section name header

Indications

BEERS REMS


Contraind./Precautions

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects

Interactions

Drug-drug:

Drug-Natural Products:

Availability

(Generic available)

Route/Dosage

Anti-inflammatory

PDA Closure

US Brand Names

Indocin, Tivorbex

Action

  • Inhibits prostaglandin synthesis. In the treatment of PDA, decreased prostaglandin production allows the ductus to close.
Therapeutic effects:
  • PO: Suppression of pain and inflammation.
  • IV: Closure of PDA.

Classifications

Therapeutic Classification: antirheumatics, ductus arteriosus patency adjuncts (IV only ), nonopioid analgesics

Pharmacologic Classification: nonsteroidal anti inflammatory drugs nsaids

Pharmacokinetics

Absorption: Well absorbed after oral administration in adults; incomplete oral absorption in neonates.

Distribution: Crosses the blood-brain barrier.

Protein Binding: 99%.

Metabolism/Excretion: Mostly metabolized by the liver.

Half-Life: Neonates <2 wk: 20 hr; Neonates >2 wk: 11 hr; Adults: 2.6–11 hr.

Time/Action Profile

ROUTEONSETPEAKDURATION
PO (analgesic)30 min0.5–2 hr4–6 hr
PO-ER (analgesic)30 minunknown4–6 hr
PO (anti-inflammatory)up to 7 days1–2 wk4–6 hr
PO-ER (anti-­inflammatory)up to 7 days1–2 wk4–6 hr
IV (closure of PDA)up to 48 hrunknownunknown

Patient/Family Teaching

  • Explain purpose and side effects of medication. Advise patient to read Patient Information before starting therapy.
  • Advise patient to take this medication with a full glass of water and to remain in an upright position for 15–30 min after administration.
  • May cause drowsiness or dizziness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications. Avoid concurrent use of alcohol, aspirin and other NSAIDs.
  • Caution patient to wear sunscreen and protective clothing to prevent photosensitivity reactions.
  • Advise patient to inform health care provider of medication regimen before treatment or surgery.
  • Inform patient of risk of MI and stroke. Use lowest effective dose for shortest time. Advise patient to notify health care provider immediately if signs and symptoms (shortness of breath or trouble breathing, chest pain, weakness in one part or side of body, slurred speech, swelling of the face or throat) occur.
  • Advise patient to notify health care provider promptly if signs or symptoms of GI toxicity (abdominal pain, black stools) occur.
  • Instruct patient to notify health care provider immediately if signs and symptoms of hepatotoxicity (nausea, fatigue, lethargy, diarrhea, pruritus, jaundice, right upper quadrant tenderness, flu-like symptoms), rash, itching, chills, fever, muscle aches, visual disturbances, weight gain, edema, or persistent headache occurs.
  • Rep: May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Advise women to avoid indomethacin in the 3rd trimester of pregnancy (after 29 wk); may cause premature closure of the fetal ductus arteriosus. Use of indomethacin after 20 wk may cause fetal renal dysfunction leading to oligohydramnios. May cause temporary infertility in women.

Pronunciation

in-doe-METH-a-sin

Code

NDC Code