Indomethacin

Indomethacin

Indomethacin is a highly effective Non-Steroidal Anti-Inflammatory Drug (NSAID) with many applications. It inhibits the synthesis of prostaglandins, critical mediators of inflammation, fever, and pain. While it is effective for moderate to severe pain, indomethacin carries a higher risk of gastrointestinal issues and cardiovascular events compared to some other NSAIDs. Therefore, doctors typically prescribe it when other pain relievers are insufficient and should be used under careful medical supervision.

Indomethacin Uses

Indomethacin is a versatile medication used to manage a wide range of conditions. Its primary uses include:

• Rheumatoid Arthritis: Indomethacin helps alleviate moderate to severe symptoms of rheumatoid arthritis, including acute flares of chronic disease. 
• Ankylosing Spondylitis: indomethacin tablets can relieve the debilitating symptoms of this inflammatory arthritis for individuals with moderate to severe ankylosing spondylitis.
• Osteoarthritis: Indomethacin is effective in managing moderate to severe osteoarthritis.
• Bursitis and Tendinitis: Indomethacin can help alleviate the associated inflammation and discomfort in acute painful shoulder conditions like bursitis or tendinitis.
• Gouty Arthritis: Indomethacin tablet helps reduce the intense pain, inflammation, and swelling developed by the buildup of uric acid crystals in the joints.
• Patent Ductus Arteriosus: Indomethacin helps induce closure of a hemodynamically significant patent ductus arteriosus when standard medical management is ineffective after 48 hours.
• General Pain and Inflammation: Indomethacin's potent anti-inflammatory and analgesic properties make it suitable for managing moderate to severe pain and inflammation from various other conditions.

How to Use Indomethacin

Follow your doctor's instructions carefully to use this medicine safely and effectively. Taking too much tablet indomethacin may increase the chance of unwanted side effects.

Dosage and Administration

When used for severe or continuing arthritis, you must take an indomethacin tablet regularly as prescribed by your doctor for it to be effective. The medicine usually starts to work within one week, but in severe instances, up to two weeks or even longer may pass before you start to feel better. Additionally, several weeks may pass before you feel the full effects of this medicine.

• Swallow the capsule whole. Do not open, crush, break, or chew it.
• For the oral suspension, shake it well before use. Measure the drug with a marked measuring spoon, oral syringe, or medicine cup. 
• It is best to take indomethacin with food.

Side Effects of Indomethacin Tablet

Like most medications, tablet indomethacin can cause side effects, such as:

• Common Side Effects:
  • Headache
  • Dizziness
  • Vomiting
  • Diarrhea or constipation
  • Ringing in the ears
• Serious Side Effects: Indomethacin can also cause more severe side effects that require immediate medical attention:
  • Unexplained weight gain
  • Shortness of breath or difficulty breathing
  • Swelling in the abdomen, ankles, feet, or legs
  • Fever, rash, lymph node swelling, or facial swelling
  • Blisters or hives
  • Swelling of the eyes, face, tongue, lips, throat, or hands
  • Difficulty breathing or swallowing
  • Hoarseness
  • Pale skin
  • Fast heartbeat and lack of energy
  • Excessive tiredness
  • Pain in the upper right part of the stomach
  • Unusual bleeding or bruising
  • Nausea
  • Loss of appetite
  • Flu-like symptoms
  • Yellowing of the skin or eyes
  • Cloudy, discoloured, or bloody urine
  • Back pain
  • Difficult or painful urination
  • Blurred vision or other vision problems

Precautions

Disclose your complete medical history to your doctor, particularly if you have:

• Asthma (including worsening breathing after taking aspirin or NSAIDs)
• Bleeding or clotting disorders
• Nasal polyps
• Heart disease (e.g., previous heart attack)
• High blood pressure
• Liver disease
• Stomach, intestinal, or oesophageal problems (such as bleeding, ulcers, or recurring heartburn)
• History of stroke
• Indomethacin and other NSAIDs can sometimes cause kidney problems, especially if you are dehydrated, have a history of heart attack or kidney disease, are an older adult, or take certain medications.
• Indomethacin can make you more sensitive to sunlight. To avoid this, limit your time in the sun and wear sunscreen and protective clothing outdoors. 

How Indomethacin Works?

Indomethacin functions like most other non-steroidal anti-inflammatory drugs (NSAIDs) by inhibiting the synthesis of prostaglandins. Prostaglandins are primarily produced by cyclooxygenase (COX) enzymes and play an elementary role in mediating inflammation, fever, and pain. They also maintain renal function, gastrointestinal mucosa, and platelet activity.

