Indomethacin Drug Flashcards

Indomethacin Overview

• Brand names include Indocin and Tivorbex.
• Classified as a Non-Steroidal Anti-Inflammatory Drug (NSAID).

Administration Routes

• Available in multiple forms:
  • Oral capsules (immediate): 20 mg, 25 mg, 40 mg, 50 mg.
  • Oral capsules (extended release): 75 mg.
  • Oral suspension: 25 mg / 5 mL.
  • Rectal suppository: 50 mg.

Indications

• Commonly indicated for osteoarthritis, rheumatoid arthritis, and management of acute pain.

Dosing Information

• Osteoarthritis/Rheumatoid Arthritis:
  • Immediate release: 25-50 mg taken orally two to three times daily, maximum 200 mg per day.
  • Extended release: 75 mg taken orally daily split into two doses.
• Acute Pain (Mild to Moderate):
  • Immediate release (Tivorbex): 20 mg taken orally three times a day or 40 mg taken two to three times daily.

Mechanism of Action

• Functions as a nonselective inhibitor of COX-1 and COX-2.
• Reversibly alters platelet function, potentially prolonging bleeding time.

Renal Dose Adjustment

• Dose adjustment is required when creatinine clearance (CrCl) is less than 15 mL/min; caution is advised.

Contraindications

• Contraindicated in patients with hypersensitivity, asthma/bronchospasm, urticaria, and allergic reactions to NSAIDs.
• Not recommended for individuals with a history of coronary artery bypass graft (CABG) surgery within the past 14 days or myocardial infarction (MI) within the last year.
• Avoid in patients with CrCl less than 30 mL/min.

Boxed Warnings

• Associated with an increased risk of cardiovascular events, gastrointestinal (GI) toxicity, and complications related to CABG.

Drug Interactions

• Increased risk of GI ulceration and bleeding when taken with aspirin or other antiplatelet agents.
• May cause renal toxicity and fluid retention when used with ACE inhibitors, potentially reducing their antihypertensive effects.
• Co-administration with Ketorolac is contraindicated due to additive GI toxicity and bleeding risks.
• Warfarin may have increased bleeding risk due to competitive metabolism.

Adverse Reactions

• Common adverse reaction includes headache.
• Serious but rare reactions include:
  • Stevens-Johnson syndrome, gastrointestinal bleeding, thrombosis, elevated liver function tests (LFTs), acute renal failure, heart failure, and aplastic anemia.

Monitoring Parameters

• Efficacy: Look for decreased pain and improved range of motion in osteoarthritis or rheumatoid arthritis patients.
• Toxicity: Monitor CBC, LFTs, SCr, and perform fecal occult blood tests if used chronically. Seek medical attention for severe skin rash, black tarry stools, chest pains, yellowing of eyes or skin, or changes in urination.