II. Mechanism

  1. NSAID in the acetic acid class (indole)

III. Pharmacokinetics

  1. Half life: 2 hours

IV. Advantages

  1. Only NSAID in suppository form
  2. Most potent NSAID (however this carries renal and GI risks)

V. Indications

VI. Contraindications

  1. Peptic Ulcer Disease
  2. Aspirin Sensitivity
  3. Renal Disease
  4. Coagulopathy
  5. Pregnancy beyond 30 weeks
  6. Childhood (except Patent Ductus Arteriosus)
  7. Dementia (consider avoiding in elderly)

VII. Dosing: General Analgesic use

  1. Regular: 25-50 mg PO tid with food or milk
  2. Sustained Release: 75 mg PO qd to bid
  3. Maximum: 200 mg/day

VIII. Dosing Protocol: Preterm Labor

  1. Protocol 1
    1. Loading dose: 100 mg suppository rectally
    2. Maintenance: 25 mg PO every 6 hours for 24 hours
    3. Repeat for an additional 24 hours maximum
  2. Protocol 2
    1. Loading dose: 50 mg PO
    2. Maintenance: 25 mg PO every 4 hours for 24 hours
    3. Repeat for an additional 24 hours maximum
  3. Monitoring
    1. Amniotic Fluid Index biweekly for use >48 hours

IX. Adverse Effects (more than other NSAIDs)

  1. Headache
  2. Peptic ulcer
  3. Gastrointestinal upset
  4. Fluid retention
  5. Prolonged Bleeding Time
  6. Nausea or Vomiting
  7. Pruritus
  8. Bowel changes
  9. Fetal effects
    1. Early ductus arteriosus closure
    2. Oligohydramnios
    3. Not linked to Intraventricular Hemorrhage
      1. Suarez (2001) Obstet Gynecol 97:921-5 [PubMed]
  10. Nephrotoxic
    1. See Nephrotoxicity due to NSAIDs

X. Drug Interactions

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Related Studies

Cost: Medications

indomethacin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
INDOMETHACIN 25 MG CAPSULE Generic $0.10 each
INDOMETHACIN 50 MG CAPSULE Generic $0.09 each
INDOMETHACIN ER 75 MG CAPSULE Generic $0.26 each