- Indications
-
Off-Label (Not FDA approved)
-
Peptic Ulcer Disease
-
Aspirin Sensitivity
- Renal Disease
-
Coagulopathy
- Pregnancy beyond 30 weeks
- Childhood (except Patent Ductus Arteriosus)
-
Dementia
-
NSAID in the acetic acid class (indole)
- Immediate Release Capsules: 25 mg, 50 mg
- Sustained Release Capsules: 75 mg
- Do not open or crush sustained release capsules
- Oral suspension: 25 mg/5 ml
- Suppository: 50 mg
- Only NSAID available in suppository form
- Precautions
- Limit to lowest effective dose and for least time needed
- See other references for dosing and indications for use in polyhydramnios
- Immediate Release
- Typical dosing range (acute musculoskeletal pain, Dysmenorrhea)
- Start 25 mg orally three times daily with food or milk
- May advance to 50 mg orally three times daily if needed
- Arthritis (RA, OA)
- Start: 25 mg orally twice to three times daily
- May advance to 150 to 200 mg/day divided three to four times daily)
- Acute Gouty Arthritis
- Start 50 mg orally three times daily for 2 to 3 days (until pain is controlled)
- Next 25 mg orally three times daily for 7 to 10 days
- Sustained Release (Cluster Headache, acute Gouty Arthritis)
- Dose 75 mg orally daily to twice daily
- Maximum: 200 mg/day (divided three to four times daily)
-
Juvenile Rheumatoid Arthritis (not FDA approved)
- Start 1 to 3 mg/kg/day divided 3 to 4 times daily
- May advance as needed to 4 mg/kg/day (up to max: 200 mg/day)
- Precautions
- Associated with risk of significant maternal and fetal complications when used in Preterm Labor (see below)
- Confirm with other references and consult maternal fetal medicine before using Indomethacin in pregnancy
- 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
-
General (more than other NSAIDs)
- Adverse Effects
-
Maternal and Fetal
- See NSAID
- Maternal effects
- Postpartum Hemorrhage
- Fetal effects
- Early ductus arteriosus closure
- Fetal Pulmonary Hypertension
- Oligohydramnios
- Not linked to Intraventricular Hemorrhage
- Suarez (2001) Obstet Gynecol 97:921-5 [PubMed]
- Considered safe in Lactation
- Avoid NSAIDs in pregnancy outside the first part of the second trimester (13 to 20 weeks)
- Teratogenic in first trimester
- Risk of premature ductus arteriosus closure in the fetus in third trimester
- Most NSAIDs carry a legacy system Pregnancy Category B or C designation (aside from third trimester)
- However, many obstetricians avoid NSAIDs entirely in pregnancy (even in second trimester)
- Most potent NSAID (however this carries renal and GI risks)
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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