Analgesic
Indomethacin
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Indomethacin
, Indocin
Mechanism
NSAID
in the acetic acid class (indole)
Pharmacokinetics
Half life: 2 hours
Advantages
Only
NSAID
in suppository form
Most potent
NSAID
(however this carries renal and GI risks)
Indications
Acute
Gouty Arthritis
Ankylosing Spondylitis
Pericarditis
Bartter's Syndrome
Preterm Labor
(
Tocolysis
)
Patent Ductus Arteriosus
in the newborn
Contraindications
Peptic Ulcer Disease
Aspirin
Sensitivity
Renal Disease
Coagulopathy
Pregnancy beyond 30 weeks
Childhood (except
Patent Ductus Arteriosus
)
Dementia
(consider avoiding in elderly)
Dosing
Gene
ral
Analgesic
use
Regular: 25-50 mg PO tid with food or milk
Sustained Release: 75 mg PO qd to bid
Maximum: 200 mg/day
Dosing Protocol
Preterm Labor
Protocol 1
Loading dose: 100 mg suppository rectally
Maintenance: 25 mg PO every 6 hours for 24 hours
Repeat for an additional 24 hours maximum
Protocol 2
Loading dose: 50 mg PO
Maintenance: 25 mg PO every 4 hours for 24 hours
Repeat for an additional 24 hours maximum
Monitoring
Amniotic Fluid Index biweekly for use >48 hours
Adverse Effects (more than other NSAIDs)
Headache
Peptic Ulcer
Gastrointestinal upset
Fluid retention
Prolonged
Bleeding Time
Nausea
or
Vomiting
Pruritus
Bowel
changes
Fetal effects
Early ductus arteriosus closure
Oligohydramnios
Not linked to Intraventricular
Hemorrhage
Suarez (2001) Obstet Gynecol 97:921-5 [PubMed]
Nephrotoxic
See
Nephrotoxicity due to NSAIDs
Drug Interactions
Lithium
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