Indomethacin

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Contraindications 4 Dosage 5 Pharmacokinetics 6 Adverse-effects 7 Drug-interactions 8 Laboratory 9 Mechanism-of-action 10 More General Terms 11 Internet Database 12 References

Introduction

• Tradename: Indocin.

Indications

• temporary relief of minor pains, fevers & inflammation
• treatment of acute flairs of gout
• treatment of pericarditis
• alternative to surgery for closure of patent ductus arteriosus in neonates

Contraindications

• other NSAIDs
• active GI bleeding
• peptic ulcer disease
• impaired renal function
• platelet count < 60,000/ mm3
  

• pregnancy category = ?
• safety in lactation = -

Dosage

• 25-50 mg TID, max 200 mg/day

• Tabs: 25 & 50 mg tabs
• Suppository: 50 mg
• Suspension: 25 mg/5 mL.
• Indocin SR: 75 mg PO BID/ QD. 75 mg.

Pharmacokinetics

• rapid absorption from the GI tract
• onset of action: within 30 minutes to several hours
• extensive enterohepatic recirculation
• duration of action 4-12 hours
• 1/2life is 2.4 hours
  

• elimination via liver
• 1/2life = 1-16 hours
• protein binding = >90 %
• elimination by hemodialysis = -
• elimination by peritoneal dialysis = -

Adverse-effects

• common (> 10%)

• skin rash
• dizziness
• abdominal cramps
• heartburn
• indigestion
• nausea

• less common (1-10%)

• itching, tinnitus, fluid retention, headache, nervousness vomiting

• uncommon (< 10%)

• congestive heart failure, hypertension, arrhythmias, epistaxis, confusion, hallucinations, aseptic meningitis, mental depression, peripheral neuropathy, hives, erythema multiforme, epidermal necrolysis, Stevens-Johnson syndrome, gastritis, GI ulceration, cystitis, agranulocytosis, anemia, bone marrow suppression, leukopenia, thrombocytopenia, hepatitis, angioedema, allergic rhinitis, toxic amblyopia, blurred vision, conjunctivitis, dry eyes, hearing loss, polyuria, shortness of breath, polydipsia, tachycardia, hot flashes, drowsiness, insomnia, acute renal failure
  

• drug adverse effects of NSAIDs

Drug-interactions

• corticosteroids

• increase the clearance of salicylates
• increased renal toxicity when used in combination

• decreased antihypertensive effect of ACE inhibitor
• increased anticoagulant effect of warfarin
• aluminum & magnesium hydroxide may decrease rate but not extent of indomethacin absorption
• bicarbonate increases rate of indomethacin absorption
• probenecid increases indomethacin concentrations
• indomethacin may decrease renal elimination of:

• Li+
• digoxin
• methotrexate

• indomethacin may inhibit diuretic effect of furosemide
  
• drug interaction(s) of lithium carbonate with NSAIDs
• drug interaction(s) of NSAIDs with SSRIs
• drug interaction(s) of aspirin with NSAIDs
• drug interaction(s) of NSAIDs with beta blockers
• drug interaction(s) of NSAIDs with ARBs
• drug interaction(s) of NSAIDs with ACE inhibitors
• drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
• drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
• drug interaction(s) of NSAIDs & loop diuretics
• drug interaction(s) of NSAIDs & aspirin

Laboratory

• specimen:

• serum, plasma ( EDTA), urine
• stable for at least 14 days at -20 degrees C

• methods:

• serum/ plasma: HPLC, GC, GC-MS, TLC, RIA, EIA
• urine: GC, HPLC, TLC, RIA

Mechanism-of-action

• acetic acid class NSAID
• analgesic
• antipyretic
• anti-inflammatory agent

More General Terms

• indole
• non-steroidal anti-inflammatory agent (NSAID)
• peroxisome proliferator

Internet Database

PubChem: 3715
PubChem: 15339
PubChem: 156283
PubChem: 3717

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
4. Clinical Guide to Laboratory Tests, NW Tietz (ed) 3rd ed, WB Saunders, Philadelpha 1995

indomethacin (Indocin)