Celebrex vs. Indomethacin

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

Key Takeaways

  • Celebrex is a COX-2 selective NSAID usually taken once or twice a day, while indomethacin is an older, non-selective NSAID typically taken 2 to 4 times a day.

  • Both drugs carry the same class-wide NSAID warnings for heart attack, stroke, and stomach bleeding, but celecoxib's selectivity is linked to fewer stomach ulcers in trials.

  • Indomethacin is FDA-approved for acute gout attacks and painful shoulder from bursitis or tendinitis, uses that are not on Celebrex's label.

Celebrex vs. Indomethacin Drug Summary

Celebrex

Celebrex (celecoxib) is a COX-2 selective NSAID used to relieve pain and inflammation from osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and menstrual cramps. It comes as a capsule taken once or twice daily, with doses ranging from 100 mg to 400 mg depending on the condition.

Indomethacin

Indomethacin is an older, non-selective NSAID used for moderate to severe rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, acute gout, and painful shoulder from bursitis or tendinitis. It is taken as a capsule 2 to 4 times a day, with the dose adjusted weekly based on response.

Celebrex vs. Indomethacin Side Effects

Celebrex

Most common
Dyspepsia (up to 8.8%)
Diarrhea (up to 5.6%)
Flatulence (up to 2.2%)
Peripheral edema (up to 2.1%)

Indomethacin

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

Celebrex vs. Indomethacin Dosage

Celebrex

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 200 mg once daily At the start
Maximum dose 200 mg twice daily Day 1
Dose changes 4 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 three times daily If needed
Dose changes 4 increases As tolerated

Celebrex vs. Indomethacin Indications

Celebrex

Celebrex (celecoxib) is FDA-approved to treat pain and inflammation from osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis in children 2 and older, and ankylosing spondylitis. It's also approved for short-term management of acute pain and for menstrual cramps.

  • Osteoarthritis

  • Rheumatoid arthritis (adults and children 2+)

  • Ankylosing spondylitis

  • Acute pain

  • Primary dysmenorrhea (menstrual cramps)

Indomethacin

Indomethacin is FDA-approved to treat moderate to severe rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis, including acute flares of chronic disease. It's also approved for acute gouty arthritis and for acute painful shoulder caused by bursitis or tendinitis.

  • Rheumatoid arthritis

  • Ankylosing spondylitis

  • Osteoarthritis

  • Acute gouty arthritis

  • Bursitis or tendinitis (painful shoulder)

Celebrex vs. Indomethacin Pros and Cons

Celebrex

Celebrex's COX-2 selectivity is associated with lower rates of stomach ulcers than older NSAIDs, though it still carries the same cardiovascular warning as the rest of the class. Both brand and generic versions are on the market, so coverage and cost vary widely by plan.

Pros

  • Once or twice daily dosing, less frequent than indomethacin

  • Selective COX-2 action linked to fewer stomach ulcers in trials

  • Approved for a broader range of uses, including menstrual cramps and pediatric JRA

Cons

  • Contains a sulfonamide group, so it's avoided in patients with sulfa allergy

  • Not FDA-approved for gout, unlike indomethacin

  • Brand-name capsules can be costly without insurance

Indomethacin

Indomethacin is a stronger, non-selective NSAID with decades of clinical use, including a specific approval for acute gout flares. It tends to cause more stomach and nervous system side effects than newer NSAIDs, and its label advises against long-term use.

Pros

  • Specifically FDA-approved for acute gout flares

  • Long track record of use since 1965

  • Available in capsule, extended-release, suspension, and suppository forms

Cons

  • Requires dosing 2 to 4 times a day, more often than Celebrex

  • Non-selective COX inhibition carries a higher risk of GI ulcers and bleeding

  • Higher rates of headache and dizziness than celecoxib

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