Indocin (Indomethacin)
Class and Category of Drug
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Chemical class: Indoleacetic acid derivative
Therapeutic class: Antigout, anti-inflammatory, antirheumatic
Pregnancy category: Not rated
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Drug Indications and Dosages
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To relieve symptoms of ankylosing spondylitis, osteoarthritis, and rheumatoid arthritis
Capsules, Oral Suspension
Adults. 25 to 50 mg b.i.d. to q.i.d., increased by 25 or 50 mg daily every wk, if needed. Maximum: 200 mg daily. After adequate response, dosage reduced as low as possible.
E.R. Capsules (Antirheumatic)
Adults. 75 mg daily, increased to 75 mg b.i.d, if needed. Suppositories Adults. 50 mg up to q.i.d.
To relieve symptoms of acute gouty arthritis
Capsules, Oral Suspension
Adults. Initial: 100 mg. Increased up to 50 mg t.i.d. Maximum: 200 mg daily. After pain is relieved, dosage tapered until drug is discontinued.
Suppositories
Adults. 50 mg up to q.i.d. Maximum: 200 mg daily.
To treat inflammation and relieve acute shoulder pain from hursitis or tendinitis
Capsules, Oral Suspension
Adults. 75 to 150 mg daily in divided doses t.i.d. or q.i.d. for 7 to 14 days.
Suppositories
Adults. 50 mg up to q.i.d. Maximum: 200 mg daily.
Dosage Adjustment
Dosage reduced for elderly patients.
To treat hemodynamically significant patent ductus arteriosus in premature infants weighing 500 to 1,750 g (1 to 3.9 lb)
Intravenous Injection
Infants over age 7 days. Initial: 200 mcg/kg (0.2 mg/kg) over 5 to 10 sec; 1 or 2 additional doses of 250 mcg/kg (0.25 mg/kg) given at 12- to 24-hr intervals, if needed. Neonates ages 2 to 7 days. Initial: 200 meg/ kg (0.2 mg/kg) over 5 to 10 sec; 1 or 2 additional doses of 200 mcg/kg (0.2 mg/kg) given at 12- to 24-hr intervals, if needed. Neonates under age 48 hours. Initial: 200 mcg/kg (0.2 mg/kg) over 5 to 10 sec; 1 or 2 additional doses of 100 mcg/kg (0.1 mg/kg) given at 12- to 24-hr intervals, if needed.
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Incompatibilities
Don't give indomethacin suspension with alkaline antacids or liquids. Don't mix reconstituted indomethacin sodium with intravenous infusion solutions.
Contraindications of Drug
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Allergy or hypersensitivity to aspirin, indomethacin, iodides, other nonsteroidal anti-inflammatory drugs (NSAIDs), or their components; history of proctitis or recent rectal bleeding (suppositories)
For antigout effects.
For anti-inflammatory effects.
For antirheumatic effects.
