Diclofenac vs. Indomethacin

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

Key Takeaways

  • Both diclofenac and indomethacin are NSAIDs with boxed warnings for cardiovascular and gastrointestinal bleeding risk, so neither is inherently the safer choice.

  • Diclofenac comes in more delivery forms, including an over-the-counter topical gel and a once-daily tablet, while indomethacin has specific approval for acute gout and painful shoulder.

  • Indomethacin causes headache and dizziness more often than diclofenac, so tolerance for these side effects can help guide the choice between them.

Diclofenac vs. Indomethacin Drug Summary

Diclofenac

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation from osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and other conditions. It is taken as an oral tablet, with dosing that ranges from two or three times a day to a once-daily extended-release option.

Indomethacin

Indomethacin is also an NSAID, approved for arthritis, ankylosing spondylitis, acute gout, and painful shoulder from bursitis or tendinitis. It is taken as an oral capsule, usually starting at two or three times a day, with the dose adjusted based on how well symptoms respond.

Diclofenac vs. Indomethacin Side Effects

Diclofenac

Most common
Headache (up to 7%)
Dizziness (up to 3%)
GI symptoms (up to 20%)
Liver enzyme rise (up to 2%)

Indomethacin

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

Diclofenac vs. Indomethacin Dosage

Diclofenac

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 50 mg two-three x daily At the start
Maximum dose 150 mg/day maximum If needed
Dose changes 3 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

Diclofenac vs. Indomethacin Indications

Diclofenac

Diclofenac is FDA-approved to relieve pain and inflammation from osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. It is also approved for mild to moderate acute pain and menstrual cramps (primary dysmenorrhea). It is not approved for perioperative pain after heart bypass surgery or for use in children.

  • Osteoarthritis pain and inflammation

  • Rheumatoid arthritis pain and inflammation

  • Ankylosing spondylitis

  • Mild to moderate acute pain

  • Primary dysmenorrhea (menstrual cramps)

Indomethacin

Indomethacin is FDA-approved for moderate to severe rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis, including acute flare-ups. It also carries specific approvals for acute gouty arthritis and painful shoulder from bursitis or tendinitis. It is generally not recommended for patients 14 and under.

  • Osteoarthritis (moderate to severe)

  • Rheumatoid arthritis (moderate to severe)

  • Ankylosing spondylitis (moderate to severe)

  • Acute gouty arthritis

  • Acute painful shoulder (bursitis or tendinitis)

Diclofenac vs. Indomethacin Pros and Cons

Diclofenac

Diclofenac is available in more delivery forms than indomethacin, including an over-the-counter topical gel, an ophthalmic solution, and an injectable version, alongside standard oral tablets. Its oral dosing ranges from a once-daily extended-release tablet to divided doses taken several times a day. This flexibility, plus a wide range of FDA-approved uses, makes it one of the most commonly prescribed NSAIDs.

Pros

  • Available in oral, topical, ophthalmic, and injectable forms for flexible treatment

  • Once-daily extended-release tablet option simplifies dosing for some patients

  • FDA-approved specifically for primary dysmenorrhea, a use indomethacin's label lacks

  • Topical 1% gel is available over-the-counter for localized joint pain

Cons

  • Liver enzyme elevation is specifically flagged on its label, warranting monitoring

  • Not FDA-approved for acute gout flares, unlike indomethacin

  • No pediatric indication has been established

Indomethacin

Indomethacin has a longer FDA history, in use since 1965, and carries specific approvals for acute gout flares and painful shoulder conditions that diclofenac's label does not include. Standard capsules require dosing two to three times a day, and the drug is linked to higher rates of headache and dizziness than diclofenac. An extended-release capsule exists for less frequent dosing, though it is a separate formulation.

Pros

  • FDA-approved specifically for acute gouty arthritis, unlike diclofenac

  • FDA-approved for acute painful shoulder from bursitis or tendinitis

  • Long real-world track record, approved since 1965

  • Extended-release capsule option available for less frequent dosing

Cons

  • Headache occurs more often (up to 16%) than with diclofenac (up to 7%)

  • Dizziness occurs more often (up to 9%) than with diclofenac (up to 3%)

  • Standard capsules require dosing two to three times a day even at maintenance

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