Indomethacin

Indomethacin Brand Names

Indocin | Indocin SR | TIVORBEX

What is Indomethacin

Indomethacin is a nonsteroidal antiinflammatory drug (NSAID) of the indole and indene acetic acid chemical class.

Indomethacin possesses analgesic and antipyretic effects used primarily in the treatment of rheumatoid and osteoarthritis. In premature neonates, indomethacin is used to accelerate closure of patent ductus arteriosus.

It also has been used in a variety of other non-FDA-approved conditions including primary dysmenorrhea, juvenile arthritis, Reiter’s syndrome, Paget’s disease, acute pseudogout, pleuritic chest pain, and pericarditis.

Indomethacin is related, chemically and structurally, to sulindac.

All NSAIDs including indomethacin cause an increased risk of serious gastrointestinal adverse effects including bleeding, ulceration, and perforation of the stomach or intestines and may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke.

The lowest effective indomethacin dose for the shortest possible duration is recommended, as the risk for adverse effects may increase with duration of use.

The American Geriatrics Society (AGS) recommends that NSAIDs (both nonselective and COX-2 inhibitors) not be used to treat persistent pain in elderly patients except rarely.

The AGS recommends use only in those elderly patients who have failed other therapies and have a favorable benefit vs risk assessment; extreme caution, continued therapy evaluation, and the use of a concurrent proton pump inhibitor (PPI) or misoprostol are advised.

Indomethacin was approved by the FDA in 1965.

Indications

1. ankylosing spondylitis
2. arthralgia
3. bursitis
4. gouty arthritis
5. headache
6. heterotopic ossification
7. intraventricular hemorrhage prevention
8. juvenile rheumatoid arthritis (JRA)/juvenile idiopathic arthritis (JIA)
9. mild pain
10. moderate pain
11. myalgia
12. osteoarthritis
13. patent ductus arteriosus (PDA)
14. pericarditis
15. rheumatoid arthritis
16. severe pain
17. tendinitis

Side Effects

1. abdominal pain
2. agranulocytosis
3. alopecia
4. anaphylactic shock
5. anaphylactoid reactions
6. anemia
7. angioedema
8. anorexia
9. anxiety
10. aplastic anemia
11. apnea
12. aseptic meningitis
13. azotemia
14. blurred vision
15. bradycardia
16. chest pain (unspecified)
17. coma
18. confusion
19. constipation
20. corneal deposits
21. depression
22. diarrhea
23. disseminated intravascular coagulation (DIC)
24. dizziness
25. drowsiness
26. dysarthria
27. dyspepsia
28. dysphagia
29. ecchymosis
30. elevated hepatic enzymes
31. enterocolitis
32. epistaxis
33. erythema multiforme
34. erythema nodosum
35. esophageal stricture
36. esophageal ulceration
37. esophagitis
38. exfoliative dermatitis
39. fatigue
40. fever
41. flatulence
42. fluid retention
43. flushing
44. gastritis
45. GI bleeding
46. GI perforation
47. glycosuria
48. headache
49. hearing loss
50. heart failure
51. hematuria
52. hemolytic anemia
53. hepatitis
54. hyperglycemia
55. hyperhidrosis
56. hyperkalemia
57. hypertension
58. hypoglycemia
59. hyponatremia
60. hypotension
61. ileus
62. infection
63. insomnia
64. interstitial nephritis
65. jaundice
66. leukopenia
67. malaise
68. myasthenia
69. myocardial infarction
70. nausea
71. necrotizing fasciitis
72. nephrotic syndrome
73. odynophagia
74. oliguria
75. palpitations
76. pancreatitis
77. paresthesias
78. peptic ulcer
79. peripheral edema
80. peripheral neuropathy
81. petechiae
82. platelet dysfunction
83. pneumothorax
84. proctitis
85. proteinuria
86. pruritus
87. pulmonary hypertension
88. pyrosis (heartburn)
89. rash
90. renal failure (unspecified)
91. renal papillary necrosis
92. retinopathy
93. seizures
94. skin irritation
95. Stevens-Johnson syndrome
96. stomatitis
97. stroke
98. syncope
99. thromboembolism
100. thrombotic thrombocytopenic purpura (TTP)
101. tinnitus
102. toxic epidermal necrolysis
103. urticaria
104. vaginal bleeding
105. vertigo
106. vomiting
107. weight gain

Monitoring Parameters

• CBC
• LFTs
• serum creatinine/BUN
• stool guaiac
• urinalysis

Contraindications

• acute bronchospasm
• acute myocardial infarction
• alcoholism
• anemia
• angina
• anticoagulant therapy
• aortic coarctation
• asthma
• bleeding
• bone marrow suppression
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• cardiomyopathy
• cerebrovascular disease
• chemotherapy
• children
• coagulopathy
• congenital heart disease
• coronary artery bypass graft surgery (CABG)
• coronary artery disease
• corticosteroid therapy
• dehydration
• dental disease
• dental work
• depression
• driving or operating machinery
• geriatric
• GI bleeding
• GI disease
• GI perforation
• headache
• heart failure
• hemophilia
• hemorrhoids
• hepatic disease
• hyperkalemia
• hypertension
• immunosuppression
• infants
• infection
• intracranial bleeding
• intramuscular injections
• jaundice
• labor
• myocardial infarction
• nasal polyps
• necrotizing enterocolitis
• neonates
• neutropenia
• NSAID hypersensitivity
• Parkinson’s disease
• peptic ulcer disease
• peripheral vascular disease
• pregnancy
• renal disease
• renal failure
• renal impairment
• salicylate hypersensitivity
• seizure disorder
• stroke
• surgery
• thrombocytopenia
• thromboembolism
• tobacco smoking
• ulcerative colitis
• urticaria
• visual disturbance

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