Generic Drug Interactions
Drugs
Note: All effects listed are for oral forms and suppositories unless indicated. acetaminophen: Increased risk of adverse renal effects (long-term use of both drugs) aluminum- and magnesium-containing antacids: Possibly decreased blood indomethacin level
aminoglycosides: Increased risk of amino-glycoside toxicity
antihypertensives: Decreased effectiveness of these drugs
aspirin, other NSAIDs: Increased risk of adverse gastrointestinal effects and non-GI bleeding
bone marrow depressants: Possibly increased leukopenic or thrombocytopenic effects of these drugs
cefamandole, cefoperazone, cefotetan: Increased risk of hypoprothrombinemia and bleeding
colchicine, platelet aggregation inhibitors: Increased risk of gastrointestinal bleeding, hemorrhage, and ulcers
corticosteroids, potassium supplements: Increased risk of adverse gastrointestinal effects
cyclosporine: Increased risk of nephrotoxicity from both drugs, increased blood cyclosporine level
diflunisal: Increased blood indomethacin level and risk of gastrointestinal bleeding
digoxin: Increased blood digoxin level and risk of digitalis toxicity (all forms)
diuretics (thiazide, loop, and potassium-sparing): Decreased diuretic and antihypertensive effects
gold compounds, nephrotoxic drugs: Increased risk of adverse renal effects heparin, oral anticoagulants, thrombolytics: Possibly increased anticoagulant effects and risk of hemorrhage
lithium: Increased blood lithium level and risk of toxicity
methotrexate: Increased risk of methotrexate toxicity
plicamycin, valproic acid: Increased risk of hypoprothrombinemia and gastrointestinal bleeding, hemorrhage, and ulcers
probenecid: Increased blood level and effectiveness of indomethacin, increased risk of indomethacin toxicity
zidovudine: Increased blood zidovudine level and risk of toxicity, increased risk of indomethacin toxicity
Activities
alcohol use: Increased risk of adverse gastrointestinal effects
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Drugs Adverse Reactions
Note: All reactions are for oral forms and suppositories unless indicated.
Central Nervous System: Confusion, depression, dizziness, drowsiness, fatigue, hallucinations, headache, intraventricular hemorrhage (I.V.), peripheral neuropathy, seizures, stroke, syncope, vertigo
Cardiovascular: Arrhythmias, chest pain, edema, fluid retention (all forms), heart failure, hypertension, MI, pulmonary hypertension (I.V.), tachycardia
Eyes, Ears, Nose, And Throat: Blurred vision, corneal and retinal damage, epistaxis, hearing loss, tinnitus
Endocrine: Hypoglycemia (I.V.)
Gastrointestinal: Abdominal cramps or pain, abdominal distention (I.V.), anorexia, constipation, diarrhea, diverticulitis, dyspepsia, dysphagia, epigastric discomfort, esophagitis, gastric perforation, gastritis, gastroenteritis, gastroesophageal reflux disease, gastrointestinal bleeding and ulceration (all forms), hemorrhoids, hepatic dysfunction (I.V.), hepatic failure, hiatal hernia, ileus (I.V.), indigestion, melena, nausea, necrotizing enterocolitis (I.V.), pancreatitis, peptic ulcer, perforation of stomach or intestine, stomatitis, vomiting (all forms)
Genitourinary: Acute renal falure, hematuria, interstitial nephritis, nephrotic syndrome, oliguria (I.V.), proteinuria, renal dysfunction (I.V.), vaginal bleeding
Hematologic: Agranulocytosis, anemia, aplastic anemia, bone marrow depression, disseminated intravascular coagulation, hemolytic anemia, iron deficiency anemia, leukopenia, neutropenia, pancytopenia, thrombocy-topenia, unusual bleeding or bruising (all forms)
Respiratory: Asthma, respiratory depression
Skin: Ecchymosis, erythema multiforme, erythema nodosum, photosensitivity, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Other: Anaphylaxis, angioedema, hyperkalemia (I.V.), hyponatremia (I.V.), injection site irritation
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Indometacin
Preparations
International Brand Drug Names
The information about drugs (tablets, pills, capsules, creams, solution, nasal spray, inhaler) around the world.
British Pharmacopoeia, 2008 edition: Indometacin Capsules; Indometacin Suppositories;
The United States Pharmacopeia 31, 2008: Indomethacin Capsules; Indomethacin Extended-release Capsules; Indomethacin for Injection; Indomethacin Oral Suspension; Indomethacin Suppositories; Indomethacin Topical Gel.
Proprietary Preparations
Argentina: Agilex; IM 75; Indotex; Klonametacina;
Australia: Arthrexin; Indocid; Indocid PDA;
Austria: Flexidin; Indo; Indobene; Indocid; Indocollyre; Indohexal; Indomelan; Indoptol; Liometacen; Luiflex; Ralicid;
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Sweden: Confortid; Indomee;
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