indomethacin

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indomethacin

 [in″do-meth´ah-sin]
a nonsteroidal antiinflammatory drug used in the treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and various other rheumatic and nonrheumatic inflammatory conditions, dysmenorrhea, and vascular headache. The trihydrated sodium salt is used to induce closure in certain cases of patent ductus arteriosus.

indomethacin (indometacin (UK))

Apo-Indomethacin (CA), Flexin, Indameth (CA), Indocid-R (UK), Indomax SR (UK), Indocid (CA), Indocid PDA (UK), Indocin SR, Indolar SR (UK), Indotec (CA), Novo-Methacin (CA), Nu-Indo (CA), Pardelprin (UK), Pro-Indo (CA), Ratio-Indomethacin (CA), Rheumacin (CA), Rhodacine (CA), Rimacid (UK), Sandoz Indomethacin (CA), Slo-Indo (UK)

Pharmacologic class: Nonsteroidal anti-inflammatory drug (NSAID)

Therapeutic class: Anti-inflammatory, analgesic, antipyretic

Pregnancy risk category B (third trimester: D)

Pregnancy risk category B (third trimester: D)

FDA Box Warning

• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke (which can be fatal). Risk may increase with duration of use, and may be greater in patients who have cardiovascular disease or risk factors for it.

• Drug is contraindicated for perioperative pain in setting of coronary artery bypass graft surgery.

• Drug increases risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation, which can be fatal. These events can occur at any time during therapy and without warning. Elderly patients are at greater risk.

Action

Unknown. Thought to inhibit cyclo-oxygenase, an enzyme needed for prostaglandin synthesis.

Availability

Capsules: 25 mg, 50 mg

Capsules (sustained-release): 75 mg

Oral suspension: 25 mg/5 ml

Indications and dosages

Rheumatoid arthritis; osteoarthritis; ankylosing spondylitis

Adults: 25 to 50 mg P.O. two or three times daily, not to exceed 200 mg daily; or one 75-mg sustained-release capsule P.O. once or twice daily

Acute gouty arthritis

Adults: 50 mg P.O. t.i.d. until pain is tolerable; then reduce dosage rapidly and, finally, discontinue drug. Don't give sustained-release form.

Acute bursitis or tendinitis of shoulder

Adults: 75 to 150 mg P.O. daily in three or four divided doses. Discontinue once inflammation is controlled.

Off-label uses

• Bartter's syndrome
• Pericarditis

Contraindications

• Hypersensitivity to drug, its components, or other NSAIDs
• Active GI bleeding
• Concurrent diflunisal use

Precautions

Use cautiously in:
• severe cardiovascular, renal, or hepatic disease
• history of ulcer disease
• elderly patients
• pregnant or breastfeeding patients
• children ages 14 and younger (efficacy not established).

Administration

• Give with food, full glass of water, or antacids to reduce GI upset.
• Don't open or crush capsules.
• For arthritis, give up to 100 mg of daily dose at bedtime as needed to reduce nighttime pain and morning stiffness.
• Don't give sustained-release form to patients with gouty arthritis.

Adverse reactions

CNS: headache, dizziness, drowsiness, fatigue, vertigo, depression, seizures

EENT: tinnitus

GI: nausea, vomiting, diarrhea, constipation, abdominal pain or cramps, dyspepsia, ulcers, GI bleeding

Other: allergic reactions including anaphylaxis

Interactions

Drug-drug.Antihypertensives, diuretics: decreased efficacy of these drugs

Corticosteroids, other NSAIDs: additive adverse GI reactions

Cyclosporine: increased risk of nephrotoxicity

Diflunisal: potentially fatal GI hemorrhage

Lithium, methotrexate, zidovudine: increased risk of toxicity from these drugs

Probenecid: increased risk of indomethacin toxicity

Drug-diagnostic tests.Dexamethasone suppression test: false-negative result

Drug-herbs.Anise, arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, ginkgo, ginseng: increased bleeding risk

Patient monitoring

• Assess for dizziness, drowsiness, headache, fatigue, and exacerbation of depression, epilepsy, or parkinsonism.
• Monitor for drug efficacy, indicated by improved joint mobility, pain relief, and decreased inflammation.
• Monitor urine output for marked reduction.
• Watch for signs and symptoms of GI bleeding and ulcers.

Patient teaching

• Tell patient to take with food, full glass of water, or antacid to reduce GI upset.
• Advise patient not to open or crush capsules.
• Inform breastfeeding patient that indomethacin enters breast milk and may cause seizures in infant. Advise her to use a different infant feeding method during therapy.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, balance, and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

in·do·meth·a·cin

(in'dō-meth'ă-sin),
A potent analgesic, antipyretic, and nonsteroidal antiinflammatory agent used to treat acute exacerbations of various joint diseases. It is also used to produce closure of a patent ductus arteriosus in infants.

indomethacin

/in·do·meth·a·cin/ (in″do-meth´ah-sin) a nonsteroidal antiinflammatory drug; used in the treatment of various rheumatic and nonrheumatic inflammatory conditions, dysmenorrhea, and vascular headache. The trihydrated sodium salt is used to induce closure in certain cases of patent ductus arteriosus.

indomethacin

(ĭn′dō-mĕth′ə-sĭn)
n.
A nonsteroidal anti-inflammatory, antipyretic, and analgesic drug, C19H16ClNO4, used especially in the treatment of some forms of arthritis. Also called indometacin.

indomethacin

[in′dōmeth′əsin]
a nonsteroidal antiinflammatory agent.
indications It is prescribed in the treatment of arthritis, gout attacks, and certain other inflammatory conditions.
contraindications Upper GI disease or known hypersensitivity to this drug or to aspirin prohibits its use. It is not given to children less than 15 years of age or to pregnant or lactating women.
adverse effects The most serious adverse effect is peptic ulcers. GI upset, dizziness, tinnitus, and rashes also may occur.

in·do·meth·a·cin

(in'dō-meth'ă-sin)
A potent analgesic, antipyretic, and nonsteroidal antiinflammatory agent used to treat acute exacerbations of various joint diseases.

indomethacin

Indometacin, a non-steroidal painkilling (analgesic) and anti-inflammatory drug (NSAID) of the indole acetic acid group. Brand names are Flexin Continus, Indocid, Indocid PDA and Indomod.

antiinflammatory drug 

A drug which inhibits or suppresses most inflammatory responses of an allergic, bacterial, traumatic or anaphylactic origin, as well as being immunosuppressant. They include the corticosteroids (e.g. betamethasone, dexamethasone, fluorometholone, hydrocortisone acetate, loteprednol etabonate, prednisolone, rimexolone, triamcinolone). They are sometimes combined with an antibiotic drug (e.g. betamethasone combined with neomycin or sulfacetamide, dexamethasone combined with neomycin or polymyxin B). Corticosteroids have side effects, such as enhancing the activity of herpes simplex virus, fungal overgrowth, raising intraocular pressure or cataract formation.There are other antiinflammatory drugs that are non-steroidal (NSAID) and have little toxicity. They act mainly by blocking prostaglandin synthesis. These include diclofenac sodium, flurbiprofen sodium, indomethacin, ketorolac, nepafenac and oxyphenbutazone. See immunosuppressants; steroid.

indomethacin

an anti-inflammatory, analgesic and antipyretic agent, used in arthritic disorders and degenerative joint disease in humans, but is capable of causing serious gastrointestinal side-effects, particularly hemorrhage, in dogs and cats.