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
Indomethacin
Diclofenac vs. Indomethacin Dosage
Diclofenac
Indomethacin
| 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 |
| 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
| 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
| 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
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.