Names and pronunciation
(in-doe-meth′a-sin) Indocid , Indocin, Indocin IV
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Individual generic drug information
Extracted information for indomethacin only.
(in-doe-meth′a-sin) Indocid , Indocin, Indocin IV
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Func. class.: Nonsteroidal antiinflam- matory product (NSAID), antirheumatic
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Chem. class.: Acetic acid derivative
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Do not confuse: Indocin/Endocet/minocin/Vicodin
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ACTION: Inhibits prostaglandin syn- thesis by decreasing enzyme needed for biosynthesis; analgesic, antiinflamma- tory, antipyretic
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USES: RA, ankylosing spondylitis, osteoarthritis, bursitis, tendinitis, acute gouty arthritis; closure of patent ductus arteriosus in premature infants (IV)
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Unlabeled uses: Heterotopic ossifica- tion, juvenile rheumatoid arthritis, peri- carditis, intraventricular hemorrhage prevention
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Extracted information for indomethacin only.
CONTRAINDICATIONS: Preg- nancy 3rd trimester, aortic coarctation, bleeding, salicylate/NSAID hypersensitiv- ity, GI bleeding
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Black Box Warning: Perioperative pain in CABG, GI bleeding/perforation Precautions: Pregnancy 1st trimester, breastfeeding, children, bleeding disorders, GI disorders, cardiac disorders, depres- sion, renal/hepatic disease, asthma, diabe- tes, acute bronchospasm, ulcerative colitis, seizures, Parkinson’s disease, neonates, stroke Black Box Warning: Stroke, MI, those taking NSAIDs are at greater risk of MI and stroke, even in first few weeks of therapy, thromboembolism Black Box Warning: Cardiac disease, CV, thrombotic events (MI, stroke) before administration, not to be used in perioperative pain in CABG surgery • Patent ductus arteriosus: respiratory rate, character, heart sounds • Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, HB before treatment, periodically thereafter; if renal function has decreased, do not give subsequent doses • Eye/ear problems: blurred vision, tin- nitus; may indicate toxicity; audiometric, ophthalmic exam before, during, after treatment if patient receiving long-term therapy • Confusion, mood changes, hallucina- tions, especially among geriatric patients • Asthma, nasal polyps, aspirin sensitiv- ity, may develop hypersensitivity to indo- methacin Black Box Warning: GI bleeding/perfo- ration: chronic use can lead to GI bleed- ing, use cautiously in those with a history of active GI disease Black Box Warning: MI, stroke: may be greater with longer-term use and in those with CV risk factors • Beers: avoid use in older adults; more likely to cause CNS effects • Pregnancy/breastfeeding: do not use after 30 wk gestation; use only if benefits outweigh fetal risk <30 wk gestation; do not breastfeed, excreted in breast milk Black Box Warning: MI/stroke: to im- mediately report and seek medical at- tention for signs/symptoms of MI/stroke; discontinue product
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SIDE EFFECTS CNS: Dizziness, drowsiness, fatigue, con- fusion, insomnia, anxiety, depression, headache CV: Peripheral edema, hypertension, CV thrombotic events, MI, stroke EENT: Tinnitus, hearing loss, blurred vision GI: Nausea, anorexia, vomiting, diar- rhea, jaundice, constipation, flatulence, cramps, peptic ulcer, ulceration, perfora tion, GI bleeding GU: Nephrotoxicity: dysuria, hematuria, oliguria; azotemia (IV) HEMA: Blood dyscrasias, prolonged bleeding INTEG: Purpura, rash, pruritus, sweating, phlebitis at IV site
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INTERACTIONS Increase: hyperkalemia—potassium- sparing diuretics Increase: toxicity—lithium, methotrex ate, cycloSPORINE, probenecid, cidofovir Increase: effect of—digoxin, phenytoin, aminoglycosides Increase: bleeding risk—anticoagulants, abciximab, clopidogrel, eptifibatide, plicamycin, ticlopidine, tirofiban, throm- bolytics, aspirin, SSRIs, SNRIs Decrease: effect of—antihypertensives, diuretics Drug/Herb Increased: bleeding risk—chamomile, clove, dong quai, garlic, ginger, ginkgo Drug/Lab Increase: Potassium, LFTs Decrease: Hb, Hct
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Extracted information for indomethacin only.
