Indomethacin: Difference between revisions
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{{MedTemplate | {{MedTemplate | ||
| generic = Indomethacin | | generic = Indomethacin | ||
| brand | | brand = Indocin (oral, IV, suppository), Tivorbex (low-dose), Indo-Lemmon | ||
| classes = NSAID | | structure = | ||
| | | classes = [[:Category:NSAIDs|Non-steroidal anti-inflammatory (NSAID, potent non-selective)]], [[:Category:Analgesics|Analgesic]] | ||
| uses = <vote slug="acute-gouty-arthritis-use">Acute gouty arthritis (FDA; the classic first-line indication)</vote>, <vote slug="rheumatoid-arthritis-use">Moderate-to-severe rheumatoid arthritis (FDA)</vote>, <vote slug="osteoarthritis-use">Osteoarthritis (FDA)</vote>, <vote slug="ankylosing-spondylitis-use">Ankylosing spondylitis (FDA)</vote>, <vote slug="pseudogout-use">Calcium pyrophosphate deposition disease (pseudogout, off-label)</vote>, <vote slug="acute-migraine-indomethacin-use">Acute migraine and hemicrania continua (off-label; the latter is a uniquely indomethacin-responsive headache syndrome)</vote>, <vote slug="pda-closure-use">Patent ductus arteriosus closure in preterm neonates (FDA, IV; Indocin IV)</vote> | |||
| starting_dose = Acute gout: 50 mg PO TID until symptom relief, then taper; maximum 200 mg/day for 3-5 days. Rheumatoid arthritis / osteoarthritis: 25-50 mg PO BID-TID. Patent ductus arteriosus: 0.2 mg/kg IV, then 0.1-0.2 mg/kg every 12-24 hours for 2 doses | |||
| preparations = Capsules 25, 50 mg; ER capsules 75 mg; oral suspension 25 mg/5 mL; suppositories 50 mg; injection 1 mg/vial (PDA closure) | |||
| fda_max = 200 mg/day (typical adult oral) | |||
| pill_id = | |||
| routes = Oral, rectal, intravenous (PDA closure only) | |||
| onset = 30-60 minutes (oral); rapid relief in acute gout | |||
| duration = 4-6 hours (IR); 24 hours (ER) | |||
| halflife = 4-5 hours<ref name="indocin-label">FDA Prescribing Information, Indocin (indomethacin), Iroko/Egalet, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018332s044lbl.pdf</ref> | |||
| bioavailability = ~100% (oral)<ref name="indocin-label" /> | |||
| pregnancy = Avoid from 20 weeks gestation onward per FDA's 2020 expanded NSAID warning; contraindicated from 30 weeks (risk of premature ductus arteriosus closure, which is paradoxically the basis of the neonatal PDA-closure indication)<ref name="indocin-label" /> | |||
| legal = [[USLegal:Prescription only|Rx-only]] in US | |||
| mechanism = <vote slug="indomethacin-mech-claim">Non-selective COX-1 and COX-2 inhibitor with '''high potency''' relative to other NSAIDs, the basis of its acute-gout efficacy and the uniquely indomethacin-responsive hemicrania continua syndrome. The PDA closure indication uses prostaglandin inhibition therapeutically: the ductus arteriosus stays patent via prostaglandin E1, and inhibiting its synthesis closes the shunt.</vote> Among the higher-cardiovascular-risk NSAIDs, with elevated GI bleeding risk compared to the class average. Notable for '''CNS adverse effects''' uncommon with other NSAIDs: paradoxical headache, dizziness, depression, and confusion in elderly patients (Beers-list concerns)<ref name="indocin-label" />. | |||
}} | }} | ||
== References == | |||
<references /> | |||
[[Category:NSAIDs]] | |||
[[Category:Analgesics]] | |||