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MUSCULO-SKELETAL SYSTEM › ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS › ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS › Acetic acid derivatives and related substances
indometacin
M01AB01
Forms & Strengths
- Capsule: 25 mg, 50 mg
- Capsule, sustained-release: 75 mg
- Suppository: 50 mg
- Oral suspension: 25 mg/5 mL
- Intravenous injection: 1 mg/vial
Adult Dosing
- Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis: 25 to 50 mg orally 2 to 3 times daily; maximum 150 to 200 mg/day
- Acute gouty arthritis: 50 mg orally 3 times daily until pain subsides
- Patent ductus arteriosus (IV): Initial 0.2 mg/kg, followed by 2 doses of 0.1 mg/kg to 0.2 mg/kg at 12- to 24-hour intervals depending on age
Pediatric Dosing
- Patent ductus arteriosus (Neonates IV): Initial dose 0.2 mg/kg, subsequent doses based on postnatal age (0.1 mg/kg to 0.2 mg/kg)
- Juvenile idiopathic arthritis: 1 to 2 mg/kg/day in 2 to 4 divided doses; maximum 4 mg/kg/day or 150 to 200 mg/day
Indications
- Management of moderate to severe rheumatoid arthritis
- Osteoarthritis
- Ankylosing spondylitis
- Acute painful shoulder (bursitis and/or tendinitis)
- Acute gouty arthritis
- Closure of patent ductus arteriosus in premature infants
Mechanism of Action
- Nonsteroidal anti-inflammatory drug (NSAID) that inhibits prostaglandin synthesis
- Reversibly inhibits both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes
- Decreases formation of precursor prostaglandins involved in inflammation, pain, fever, and platelet aggregation
Contraindications
- Hypersensitivity to indometacin or other NSAIDs (history of asthma, urticaria, or allergic-type reactions)
- History of coronary artery bypass graft (CABG) surgery perioperative pain
- Active peptic ulcer disease or history of recurrent gastrointestinal ulceration/bleeding
- Severe hepatic or renal impairment
- Third trimester of pregnancy
Adverse Reactions
- Gastrointestinal: abdominal pain, nausea, vomiting, dyspepsia, GI ulceration, bleeding
- Central nervous system: headache (frequently severe), dizziness, vertigo, depression, drowsiness
- Cardiovascular: hypertension, edema, myocardial infarction, stroke
- Renal: acute renal failure, interstitial nephritis, hyperkalemia
- Hematologic: neutropenia, thrombocytopenia, aplastic anemia, prolonged bleeding time
Drug Interactions
- Anticoagulants (e.g., warfarin): increased risk of severe gastrointestinal bleeding
- Antihypertensives (ACE inhibitors, ARBs, beta-blockers, diuretics): diminished antihypertensive efficacy and increased renal impairment risk
- Lithium: decreased renal clearance of lithium, leading to potential toxicity
- Methotrexate: decreased renal elimination leading to severe bone marrow toxicity
- Other NSAIDs or corticosteroids: additive gastrointestinal ulceration and bleeding risks
Curated Content: Needs Vetting Before Put to Clinical Use