DOSAGE AND ROUTES Arthritis/antiinflammatory • Adult: PO 25-50 mg bid-tid; max 200 mg/day; EXT REL 75 mg/day, may in- crease to 75 mg bid Gout • Adult: PO 50 mg tid; use only for acute attack, then reduce dose Rectal route for all uses • Adult: PR 50 mg bid or 100 mg at bedtime (max 200 mg/day) Patent ductus arteriosus • Neonate >8 days: IV Initially, 0.2 mg/kg, then, if necessary, 2 more doses of 0.25 mg/ kg at 12-hr intervals if urine output is >1 mL/kg/hr after prior dose or at 24-hr inter- vals if urine output is <1 mL/kg/hr; hold in cases of oliguria (<0.6 mL/kg/hr) or anuria • Neonate 2-7 days: IV Initially, 0.2 mg/kg, then, if necessary, 2 more doses of 0.2 mg/ kg at 12-hr intervals if urine output is >1 mL/kg/hr after prior dose or at 24-hr inter- I vals if urine output is <1 mL/kg/hr; hold in cases of oliguria (<0.6 mL/kg/hr) or anuria • Neonate <2 days: IV Initially, 0.2 mg/kg, then, if necessary, 1 or 2 doses of 0.1 mg/kg at 12-hr intervals if urine output is >1 mL/ kg/hr after prior dose or at 24-hr intervals if urine output is <1 mL/kg/hr; hold in cases of oliguria (<0.6 mL/kg/hr) or anuria • Neonate: PO Doses of 0.3 mg/kg daily × 2 days have been used
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Available forms: Caps 20, 25, 50 mg; ext rel caps 75 mg; powder for inj 1-mg vial; rectal suppository 50 mg; oral susp 5 mg/mL (25 mg/5 mL)
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Administer: PO route • Do not break, crush, or chew sus rel cap or reg caps • With food to decrease GI symptoms and prevent ulcerations • Shake susp; do not mix with other liquids • Store at room temperature Rectal route • Use suppository that is not soft, may place in refrigerator for 15 min before use IV route • After reconstituting 1 mg with 1 or 2 mL NS or sterile water for inj without preservative; to give 1 or 0.5 mg/mL, re- spectively; do not dilute further • Infuse over 20-30 min; avoid extrava- sation • Do not inject/infuse via umbilical catheter to avoid dramatic shift in cerebral blood flow
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Extracted information for indomethacin only.
Assess: • Arthritis symptoms: ROM, pain, swell- ing before and 2 hr after treatment • Hypersensitivity: monitor for rash (those with aspirin sensitivity, nasal pol- yps are at greater risk)
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Evaluate: • Therapeutic response: decreased pain, stiffness, swelling in joints; ability to move more easily, PDA closure
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report blurred vision, ringing, roar- ing in ears; may indicate toxicity • To avoid driving, other hazardous ac- tivities if dizziness, drowsiness occurs • To report change in urine pattern, in creased weight, edema, increased pain in joints, fever, blood in urine; may indicate nephrotoxicity • To take with food for GI upset, to use as prescribed, not to skip or double doses, to take with 8 oz of water • To report signs of GI bleeding: dark stools, hematemesis • To report mood changes: anxiety, de- pression • To use sunscreen, protective clothing, hat to prevent burns • That therapeutic antiinflammatory ef- fects may take up to 1 mo • To avoid alcohol, NSAIDs, salicylates because bleeding may occur, discuss all OTC, Rx, herbals, supplements with health care professional • To report use to all health care providers
Source pages 698, 699
Extracted information for indomethacin only.
PHARMACOKINETICS PO: Onset 30 min; peak 2 hr; duration 4-6 hr; metabolized in liver, kidneys; excreted in urine 60%, feces 33%; crosses placenta; excreted in breast milk; 99% protein binding; half-life 1 hr 1st pass, 2.6-11.2 hr 2nd pass
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Filter the extracted dose blocks for this individual drug.
Arthritis/antiinflammatory
• Adult: PO 25-50 mg bid-tid; max 200 mg/day; EXT REL 75 mg/day, may in- crease to 75 mg bid Gout
Candidate age grouping · source page 697
Arthritis/antiinflammatory
• Adult: PO 50 mg tid; use only for acute attack, then reduce dose Rectal route for all uses
Candidate age grouping · source page 697
Arthritis/antiinflammatory
• Adult: PR 50 mg bid or 100 mg at bedtime (max 200 mg/day) Patent ductus arteriosus
Candidate age grouping · source page 697