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These are the most common and serious side effects of indomethacin and other NSAIDs²³. They occur because indomethacin blocks the production of prostaglandins that protect the gastric mucosa from acid and pepsin, maintain the mucosal blood flow, and promote healing of ulcers². The risk of these effects is higher in older adults, those with a history of peptic ulcer disease or gastrointestinal bleeding, those who use alcohol or tobacco, and those who take other drugs that irritate the stomach, such as corticosteroids or anticoagulants²³. The nurse should advise the client to take indomethacin with food or milk, avoid alcohol and tobacco, report any signs of gastrointestinal bleeding (such as black or tarry stools, abdominal pain, vomiting blood), and use the lowest effective dose for the shortest duration possible²³.

These are less common but potentially serious side effects of indomethacin and other NSAIDs²⁴. They occur because indomethacin blocks the production of prostaglandins that regulate renal blood flow, glomerular filtration rate, sodium excretion, and water balance². The risk of these effects is higher in those with preexisting renal impairment, heart failure, liver cirrhosis, dehydration, or hypovolemia, and those who use diuretics or angiotensin-converting enzyme inhibitors²⁴. The nurse should monitor the client's fluid intake and output, body weight, blood pressure, electrolytes, and renal function tests, and report any signs of renal dysfunction (such as oliguria, anuria, edema) or worsening heart failure (such as dyspnea, fatigue) to the doctor²⁴.

These are rare but potentially fatal side effects of indomethacin and other NSAIDs²⁵. They occur because indomethacin blocks the production of prostaglandins that inhibit platelet aggregation and vasodilation². The risk of these effects is higher in those with a history of cardiovascular disease or risk factors such as hypertension, diabetes mellitus, hyperlipidemia, smoking, or obesity²⁵. The nurse should assess the client's cardiovascular status and history before starting indomethacin therapy and advise the client to seek immediate medical attention if they experience any signs of a heart attack (such as chest pain or pressure) or a stroke (such as sudden weakness or numbness on one side of the body) while taking this drug²⁵.