Indomethacin

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase-1 and 2 (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis. It provides anti-inflammatory, analgesic and antipyretic properties. It relieves pain, reduces joint swelling and edema, and improves joint mobility.

• Rheumatoid arthritis
• Ankylosing spondylitis
• Osteoarthritis (degenerative joint disease)
• Gout
• Acute non-articular rheumatism (bursitis, synovitis, tendinitis)

Adult Dose (Oral):

• Inflammatory/Rheumatoid Disorders: 25-50 mg every 8-12 hours (max 200 mg/day); ER: 75-150 mg/day
• Bursitis/Tendinitis: 75-150 mg/day in divided doses
• Acute Gouty Arthritis: 50 mg every 8 hours for 3-5 days
• Sustained-release Capsule: Rheumatoid arthritis, ankylosing spondylitis, osteoarthritis: 75 mg once daily (twice daily if severe); Acute gout: 75 mg twice daily

Child Dose (14 years): 25-50 mg every 8-12 hours (max 200 mg/day)

Common Side Effects:

• Vomiting
• Stomach pain/epigastric pain
• Nausea
• Indigestion
• Diarrhea
• Heartburn
• Loss of appetite

Others: Headache (morning), vertigo, mental disturbances (rare), electrolyte imbalances

Precautions:

• Indomethacin may decrease alertness and affect vision; do not drive
• Take with food or milk to prevent upset stomach
• Long term use may lead to stomach bleeding and kidney problems
• Avoid alcohol (may cause excessive drowsiness and increase stomach problems)
• Inform doctor if history of heart disease or stroke
• Caution in psychiatric problems, epilepsy or parkinsonism
• Monitor kidney function, liver function and blood components for long-term treatment

Contraindications:

• Ulcer, gastritis, active ulcerative colitis
• Previous hypersensitivity

Drug Interactions:

• May increase plasma levels of methotrexate
• Increased risk of GI bleeding with warfarin
• May reduce hypotensive effects of hydralazine, furosemide, β-blockers, thiazide diuretics
• Increased risk of hyperkalemia with K-sparing diuretics, ACE inhibitors, K supplements
• Probenecid increases plasma concentration
• Diflunisal decreases renal clearance and increases plasma concentration (Potentially Fatal)

Food Interactions: It is unsafe to consume alcohol with Indomethacin.

Use in Pregnancy: Unsafe during pregnancy; definite evidence of risk to developing baby; not recommended during pregnancy.

Use in Lactation: Safe during breastfeeding; does not pass into breastmilk in significant amount and is not harmful to baby.

Pediatric Use: 14 years: 25-50 mg every 8-12 hours (max 200 mg/day); not normally given to neonates (except to assist closure of patent ductus arteriosus).

Renal Impairment: Safe in kidney disease; no dose adjustment recommended; however monitor kidney function and potassium levels regularly.

Hepatic Impairment: Caution in liver disease; dose adjustment may be needed.

Overdose: Severe headache, dizziness, confusion, nausea, vomiting, abdominal pain, diarrhea; severe cases may cause seizures, coma; gastric lavage and activated charcoal; symptomatic treatment.