Overview
Indomethacin is a potent nonsteroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic properties. It is primarily used to treat inflammatory conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis. It works by inhibiting prostaglandin synthesis, which reduces inflammation, pain, and fever.
Mechanism of Action
Indomethacin inhibits cyclooxygenase (COX) enzymes, specifically COX-1 and COX-2, which are involved in the synthesis of prostaglandins. By reducing prostaglandin production, it decreases inflammation, pain, and fever. It also has effects on polymorphonuclear leukocyte migration.
Indications
- Rheumatoid arthritis
- Osteoarthritis
- Ankylosing spondylitis
- Acute gouty arthritis
- Acute painful shoulder (bursitis/tendinitis)
- Dysmenorrhea
- Closure of patent ductus arteriosus in neonates (IV form)
Dosage
Adults: Initial dose 25 mg 2-3 times daily, may increase to 150-200 mg daily in divided doses. For acute gout: 50 mg three times daily until pain is tolerable. Pediatric dose for patent ductus arteriosus: IV administration as per neonatal protocols. Always follow specific product labeling and physician instructions.
Contraindications
- Hypersensitivity to indomethacin or other NSAIDs
- History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
- Perioperative pain in coronary artery bypass graft (CABG) surgery
- Third trimester of pregnancy
- Active gastrointestinal bleeding or ulceration
- Severe renal impairment
Side Effects
- Headache
- Dizziness
- Drowsiness
- Nausea
- Vomiting
- Diarrhea
- Dyspepsia
- Abdominal pain
- Gastrointestinal bleeding
- Edema
- Hypertension
- Tinnitus
- Rash
- Renal impairment
- Hepatotoxicity
Interactions
- Anticoagulants (warfarin) - increased bleeding risk
- Antiplatelet agents - increased bleeding risk
- ACE inhibitors/ARBs - reduced antihypertensive effect
- Diuretics - reduced diuretic effect
- Lithium - increased lithium levels
- Methotrexate - increased methotrexate toxicity
- Other NSAIDs - increased risk of adverse effects
- SSRIs - increased bleeding risk