Indocin® is an NSAID that belongs to the group of indoleacetic acid derivatives. The drug possesses analgesic and antipyretic properties and is used mainly in the treatment of rheumatoid arthritis—although, the drug does have other indications such as dysmenorrhea, juvenile arthritis, Reiter’s syndrome, Paget’s disease, pleural joint pain, and pericarditis.
Mechanism of action
The anti-inflammatory effect of indomethacin (the primary active substance of Indocin®) occurs due to the inhibition of prostaglandin synthesis, of leukocytes in the inflammatory region, and of phosphodiesterase, with the formation of inflammatory antibodies.
Instructions for use and dosage
As previously stated, the primary active substance of Indocin® is indomethacin. The drug is available in the form of tablets with a dosage of either 25 mg, 50 mg, or 75 mg as well as in the form of an ointment.
The intake of tablets should be divided into two to three doses, which must be swallowed without chewing and washed down with water after eating.
The maximum dose of Indocin® should not exceed 200 mg per day. To achieve the desired effect, Indocin® should be taken regularly for at least ten days.
In the treatment of severe or moderate pain in the pathologies of bones, arthralgia, myalgia, rheumatoid arthritis, osteoarthritis, bursitis, tendonitis, or ankylosing spondylitis, the following treatment regimens are used:
- Adults: 25 mg two to three times daily with food or antacids. These doses can be increased by 25 mg/day every seven days to a maximum of 200 mg/day.
- Elderly: doses should be reduced by 25% as compared with the usual dosages prescribed in adults.
An extensive series of clinical trials conducted with NSAIDs showed that prolonged treatment with indomethacin increases the risk of developing thrombotic complications such as myocardial infarction or stroke.
Chronic administration of indomethacin can cause bleeding, ulceration, and perforation of the esophagus and/or stomach. Thus, Indocin® is contraindicated in patients with a history of the digestive disease, including peptic ulcer disease.
Alcohol consumption and smoking increase the risk of adverse reactions in the digestive tract following indomethacin use.
Indocin® can bring on hypertension or aggravate an existing case. Additionally, Indocin® can cause fluid retention or worsen of heart failure.
Pregnancy and breastfeeding
Indomethacin is classified as a category B drug during pregnancy, although it can move to category D designation if it is used in the third trimester for more than two days. Indomethacin is excreted in breast milk; for this reason, it should not be given to mothers during breastfeeding.
During treatment with NSAIDs, renal dysfunction and other symptoms such as papillary necrosis, nephrotic syndrome, and hematuria can be observed. These reactions usually appear beginning a few days after the initiation of treatment and quickly pass.
Gastritis, perforations of the digestive tract, and peptic ulcers are frequent complications of treatment with Indocin®. Other symptoms involving the digestive tract, such as nausea and vomiting, abdominal pain, or diarrhea, can be minimized if the drug is taken with food.
Adverse reactions to the nervous system that may present include morning headaches, drowsiness, and dizziness.
Ophthalmic side effects occur in less than 1% of patients; these include including blurred vision, corneal intraepithelial deposits, and retinal abnormalities.
The rash is a side effect that occurs in 1% to 3% of patients. Other less frequent dermatological adverse reactions include vasculitis and toxic epidermal necrolysis.