INDOBID ANGLOCID ANGLOCID ANGLOCID ELMETACIN CAMOCID EPOMET EPOMET EPOMET INDOMETHACIN INDACIN MATINDOL MATINDOL INDOMETHACIN INDOCIN METHACID METHACID INCIN INCIN INCIN INDOCAP INDOCAP LISKOCID LISKOCID LIOMETACEN SHIROCIN INDOGESIC INDOGESIC EROMETHACIN METHACIL INAMACIN ENDOCIN

Dose: 50 to 200 mg
Single Dose: 120 (125)
Frequency: As recommended.
Route: PO
Instructions: in divided doses with food.

Dose: 0.2 to 0.6 mg/kg
Single Dose: 0.4 (0.4)
Frequency: 12 hourly
Route: Intravenous
Instructions: Dose for closure of ductus arteriosus

Dose: 1 mg/kg
Single Dose: 1 (1)
Frequency: 8 hourly
Route: Oral
Instructions: Recommended for 5-12 Years of Children

. It is of Synthetic origin and belongs to Indole Acetic Acid. It belongs to Cyclo-oxygenase inhibitor pharmacological group on the basis of mechanism of action and also classified in Analgesics and Anti-inflammatory Agents pharmacological group.The Molecular Weight of Indomethacin is 357.80. Its pKa is 4.5.

Indomethacin is contraindicated in conditions like Heart failure,Hypertension,Peptic ulcer,Indigestion,Rectal bleeding.

The severe or irreversible adverse effects of Indomethacin, which give rise to further complications include Fluid retension, Malaise, Non-specific bloating, Overt signs of heart failure.Indomethacin produces potentially life-threatening effects which include Hyperkalemia, Thrombocytopenia, GI bleeding, Hepatitis, Leucopenia. which are responsible for the discontinuation of Indomethacin therapy.The signs and symptoms that are produced after the acute overdosage of Indomethacin include Disorientation, Nausea, Vomiting, Convulsions, Dizziness, Headache, Lethargy, Paresthesia, Mental confusion, Numbness.The symptomatic adverse reactions produced by Indomethacin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Headache, Fatigue, Nausea, Anorexia, Tinnitus, Abdominal pain, Confusion, Somnolence, Abdominal discomfort.

Indomethacin is primarily indicated in conditions like Acute gout, Ankylosing spondylitis, Dysmenorrhoea, Gout, Musculoskeletal disorders, Osteoarthritis, Patency of ductus arteriosus, Rheumatoid arthritis, and can also be given in adjunctive therapy as an alternative drug of choice in Bone pain, Pleurisy, Rheumatic diseases.

