indomethacin (Indocin)
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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
- Bartter syndrome[5]
- nephrogenic diabetes insipidus
- premature labor[5]
Contraindications
- other NSAIDs
- active GI bleeding
- peptic ulcer disease
- impaired renal function
- platelet count < 60,000/mm3
- may excerbate asthma[6]
Dosage
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%)
- less common (1-10%)
- 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 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:
- indomethacin may inhibit diuretic effect of furosemide
- drug interaction(s) of direct oral anticoagulants (DOAC) with NSAIDs
- drug interaction(s) of cholinesterase inhibitors with NSAIDs
- drug interaction(s) of lithium carbonate with NSAIDs
- drug interaction(s) of NSAIDs with oral contraceptive
- drug interaction(s) of NSAIDs with SSRIs
- drug interaction(s) of NSAIDs with antidepressants
- drug interaction(s) of aspirin with NSAIDs
- drug interaction(s) of apixaban with NSAIDs
- drug interaction(s) of warfarin with NSAIDs
- drug interaction(s) of NSAIDs with beta blockers
- drug interaction(s) of NSAIDs with ARBs
- drug interaction(s) of NSAIDs with aldosterone antagonis
- drug interaction(s) of NSAIDs with glucocorticoid
- drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
- drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
- drug interaction(s) of NSAIDs with ACE inhibitors
- drug interaction(s) of NSAIDs & antihypertensives
- drug interaction(s) of NSAIDs & loop diuretics
- drug interaction(s) of NSAIDs & aspirin
Laboratory
- specimen:
- serum, plasma (EDTA), urine, gastric fluid
- stable for at least 14 days at -20 degrees C
- methods:
- labs with Loincs
Mechanism of action
More general terms
- indole
- non-steroidal anti-inflammatory agent (NSAID)
- peroxisome proliferator; PPAR agonist; PPAR gamma agonist
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Clinical Guide to Laboratory Tests, NW Tietz (ed) 3rd ed, WB Saunders, Philadelpha 1995
- ↑ 5.0 5.1 5.2 Deprecated Reference
- ↑ 6.0 6.1 NEJM Knowledge+ Allergy/Immunology