BSN Tracker

indomethacin

Brand: Indocin

⚠ BBW Beers Criteria Prototype: ibuprofen
Drug Class: nonsteroidal anti-inflammatory drug (NSAID)
Drug Family: NSAID
Subclass: non-selective COX inhibitor (indoleacetic acid)
Organ Systems: cnsmusculoskeletal

Mechanism of Action

Potent non-selective COX inhibitor with particularly strong COX-1 activity; one of the most potent NSAIDs. Also inhibits phospholipase A2 and neutrophil migration at higher concentrations. Notable for closing the patent ductus arteriosus in premature neonates via prostaglandin synthesis inhibition.

COX-1COX-2

Indications

  • acute gout (highly effective)
  • osteoarthritis
  • rheumatoid arthritis
  • ankylosing spondylitis
  • patent ductus arteriosus closure in premature neonates (IV)
  • pericarditis
  • Bartter syndrome

Contraindications

  • active GI disease
  • aspirin sensitivity
  • severe renal impairment
  • third trimester pregnancy
  • pre-existing CV disease (for regular use)

Adverse Effects

Common

  • GI toxicity (highest among NSAIDs)
  • headache
  • dizziness
  • CNS effects (confusion, dizziness — higher than other NSAIDs)
  • nausea

Serious

  • GI bleeding/ulceration (higher rate than other NSAIDs)
  • AKI
  • hepatotoxicity
  • aplastic anemia (rare)
  • cardiovascular events

Pharmacokinetics (ADME)

Absorption well absorbed orally; bioavailability ~90-100%; food slows absorption
Distribution protein binding ~99%; Vd ~0.34-1.57 L/kg
Metabolism hepatic CYP2C9 and glucuronidation; enterohepatic recirculation
Excretion renal (30%) and fecal (33-60%)
Half-life 2.6-11.2 hours
Onset 30-60 minutes
Peak 1-2 hours
Duration 4-6 hours (immediate-release)
Protein Binding 99%
Vd 0.34-1.57 L/kg

Drug Interactions

Drug / Agent Mechanism Severity
triamterene acute renal failure reported with this combination major
anticoagulants additive bleeding risk major
diflunisal increases indomethacin levels significantly major

Nursing Considerations

  1. Among NSAIDs, indomethacin has the highest rates of CNS adverse effects (headache, dizziness, confusion) and GI toxicity — use with caution in elderly patients.
  2. Preferred NSAID for acute gouty arthritis due to its particularly potent anti-inflammatory effect; used at 50 mg three times daily for 2-3 days.
  3. IV indomethacin for patent ductus arteriosus in premature neonates requires careful fluid management and monitoring for renal function and necrotizing enterocolitis risk.
  4. Extended-release capsules should not be used for acute gout (too slow onset); immediate-release formulation required.

Clinical Pearls

  • Indomethacin is the historical gold standard for acute gout treatment despite its high adverse effect profile; modern guidelines prefer naproxen, colchicine, or corticosteroids for most patients due to better tolerability.
  • The pharmacological basis for IV indomethacin to close PDA is elegant: ductal patency depends on prostaglandin E2; blocking prostaglandin synthesis causes ductal constriction in premature neonates without the need for surgical ligation.

Safety Profile

Pregnancy contraindicated
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

Acute Gout (highly Effective) Ankylosing Spondylitis Bartter Syndrome Nonsteroidal Anti-inflammatory Drug (NSAID) Osteoarthritis Patent Ductus Arteriosus Closure In Premature Neonates (IV) Pericarditis Rheumatoid Arthritis
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