Indomethacin is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAlcoholAluminium Hydroxide and OxideAspirinIndomethacin bind reversibly at the active site of platelet cyclogenase and thus competitively inhibit this enzyme but because this binding is reversible so it cause temporary rather than sustained depression of thromboxane formation and thus antagonize the anti-platelet and cardioprotective effect of low-dose aspirin.MajorMedications should be taken with food and report the sign and symptoms of GI ulceration and bleeding immediately.AtenololIndomethacin alters the antihypertensive effects of atenolol by inhibiting synthesis of renal prostaglandins results in unopposed pressor activity producing hypertension.ModerateClosely monitor the patient for changed antihypertensive response whenever therapy with indomethacin starts, stopped or modified.Benazepril (HCl)BenorylateBisoprolol (Fumarate)NSAIDs antagonizes antihypertensive effects of beta-blockers.BumetanideCaptoprilIndomethacin may diminish the antihypertensive effect of Captopril.ModerateRapidConsider alternative anti-inflammatory therapy, especially in CHF patients, to avoid the potential negative consequences of concomitant nonsteroidal anti-inflammatory agent (NSAID) therapy (fluid accumulation/edema). Monitor for decreased therapeutic effects of Captopril if Indomethacin is initiated/dose increased, or increased effects if Indomethacin is discontinued/dose decreased. Monitor blood pressure, in particular. This is probably of most concern with chronic dosing of NSAID; however, blood pressure increases have been noted following a single NSAID dose. In addition, concomitant therapy with Indomethacin and Captopril increases the risk of renal dysfunction.ChlorthalidoneCholine Magnesium TrisalicylateCyclosporin AIndomethacin exacerbate the nephrotoxic effect of cyclosporin.ModerateClosely monitor for renal functions.Desmopressin (Acetate)Effects of Desmopressin enhanced by Indomethacin.DiazoxideHypotensive effect of diazoxide antagonised by NSAIDs (Indomethacin).DiflunisalDiflunisal increases the serum concentration of indomethacin upto two to three folds by inhibiting its renal metabolism and excretion thus increases the risk of toxicity such as gastrointestinal and CNS side effects.MajorCoadministration of these agents should be avoided.Enalapril (Maleate)Frusemide or FurosemideIndomethacin may diminish the diuretic effect of Furosemide.ModerateMonitor for decreased therapeutic effects of Furosemide if Indomethacin is initiated/dose increased, or increased effects if Indomethacin is discontinued/dose decreased. Consider using an NSAID that holds a lesser potential for interacting with Furosemide (eg, diflunisal, flurbiprofen, ketoprofen, and ketorolac). Patients with heart failure may be more sensitive to alterations in fluid balance, in which case consideration should be given to avoiding the concomitant use of NSAIDs and Furosemide. Cirrhotic patients with ascites may also be at increased risk.GentamicinIndomethacin potentiates gentamicin nephrotoxicity.HaloperidolThis combination results in drowsiness and confusion.MinorAdverse neurological effects on close observation may be seen when these drugs use in combination.HaloperidolLisinoprilLithiumIndomethacin increases the serum concentration of lithium results in increased toxicity.ModerateClosely monitor the serum level of lithium.Losartan (K)Indomethacin alters the antihypertensive effects of losartan by inhibiting synthesis of renal prostaglandins results in unopposed pressor activity producing hypertension.ModerateClosely monitor the patient for changed antihypertensive response whenever therapy with indomethacin starts, stopped or modified.MethotrexateIndomethacin interfere with the renal excretion of methotrexate thus increases its pharmacological effects and toxicity.MajorClosely monitor for sign and symptoms of of bone marrow suppression and nephrotoxicity.Metoprolol (Tartrate)Indomethacin may attenuate the anihypertensive effect of metoprolol by inhibiting renal prostaglandin synthesis.ModerateClosely monitor for altered antihypertensive response.Muromonab-cd3Likely interaction of INDOMETHACIN increasing the CNS TOXICITY of MUROMONAB CD3. NadololNefopam (HCl)OxprenololConcomitant use may decrease antihypertensive effect of oxprenolol. Oxprenolol (HCl)PenbutololPerindoprilPhenylpropanolamine (HCl)Coadministration of these agents causes increased sensitivity to sympathomimetic-induced blood pressure by inhibiting prostaglandin synthesis results in severe hypertension.ModerateClosely monitor for blood pressure of patient.PindololProbenecidProbenecid reduces the Indomethacin clearance by interfering with biliary and renal elimination of indomethacin.thus increasing the toxocity.ModerateIncreased side effects of NSAIDS should be monitored. Dose reduction is necessary.Propranolol (HCl)Indomethacin alters the antihypertensive effects of propranolol by inhibiting synthesis of renal prostaglandins results in unopposed pressor activity producing hypertension.ModerateClosely monitor the patient for changed antihypertensive response whenever therapy with indomethacin starts, stopped or modified.QuinaprilIndomethacin may diminish the antihypertensive effect of Quinapril.ModerateRapidConsider alternative anti-inflammatory therapy, especially in CHF patients, to avoid the potential negative consequences of concomitant Indomethacin therapy (fluid accumulation/edema). Monitor for decreased therapeutic effects of Quinapril if Indomethacin is initiated/dose increased, or increased effects if Indomethacin is discontinued/dose decreased. Monitor blood pressure, in particular. This is probably of most concern with chronic dosing of Indomethacin; however, blood pressure increases have been noted following a single Indomethacin dose. In addition, concomitant therapy with Indomethacin and Quinapril increases the risk of renal dysfunction. RamiprilStreptomycinIndomethacin may increase the actions and side effects of Streptomycin.TerazosinTimolol (Maleate)TorasemideIndomethacin, a strong CYP2C9 inhibitor, may increase the serum concentration of Torasemide, a CYP2C9 substrate, by decreasing Torasemide metabolism and clearance. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of Torasemide if Indomethacin is initiated, discontinued or dose changed.TrandolaprilTriamtereneTriamtereneVORICONAZOLEIndomethacin may increase the serum concentration of voriconazole by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects Zidovudine These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Complete blood cell count

Drug should not be given to Paediatrics, Pregnant Mothers, patients suffering from Liver Malfunction, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Caps Store in a well closed container, at room temperature.

Indomethacin should be used with caution in patients with intrinsic coagulation defects and those on anticoagulant therapy. It should be used with caution in patients with compromised cardiac function, hypertension other condition predisposing to fluid retention. It should be used with extra care in the presence of existing controlled infection. Perform periodic auditory (hearing) function test during chronic therapy. Discontinue drug if skin reaction occurs. IM injection should be administered cautiously to the patient receiving indomethacin. Dental work should be performed prior to initiating therapy or deferred until blood counts return to normal. Patient should be instructed on proper oral hygiene. The drug should not be prescribed in the children less than 14 years unless possible toxicity and lack of benefit from other drug justifies the risk. If indomethacine is prescribed for children they should receive the lowest possible dose and be closely monitored.