Indomethacin: Difference between revisions
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==General== | ==General== | ||
*Type: NSAID | *Type: [[NSAID]] | ||
*Dosage Forms: PO (Generic in 25 and 50mg tabs) | *Dosage Forms: PO (Generic in 25 and 50mg tabs) | ||
*Common Trade Names: Indocin | *Common Trade Names: Indocin | ||
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==Pediatric Dosing== | ==Pediatric Dosing== | ||
Patent | [[Patent ductus arteriosus]]: | ||
*<48 hour old: start 0.2mg/kg IV x 1, then 0.1mg/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 0.2mg/kg IV x 1, then 0.2mg/kg q12-24h x 2 | *2-7 days old: Start 0.2mg/kg IV x 1, then 0.2mg/kg q12-24h x 2 | ||
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===Serious=== | ===Serious=== | ||
*pulmonary hemorrhage (neonates) | *pulmonary hemorrhage (neonates) | ||
*GI bleeding | *[[GI bleeding]] | ||
*GI perforation/ulcer | *GI perforation/ulcer | ||
*MI | *[[MI]] | ||
*Stroke | *Stroke | ||
*Thromboembolism | *Thromboembolism | ||
*hypertension | *hypertension | ||
*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]] | ||
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==See Also== | ==See Also== | ||
*[[NSAID toxicity]] | |||
==References== | ==References== | ||
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
- 25mg PO BID-TID, max 200mg/day, give with food
- 50mg PO TID, taper dose rapidly
- 25mg PO bid-tid, max 200mg/day
- 25mg PO bid-tid, max 200mg/day
Pediatric Dosing
- <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
- 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
- pulmonary hemorrhage (neonates)
- GI bleeding
- GI perforation/ulcer
- MI
- Stroke
- Thromboembolism
- hypertension
- 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