Indomethacin

General

  • Type: NSAID
  • Dosage Forms: PO (Generic in 25 and 50mg tabs)
  • Common Trade Names: Indocin

Adult Dosing

Preterm labor/Tocolysis

  • 50-100mg loading dose, 25mg q4-6 hrs for 48 hrs

Osteoarthritis:

  • 25mg PO BID-TID, max 200mg/day, give with food

Gout and Pseudogout:

  • 50mg PO TID, taper dose rapidly

Ankylosing Spondylitis:

  • 25mg PO bid-tid, max 200mg/day

Rheumatoid Arthritis:

  • 25mg PO bid-tid, max 200mg/day

Pediatric Dosing

Patent Ductus Arteriosus:

  • <48 hour old: start 0.2mg/kg IV x 1, then 0.1mg/kg q12-24h x 2
  • 2-7 days old: Start 0.2mg/kg IV x 1, then 0.2mg/kg q12-24h x 2
  • > 7 days old: Start 0.2mg/kg IV x 1, then 0.25mg/kg q12-24h x 2

Rheumatoid Arthritis

  • 1-2mg/kg/day PO divided BID-QID, max 4mg/kg/day up to 150-200mg/day

Special Populations

  • Pregnancy Rating: B
  • Lactation: probably safe
  • Renal Dosing
    • Adult: no adjustment
    • Pediatric: no adjustment
  • Hepatic Dosing
    • Adult: not defined, caution advised if hepatic impairment
    • Pediatric: not defined, caution advised if hepatic impairment

Contraindications

  • Allergy to class/drug
  • ASA or NSAID-induced ashtma or urticaria
  • Pregnancy 3rd trimester
  • Infection, untreated (neonates)
  • Active bleeding (neonates)
  • Thrombocytopenia (neonates)
  • Coagulation Disorder (neonates)
  • Necrotizing enterocolitis (neonates)
  • renal impairment, significant (neonates)
  • Pulmonary atresia (neonates)
  • Tetralogy of Fallot, severe (neonates)
  • Aortic coarctation, severe (neonates)
  • CABG surgery period use
  • caution if cardiovascular disease
  • caution if hypertension
  • caution if CHF
  • caution if fluid retention
  • caution if GI bleeding or ulcer history
  • caution in elderly patients
  • caution if dehydration
  • caution if sepsis
  • caution if asthma
  • caution if prolonged use

Adverse Reactions

Serious

  • pulmonary hemorrhage (neonates)
  • GI bleeding
  • GI perforation/ulcer
  • MI
  • Stroke
  • Thromboembolism
  • hypertension
  • CHF
  • Renal Papillary Necrosis
  • Acute Renal Failure
  • Hepatotoxicity
  • Steven-Johnson syndrome
  • Anemia
  • Thrombocytopenia, neonates
  • hyponatremia (neonates)
  • hyperkalemia (neonates)

Common

  • dyspepsia
  • nausea
  • abdominal pain
  • constipation
  • headache
  • dizziness
  • rash
  • ALT,AST elevation
  • fluid retention
  • tinnitus
  • corneal deposits
  • photosensitivity

Pharmacology

  • Half-life: 4.5 hours, 12-21 hours in neonates
  • Metabolism: Liver; CYP450, 2C9 substrate
  • Excretion: urine 60%, feces 33%
  • Mechanism of Action: exact mechanism unknown, inhibits cyclooxygenase, reducing prostaglandin and thromboxane synthesis

See Also

References