Indocin Medication Guide

Drug Classification

Indocin, also known by its generic name indomethacin, belongs to a class of medications known as nonsteroidal anti-inflammatory drugs (NSAIDs). This classification indicates its function in reducing inflammation, pain, and fever.

Active Ingredient

The active ingredient in Indocin is indomethacin. Indomethacin is a potent nonselective inhibitor of the enzyme cyclooxygenase, leading to decreased formation of prostaglandins, which are mediators of inflammation and pain.

Formulations Available

Indocin is available in several formulations including oral capsules, extended-release capsules, oral suspension, and rectal suppositories. The different formulations allow for customized dosing and administration based on patient needs and preferences.

Indications of Use

Indocin is indicated for the treatment of moderate to severe rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis. It is also indicated for the treatment of acute painful shoulder (bursitis and/or tendinitis) and for therapy of acute pain conditions.

Dosage Instructions

The typical starting dose for Indocin in adults for most indications ranges from 25 mg two to three times daily. Doses may be gradually increased depending on patient response and tolerance. Extended-release formulations are typically dosed at 75 mg once or twice daily.

Administration Guidelines

Oral doses of Indocin should be taken with food or milk to minimize gastrointestinal discomfort. The extended-release capsules should not be crushed or chewed. Rectal suppositories should be inserted rectally and not swallowed.

Pharmacokinetics

Indomethacin is rapidly absorbed after oral administration, with peak plasma concentrations typically occurring within 1-2 hours. The drug has a half-life of approximately 4.5 hours and is metabolized primarily in the liver, with renal excretion of metabolites.

Potential Drug Interactions

Indocin might interact with other medications such as anticoagulants, other NSAIDs, antihypertensive medications, and certain diuretics. Potential interactions may lead to increased risk of bleeding, reduced efficacy of antihypertensive medications, or renal function impairment.

Contraindications

Indocin is contraindicated in patients with a history of hypersensitivity to indomethacin or other NSAIDs, peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery, and active gastrointestinal bleeding or peptic ulcer disease.

Common Side Effects

Common side effects of Indocin include gastrointestinal pain, nausea, headache, dizziness, and indigestion. These side effects are generally dose-related and may be minimized by the use of the lowest effective dose for the shortest duration possible.

Serious Adverse Reactions

Serious adverse reactions that may occur with Indocin use include gastrointestinal bleeding, ulceration, and perforation, hepatotoxicity, renal toxicity, severe skin reactions, and cardiovascular thrombotic events.

Monitoring Parameters

Patients on long-term Indocin therapy should have their blood pressure, renal function, liver function, and complete blood count monitored periodically. Regular ophthalmologic exams may also be suggested to monitor for potential visual disturbances.

Patient Counseling Points

Patients should be counseled to take Indocin with food to reduce gastrointestinal discomfort and to report any signs of gastrointestinal bleeding, such as black tarry stools or vomiting blood, to their healthcare provider immediately. Additionally, patients should be advised to avoid alcohol, which may increase gastrointestinal risk.

Storage Instructions

Indocin should be stored at room temperature, away from moisture, heat, and light. The medication should be kept out of reach of children and pets to prevent accidental ingestion.

Brand Alternatives and Generics

Besides the brand name Indocin, generic versions of indomethacin are widely available. The efficacy and safety profile of generic indomethacin are considered equivalent to the brand-name formulation.

Off-Label Uses

Indocin is sometimes used off-label for the treatment of other conditions such as pericarditis and patent ductus arteriosus (PDA) in preterm infants. These off-label uses are typically guided by the prescribing physician’s clinical judgment.