Screen carefully before using indomethacin due to high adverse effect burden.
Absolute: NSAID anaphylaxis, significant GI bleeding, or neonates with high-risk comorbidities. Relative: renal/hepatic impairment, seizure disorders, coagulation defects, and uncontrolled hypertension.
Indomethacin can trigger life-threatening bronchospasm, angioedema, and anaphylaxis in patients who reacted to aspirin or other NSAIDs; choose a non–NSAID analgesic instead.
NSAID-related prostaglandin inhibition increases bleeding risk and delays mucosal healing, so avoid indomethacin until the lesion has resolved.
Labeling warns of higher cardiovascular thrombotic events with peri-CABG NSAID use; alternative analgesia is required.
Indomethacin reduces renal perfusion and may precipitate acute kidney injury; monitor creatinine closely and hydrate before dosing if no safer option exists.
Platelet inhibition increases bleeding, so weigh risks and consider gastroprotection or a different agent in high-risk children.
Indomethacin can elevate blood pressure and worsen edema; titrate carefully with baseline and follow-up blood pressure checks.
Late pregnancy exposure can cause premature ductus arteriosus closure and fetal renal dysfunction; reserve use for earlier gestational windows when maternal benefit outweighs fetal risk.