alcohol use.

Pros

  • Available OTC in multiple forms (tablet, chewable, enteric-coated)

  • Only common analgesic with an FDA-recognized secondary CV prevention role

  • No controlled-substance restrictions, widely accessible

Cons

  • Bleeding risk increases with age, alcohol use, or long-term use

  • Not safe for children or teens with viral illness due to Reye's syndrome risk

  • Contraindicated in people with NSAID allergy or aspirin-sensitive asthma

  • Long-term high-dose use linked to kidney injury

Indomethacin

Indomethacin is one of the more potent NSAIDs, making it effective for painful flares that don't respond well to milder options. It requires a prescription and carries an FDA boxed warning for cardiovascular and gastrointestinal risks, and it isn't intended for everyday long-term use.

Pros

  • More potent anti-inflammatory effect for severe arthritis and gout flares

  • Effective for conditions aspirin isn't typically used for, like ankylosing spondylitis

  • Available in immediate-release, extended-release, and suppository forms

Cons

  • Requires a prescription, unlike aspirin

  • Carries an FDA boxed warning for cardiovascular thrombotic risk

  • Higher rate of headache and dizziness than aspirin

  • Prolonged use can cause corneal or retinal changes requiring eye exams

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