Indocin

Indocin Medication Overview

Indocin is the brand name for the medication indomethacin, which is a nonsteroidal anti-inflammatory drug (NSAID) used to treat moderate to severe pain, inflammation, and stiffness caused by certain conditions, such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, bursitis, and gout attacks. It works by inhibiting the production of substances in the body that cause inflammation and pain.

Formulations and Strengths

Indocin comes in various forms and strengths. It is available as an oral capsule (immediate-release and extended-release), an oral suspension, and rectal suppositories. The immediate-release capsules come in strengths of 25 mg and 50 mg, while the extended-release capsules are available in a strength of 75 mg. The oral suspension is typically prescribed in a concentration of 25 mg per 5 ml. The rectal suppositories are 50 mg each.

Dosage Administration Instructions

Patient-specific dosage should be determined by a healthcare provider. Indocin should be taken with food or milk to reduce the risk of gastrointestinal side effects. The immediate-release capsules can be administered two to three times a day. The extended-release capsules should be taken once a day, and the rectal suppositories are usually used one to three times a day. Dosage may vary depending on the condition being treated and patient response to the medication.

Indocin Therapeutic Indications

Indocin is indicated for managing signs and symptoms of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and acute gouty arthritis. It is also indicated for treatment of bursitis, tendonitis, and acute painful shoulder (acute subacromial bursitis/supraspinatus tendinitis). Additionally, it can be used in the treatment of moderate to severe inflammatory disorders.

Pharmacokinetics and Metabolism

The absorption of indomethacin from Indocin occurs rapidly for immediate-release forms, and the peak plasma levels are reached within 1 to 2 hours after oral administration. The extended-release form reaches the peak concentration within 4 to 5 hours. Indomethacin is metabolized primarily in the liver and is excreted via the kidneys in urine and, to a lesser extent, in feces. The half-life of indomethacin is approximately 4.5 hours for immediate-release forms and somewhat longer for extended-release forms.

Indocin Mechanism of Action

Indocin’s therapeutic effects are realized through its ability to inhibit cyclooxygenase (COX-1 and COX-2), which are the enzymes responsible for the conversion of arachidonic acid to prostaglandins and thromboxanes. By inhibiting these enzymes, Indocin reduces the levels of prostaglandins, which are responsible for causing inflammation, pain, and fever.

Monitoring Patient Response

Healthcare providers should monitor the patient’s response to Indocin therapy. This includes assessing the relief of pain and inflammation, as well as monitoring for any potential adverse effects. Renal and liver function should be periodically evaluated, especially for long-term users and the elderly. Blood pressure should also be monitored throughout therapy as NSAIDs can lead to the onset of new hypertension or worsening of pre-existing hypertension.

Adverse Reactions and Side Effects

As with all NSAIDs, Indocin may cause a range of adverse reactions and side effects. These can include gastrointestinal disturbances such as nausea, vomiting, dyspepsia, gastritis, and even serious gastrointestinal bleeding or ulceration. CNS effects such as headache, dizziness, vertigo, and depression have also been reported. Hypersensitivity reactions, including rash and anaphylaxis, may occur. Cardiovascular risks including myocardial infarction and stroke have been reported with long-term use of NSAIDs.

Drug Interactions with Indocin

Indocin can interact with other medications which may affect its effectiveness or increase the risk of serious side effects. Concomitant use with other NSAIDs or aspirin can increase the risk of gastrointestinal bleeding. Indocin can affect the efficacy of antihypertensives and diuretics. It can also interact with anticoagulants, increasing the risk of bleeding, and with methotrexate or cyclosporine, exacerbating their toxicity. Alcohol should be avoided as it can increase the risk of gastrointestinal bleeding.

Special Precautions for Use

Special precautions should be taken when Indocin is prescribed to patients with a history of gastrointestinal disease, cardiovascular disease, kidney or liver disease, or with known hypersensitivity to indomethacin or other NSAIDs. It should be used cautiously in the elderly and in those with coagulation disorders or taking concomitant anticoagulants. Women who are pregnant, especially in the third trimester, or breastfeeding, should avoid using Indocin unless prescribed by a healthcare provider.

Storage and Handling of Indocin

Indocin should be stored at room temperature, away from light and moisture. The capsules and oral suspension should not be stored in the bathroom and should be kept out of reach of children and pets. If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next dose, in which case the missed dose should be skipped.