Drug interactions
Indomethacin + Prasugrel
Severity: Major
Indomethacin and Prasugrel: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining indomethacin with prasugrel increases the risk of bleeding, particularly gastrointestinal bleeding. Prasugrel labeling advises caution with chronic NSAID use for this reason.
What this interaction means in plain words
Indomethacin and Prasugrel can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Indomethacin belongs to Musculoskeletal; Prasugrel belongs to Cardiovascular.
Why it happens
Prasugrel irreversibly blocks platelet P2Y12 receptors while indomethacin inhibits platelet COX-1 and damages the gastric mucosa, producing additive bleeding risk.
What to do
Avoid chronic NSAID use where possible and choose paracetamol for analgesia. If an NSAID is unavoidable, consider gastroprotection with a proton pump inhibitor and monitor for bleeding.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Indomethacin
- Indomethacin + Ketorolac Contraindicated
- Indomethacin + Ketorolac intranasal Contraindicated
- Aceclofenac + Indomethacin Major
- Acemetacin + Indomethacin Major
- Acetylsalicylic acid + Indomethacin Major
- Alteplase + Indomethacin Major
Other interactions of Prasugrel
Frequently asked questions
Can I take Indomethacin with Prasugrel?
MediHelp rates the interaction as major. Indomethacin and Prasugrel can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining indomethacin with prasugrel increases the risk of bleeding, particularly gastrointestinal bleeding. Prasugrel labeling advises caution with chronic NSAID use for this reason.
How serious is the interaction between Indomethacin and Prasugrel?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid chronic NSAID use where possible and choose paracetamol for analgesia. If an NSAID is unavoidable, consider gastroprotection with a proton pump inhibitor and monitor for bleeding.
What other medicines interact with Indomethacin?
MediHelp also lists interactions of Indomethacin with, for example, Ketorolac, Ketorolac intranasal, Aceclofenac. The full list is on the Indomethacin page.
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