Top 300 Pharmacy Drug Cards

INDOMETHACIN: Indocin, Various

Class: NSAID

Dosage Forms. Capsule, Immediate Release: 25 mg, 50 mg; Capsule, Extended Release: 75 mg; Rectal Suppository: 50 mg; Suspension: 25 mg/5 mL

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Common FDA Label Indication, Dosing, and Titration.

1. Ankylosing spondylitis, osteoarthritis, rheumatoid arthritis: Immediate Release: 25-50 mg po bid-tid, max 200 mg/d; Extended Release: 75 mg po daily bid

2. Pain: Immediate Release: 75-150 mg/d in 3-4 divided doses × 7-14 d

Off-Label Uses.

1. Preterm labor, prevention: 25 mg po q6-12h

MOA. Nonselective inhibitor of cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2), and reversibly alters platelet function and prolongs bleeding time.

Drug Characteristics: Indomethacin

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Medication Safety Issues: Indomethacin

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Drug Interactions: Indomethacin

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Adverse Reactions: Indomethacin

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Efficacy Monitoring Parameters. Osteoarthritis and rheumatoid arthritis: decreased pain and improved range of motion.

Toxicity Monitoring Parameters. CBC, liver function tests, SCr, fecal occult blood tests if chronic use. Seek medical attention if severe skin rash, black tarry stools, chest pains, yellowing of eyes or skin, or change in urination.

Key Patient Counseling Points. Take with food or milk to decrease GI upset.

Clinical Pearls. Elderly patients are at increased risk of GI ulceration. NSAIDs are associated with an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke. Use lowest effective dose for shortest possible duration; after observing initial response, adjust dose and frequency to meet individual patient’s needs. Various OTC NSAID products are available; caution patients not to duplicate dosing with multiple NSAID products. Indomethacin is effective for stopping premature labor and delaying delivery for several weeks, but should be used with caution as it may cause harm to the infant. Medication guide required at dispensing.