Indomethacin: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Drugs" to "Category:Pharmacology") |
Neil.m.young (talk | contribs) (Text replacement - "* " to "*") |
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[[Osteoarthritis]]: | [[Osteoarthritis]]: | ||
* 25 mg PO BID-TID, max 200 mg/day, give with food | *25 mg PO BID-TID, max 200 mg/day, give with food | ||
[[Gout and Pseudogout]]: | [[Gout and Pseudogout]]: | ||
* 50 mg PO TID, taper dose rapidly | *50 mg PO TID, taper dose rapidly | ||
[[Ankylosing Spondylitis]]: | [[Ankylosing Spondylitis]]: | ||
* 25 mg PO bid-tid, max 200 mg/day | *25 mg PO bid-tid, max 200 mg/day | ||
[[Rheumatoid Arthritis]]: | [[Rheumatoid Arthritis]]: | ||
* 25 mg PO bid-tid, max 200 mg/day | *25 mg PO bid-tid, max 200 mg/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 0.2 mg/kg IV x 1, then 0.1 mg/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 0.2 mg/kg IV x 1, then 0.2 mg/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 0.2 mg/kg IV x 1, then 0.25 mg/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 | *1-2 mg/kg/day PO divided BID-QID, max 4 mg/kg/day up to 150-200 mg/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 | *ASA or NSAID-induced ashtma or urticaria | ||
* Pregnancy 3rd trimester | *Pregnancy 3rd trimester | ||
* Infection, untreated (neonates) | *Infection, untreated (neonates) | ||
* Active bleeding (neonates) | *Active bleeding (neonates) | ||
* Thrombocytopenia (neonates) | *Thrombocytopenia (neonates) | ||
* Coagulation Disorder (neonates) | *Coagulation Disorder (neonates) | ||
* Necrotizing enterocolitis (neonates) | *Necrotizing enterocolitis (neonates) | ||
* renal impairment, significant (neonates) | *renal impairment, significant (neonates) | ||
* Pulmonary atresia (neonates) | *Pulmonary atresia (neonates) | ||
* Tetralogy of Fallot, severe (neonates) | *Tetralogy of Fallot, severe (neonates) | ||
* Aortic coarctation, severe (neonates) | *Aortic coarctation, severe (neonates) | ||
* CABG surgery period use | *CABG surgery period use | ||
* caution if cardiovascular disease | *caution if cardiovascular disease | ||
*caution if HTN | *caution if HTN | ||
* caution if CHF | *caution if CHF | ||
* caution if fluid retention | *caution if fluid retention | ||
*caution if GI bleeding or ulcer history | *caution if GI bleeding or ulcer history | ||
*caution in elderly patients | *caution in elderly patients | ||
| Line 68: | Line 68: | ||
===Serious=== | ===Serious=== | ||
*pulmonary hemorrhage (neonates) | *pulmonary hemorrhage (neonates) | ||
* GI bleeding | *GI bleeding | ||
* GI perforation/ulcer | *GI perforation/ulcer | ||
* MI | *MI | ||
* Stroke | *Stroke | ||
* Thromboembolism | *Thromboembolism | ||
* HTN | *HTN | ||
* CHF | *CHF | ||
* Renal Papillary Necrosis | *Renal Papillary Necrosis | ||
* Acute Renal Failure | *Acute Renal Failure | ||
* Hepatotoxicity | *Hepatotoxicity | ||
* [[Steven_Johnson_syndrome|Steven-Johnson syndrome]] | *[[Steven_Johnson_syndrome|Steven-Johnson syndrome]] | ||
* Anemia | *Anemia | ||
*[[Thrombocytopenia|Thrombocytopenia, neonates]] | *[[Thrombocytopenia|Thrombocytopenia, neonates]] | ||
* hyponatremia (neonates) | *hyponatremia (neonates) | ||
* hyperkalemia (neonates) | *hyperkalemia (neonates) | ||
===Common=== | ===Common=== | ||
* dyspepsia | *dyspepsia | ||
* nausea | *nausea | ||
* abdominal pain | *abdominal pain | ||
* constipation | *constipation | ||
* headache | *headache | ||
* dizziness | *dizziness | ||
* rash | *rash | ||
* ALT,AST elevation | *ALT,AST elevation | ||
*fluid retention | *fluid retention | ||
* tinnitus | *tinnitus | ||
* corneal deposits | *corneal deposits | ||
* photosensitivity | *photosensitivity | ||
==Pharmacology== | ==Pharmacology== | ||
Revision as of 18:32, 4 July 2016
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
- 25 mg PO BID-TID, max 200 mg/day, give with food
- 50 mg PO TID, taper dose rapidly
- 25 mg PO bid-tid, max 200 mg/day
- 25 mg PO bid-tid, max 200 mg/day
Pediatric Dosing
Patent Ductus Arteriosus:
- <48 hour old: start 0.2 mg/kg IV x 1, then 0.1 mg/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
- > 7 days old: Start 0.2 mg/kg IV x 1, then 0.25 mg/kg q12-24h x 2
- 1-2 mg/kg/day PO divided BID-QID, max 4 mg/kg/day up to 150-200 mg/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 HTN
- 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
- HTN
- 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