Ibuprofen vs. Indomethacin

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

Key Takeaways

  • Ibuprofen is sold over the counter for everyday pain and fever, while indomethacin is prescription-only and reserved for specific inflammatory conditions like gout and bursitis.

  • Ibuprofen is usually taken every four to six hours, while indomethacin is taken two to three times a day and slowly increased to find the lowest effective dose.

  • Both carry FDA boxed warnings for cardiovascular and gastrointestinal risks, but indomethacin has higher reported rates of headache and dizziness.

Ibuprofen vs. Indomethacin Drug Summary

Ibuprofen

Ibuprofen is a propionic acid NSAID used for pain, fever, and inflammation from conditions like osteoarthritis, rheumatoid arthritis, and menstrual cramps. It's sold over the counter in doses up to 400 mg and by prescription up to 800 mg, taken every four to six hours as needed.

Indomethacin

Indomethacin is an indole acetic acid NSAID used for moderate to severe rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, acute gout, and bursitis or tendinitis pain. It's taken two to three times daily starting at 25 mg, with the dose raised gradually to a maximum of 150 to 200 mg a day.

Ibuprofen vs. Indomethacin Side Effects

Ibuprofen

Most common
Dyspepsia (up to 9%)
Nausea (up to 9%)
Epigastric pain (up to 3%)
Heartburn (up to 3%)

Indomethacin

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

Ibuprofen vs. Indomethacin Dosage

Ibuprofen

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 400 mg every 4-6 hours At the start
Maximum dose 300-800 mg 3-4x daily If needed
Dose changes 1 increase As tolerated

Indomethacin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 25mg 2-3x daily At the start
Maximum dose 75-150mg/day divided If needed
Dose changes 3 increases As tolerated

Ibuprofen vs. Indomethacin Indications

Ibuprofen

Ibuprofen treats mild to moderate pain, fever, and inflammation, and it's commonly used for headaches, muscle aches, menstrual cramps, and arthritis flares. It's available over the counter for everyday aches and by prescription at higher doses for ongoing joint conditions.

  • Rheumatoid arthritis

  • Osteoarthritis

  • Mild to moderate pain

  • Primary dysmenorrhea

  • Fever reduction

Indomethacin

Indomethacin treats more severe, specific inflammatory conditions, including active rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, acute gout attacks, and bursitis or tendinitis pain. It's typically reserved for flares that haven't responded well to gentler NSAIDs.

  • Moderate to severe rheumatoid arthritis

  • Moderate to severe ankylosing spondylitis

  • Moderate to severe osteoarthritis

  • Acute painful shoulder (bursitis/tendinitis)

  • Acute gouty arthritis

Ibuprofen vs. Indomethacin Pros and Cons

Ibuprofen

Ibuprofen's short half-life and over-the-counter availability make it a flexible first choice for everyday pain, fever, and mild inflammation. It's one of the most extensively studied and widely stocked NSAIDs, with generic versions available almost everywhere.

Pros

  • Available over the counter at lower doses

  • Short half-life allows quick dose adjustments

  • Extensive long-term safety track record

Cons

  • Needs dosing every 4-6 hours for pain control

  • Not FDA-approved for gout or bursitis/tendinitis

  • Less potent anti-inflammatory effect for severe flares

Indomethacin

Indomethacin's stronger anti-inflammatory action and specific approval for gout and bursitis make it a go-to option when other NSAIDs haven't worked well enough. It requires a prescription and tends to cause more headache and dizziness than gentler NSAIDs.

Pros

  • FDA-approved specifically for acute gout attacks

  • FDA-approved for bursitis/tendinitis pain

  • Longer acting, taken only 2-3 times daily

Cons

  • Prescription-only, no OTC option

  • Higher reported rates of headache and dizziness

  • Not approved for fever or general mild pain relief

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