25 mg, 50 mg capsules; 75 mg sustained release capsules; 25 mg/5 mL oral suspension; 50 mg suppositories; 1 mg injection
Potent nonsteroidal compound that competes with COX-1 and COX-2 enzymes, thus interfering with formation of prostaglandin.
Appears to reduce motility of polymorphonuclear leukocytes, development of cellular exudates, and vascular permeability
in injured tissue resulting in its antiinflammatory effects. Inhibition of prostaglandins is thought to promote closure
of the patency of the ductus arterious. Antipyretic and antiinflammatory actions may be related to its ability to inhibit
It is a potent analgesic, antiinflammatory, and antipyretic agent. Promotes closure of persistent patent ductus arteriosus.
Palliative treatment in active stages of moderate to severe rheumatoid arthritis, ankylosing rheumatoid spondylitis, acute
gouty arthritis, and osteoarthritis of hip in patients intolerant to or unresponsive to adequate trials with salicylates
and other therapy. Also used IV to close patent ductus arteriosus in the premature infant.
To relieve biliary pain and dysmenorrhea, Paget's disease, athletic injuries, juvenile arthritis, idiopathic pericarditis.
Allergy to indomethacin, aspirin, or other NSAID; nasal polyps associated with angioedema; history of GI lesions; perioperative pain with CABG; pregnancy (category B; D
in third trimester).
History of psychiatric illness, epilepsy, parkinsonism; impaired renal or hepatic function; uncontrolled infections; coagulation
defects, CHF; older adults, persons in hazardous occupations.
Route & Dosage
Adult: PO 2550 mg b.i.d or t.i.d. (max: 200 mg/d) or 75 mg sustained release 12 times/d
Child: PO 12 mg/kg/d in 24 divided doses (max: 4 mg/kg/d) or 150200 mg/d
Acute Gouty Arthritis
Adult: PO/PR 50 mg t.i.d. until pain is tolerable, then rapidly taper
Adult: PO 2550 mg t.i.d. or q.i.d. (max: 200 mg/d) or 75 mg sustained release 12 times/d
Close Patent Ductus Arteriosus
Premature neonate: IV <48 h, 0.2 mg/kg followed by 2 doses of 0.1 mg/kg q1224h; 27 d, 0.2 mg/kg followed by 2 doses of 0.2 mg/kg q1224h; <7 d, 0.2 mg/kg followed by 2 doses of 0.25 mg/kg q1224h
- Give immediately after meals, or with food, milk, or antacid (if prescribed) to minimize GI side effects.
- Indomethacin rectal suppository use is contraindicated with history of proctitis or recent bleeding.
PREPARE: Direct: Dilute 1 mg with 1 mL of NS or sterile water for injection without preservatives. Resulting concentration (1 mg/mL) may
be further diluted with an additional 1 mL for each 1 mg to yield 0.5 mg/mL.
ADMINISTER: Direct: Give by direct IV with a single dose given over 2030 min.
INCOMPATIBILITIES Y-site: Amino acid, calcium gluconate, cimetidine, dobutamine, dopamine, gentamicin, levofloxacin, tobramycin, tolazoline.
- Avoid extravasation or leakage; drug can be irritating to tissue.
- Discard any unused drug, since it contains no preservative.
- Store oral and rectal forms in tight, light-resistant containers unless otherwise directed. Do not freeze.
Adverse Effects (≥1%)Body as a Whole:
Hypersensitivity (rash, purpura, pruritus, urticaria, angioedema, angiitis, rapid fall in blood pressure, dyspnea, asthma
syndrome in aspirin-sensitive patients), edema, weight gain, flushing, sweating. CNS:
vertigo, light-headedness, syncope, fatigue
, muscle weakness, ataxia, insomnia
, nightmares, drowsiness, confusion, coma,
convulsions, peripheral neuropathy, psychic disturbances (hallucinations, depersonalization, depression), aggravation of
, parkinsonism. CV:
Elevated BP, palpitation, chest pains, tachycardia, bradycardia, CHF. Special Senses:
Blurred vision, lacrimation, eye pain, visual field changes, corneal deposits, retinal disturbances including macula, tinnitus,
hearing disturbances, epistaxis. GI: Nausea, vomiting,
diarrhea, anorexia, bloating, abdominal distention, ulcerative stomatitis, proctitis, rectal bleeding, GI ulceration, hemorrhage, perforation, toxic hepatitis. Hematologic:
Hemolytic anemia, aplastic anemia
(sometimes fatal), agranulocytosis,
leukopenia, thrombocytopenic purpura, inhibited platelet aggregation. Urogenital:
Renal function impairment, hematuria, urinary frequency; vaginal bleeding, breast changes. Skin:
Hair loss, exfoliative dermatitis, erythema nodosum, tissue
irritation with extravasation. Metabolic:
Hyponatremia, hypokalemia, hyperkalemia, hypoglycemia
or hyperglycemia, glycosuria (rare).
Diagnostic Test Interference
Increased AST, ALT, bilirubin, BUN; positive direct Coombs' test.
InteractionsDrug: oral anticoagulants
, heparin, alcohol
may prolong bleeding time; may increase lithium
toxicity; effects of oral anticoagulants
, phenytoin, salicylates
increased because of protein-binding displacement; increased toxicity including GI bleeding with salicylates
s; may blunt effects of antihypertensives
. Herbal: Feverfew, garlic, ginger, ginkgo
may increase bleeding potential.
Completely absorbed from GI tract. Onset:
12 h. Peak:
3 h. Duration:
46 h. Metabolism:
In liver. Elimination:
Primarily in urine. Half-Life:
Assessment & Drug Effects
- Monitor for therapeutic effectiveness: In acute gouty attack, relief of joint tenderness and pain is usually apparent in
2436 h; swelling generally disappears in 35 d. In rheumatoid arthritis: Reduced fever, increased strength, reduced
stiffness, and relief of pain, swelling, and tenderness.
- Question patient carefully regarding aspirin sensitivity before initiation of therapy.
- Observe patients carefully; instruct to report adverse reactions promptly to prevent serious and sometimes irreversible or
- Lab tests: Monitor renal function, hepatic function, CBC with differential, BP and HR, visual and hearing acuity periodically.
- Monitor weight and observe dependent areas for signs of edema in patients with underlying cardiovascular disease.
- Monitor I&O closely and keep physician informed during IV administration for patent ductus arteriosus. Significant impairment
of renal function is possible; urine output may decrease by 50% or more. Also monitor BUN, serum creatinine, glomerular
filtration rate, creatinine clearance, and serum electrolytes.
Patient & Family Education
- Notify physician of S&S of GI bleeding, visual disturbance, tinnitus, weight gain, or edema.
- Do not take aspirin or other NSAIDs; they increase possibility of ulcers.
- Note: Frontal headache is the most frequent CNS adverse effect; if it persists, dosage reduction or drug withdrawal may be indicated.
Take drug at bedtime with milk to reduce the incidence of morning headache.
- Do not drive or engage in other potentially hazardous activities until response to drug is known.