Indomethacin: Difference between revisions
 
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==General==
==General==
*Type:  
*Type: [[NSAID]]
*Dosage Forms:
*Dosage Forms: PO (Generic in 25 and 50mg tabs)
*Common Trade Names:  
*Common Trade Names: Indocin


==Adult Dosing==
==Adult Dosing==
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*50-100mg loading dose, 25mg q4-6 hrs for 48 hrs
*50-100mg loading dose, 25mg q4-6 hrs for 48 hrs


Osteoarthritis:  
[[Osteoarthritis]]:  
* 25 mg PO BID-TID, max 200 mg/day, give with food
*25mg PO BID-TID, max 200mg/day, give with food


[http://www.wikem.org/wiki/Gout| Acute Gout]:
[[Gout and Pseudogout]]:
* 50 mg PO TID, taper dose rapidly
*50mg PO TID, taper dose rapidly


Ankylosing Spondylitis:
[[Ankylosing Spondylitis]]:
* 25 mg PO bid-tid, max 200 mg/day
*25mg PO bid-tid, max 200mg/day


[http://www.wikem.org/wiki/Rheumatoid_arthritis Rheumatoid Arthritis]:
[[Rheumatoid Arthritis]]:
* 25 mg PO bid-tid, max 200 mg/day
*25mg PO bid-tid, max 200mg/day


==Pediatric Dosing==
==Pediatric Dosing==


Patent Ductus Arteriosus:
[[Patent ductus arteriosus]]:
* <48 hour old: start 0.2 mg/kg IV x 1, then 0.1 mg/kg q12-24h x 2
*<48 hour old: start 0.2mg/kg IV x 1, then 0.1mg/kg q12-24h x 2
* 2-7 days old: Start 0.2 mg/kg IV x 1, then 0.2 mg/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 0.2 mg/kg IV x 1, then 0.25 mg/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|Rheumatoid Arthritis]]
[[Rheumatoid_arthritis|Rheumatoid Arthritis]]
* 1-2 mg/kg/day PO divided BID-QID, max 4 mg/kg/day up to 150-200 mg/day
*1-2mg/kg/day PO divided BID-QID, max 4mg/kg/day up to 150-200mg/day


==Special Populations==
==Special Populations==
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==Contraindications==
==Contraindications==
*Allergy to class/drug
*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==
==Adverse Reactions==
===Serious===
===Serious===
*pulmonary hemorrhage (neonates)
*[[GI bleeding]]
*GI perforation/ulcer
*[[MI]]
*Stroke
*Thromboembolism
*hypertension
*[[CHF]]
*Renal Papillary Necrosis
*[[Acute Renal Failure]]
*Hepatotoxicity
*[[Steven_Johnson_syndrome|Steven-Johnson syndrome]]
*Anemia
*[[Thrombocytopenia|Thrombocytopenia, neonates]]
*hyponatremia (neonates)
*hyperkalemia (neonates)


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


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


==See Also==
==See Also==
*[[NSAID toxicity]]


==Sources==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]

Latest revision as of 22:40, 7 March 2021

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

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

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