Can I Take Indomethacin with Other Medicines?

Some important considerations regarding indomethacin and other medicines include:

• Anticoagulants and Antiplatelet Drugs: Indomethacin may increase the possibility of bleeding when taken with anticoagulants (blood thinners).
• Angiotensin-converting enzyme (ACE) Inhibitors: This combination should be avoided, especially in older adults and those with existing kidney disease.
• Diuretics: Indomethacin can reduce the effectiveness of diuretics (water pills) and elevate the risk of kidney problems when taken together. 
• Methotrexate: Indomethacin can increase the levels and toxicity of methotrexate. 
• Cyclosporine: Indomethacin may increase the levels and toxicity of cyclosporine, a medicine used to prevent organ transplant rejection. 
• Lithium: Indomethacin can elevate lithium levels in the body, potentially leading to lithium toxicity. 
• Corticosteroids: Indomethacin may increase the risk of gastrointestinal side effects, such as ulcers and bleeding when taken with corticosteroids.

Dosing Information

Indomethacin dosage varies and depends on the treated ailment and the formulation used. Here are some general guidelines:

• Acute Gouty Arthritis
  • 50 mg of indomethacin orally or rectally as an immediate-release formulation three times daily.
• Bursitis and Tendinitis
  • Immediate-release capsules or suspension: 75 to 150 mg daily, divided into 3 or 4 dosing schedule
  • Suppository: 50 mg rectally. It can be given up to 3 times a day.
  • Extended-release: 75 mg orally, once or twice a day.
  • The treatment span is usually 7 to 14 days or until the signs and symptoms of inflammation have been controlled.
• Mild to Moderate Acute Pain
  • The typical dosage for mild to moderate acute pain is 20 mg orally, three times a day, or 40 mg orally, two or three times daily.
• Patent Ductus Arteriosus (PDA) in Preterm Infants
  • For the closure of a hemodynamically significant PDA in premature infants weighing between 500 & 1750 grams, indomethacin is administered intravenously (IV) in the course of 3 doses given at 12- to 24-hour intervals. The dosage depends on the age of the neonate at the time of therapy.

Conclusion

Indomethacin has a significant influence on managing various inflammatory conditions and pain. Its versatility in treating arthritis, gout, and even certain heart conditions in premature infants makes it a valuable tool in the medical field. However, it's crucial to remember that this powerful medication has potential side effects and interactions that require careful consideration. Proper use of indomethacin under medical supervision can significantly enhance the quality of life. 

FAQs

1. Is indomethacin a strong painkiller?

Yes, indomethacin is a potent non-steroidal anti-inflammatory drug (NSAID) with strong analgesic (pain-relieving) properties. It effectively manages moderate to severe pain associated with various conditions, including arthritis, gout, bursitis, and tendinitis. 

2. What to avoid when taking indomethacin?

When taking indomethacin, you should avoid:

• Alcohol intake as alcoholic beverages can cause stomach-related side effects.
• Concomitant use of other NSAIDs, as this can increase the likelihood of adverse effects without providing additional benefits.
• Activities requiring mental alertness or coordination, as indomethacin, may cause dizziness or drowsiness.

3. Is indomethacin stronger than ibuprofen?

Yes, indomethacin is generally considered stronger and more potent than ibuprofen. It is a prescription NSAID, while ibuprofen is available over-the-counter. However, the increased potency of indomethacin also means a higher risk of side effects, particularly gastrointestinal and cardiovascular side effects, compared to ibuprofen.

4. Is indomethacin bad for the kidneys?

Indomethacin and other NSAIDs can potentially cause kidney problems, especially in certain high-risk groups. These include individuals who have heart failure or kidney disease, are dehydrated, are older adults, or take certain medications that may interact with indomethacin. 

5. Which is better, indomethacin or diclofenac?

The choice between indomethacin and diclofenac (another NSAID) depends on numerous factors, including the specific condition, individual response, and risk of side effects. Both medications are effective for managing pain and inflammation, but indomethacin is generally considered more potent and may have a higher risk of gastrointestinal side effects compared to diclofenac.

6. How many days can you take indomethacin?

The duration of indomethacin treatment depends on the condition and the dosage form used. The typical treatment duration for acute systemic conditions like gout or bursitis is 1-2 weeks. Doctors may prescribe indomethacin for longer periods for chronic diseases like osteoarthritis or rheumatoid arthritis.