Pharmacodynamics and pharmacokinetics
The drug Indomethacin (Sopharma; Berlin Chemie, Balkanfarma, etc.) is a derivative of indoleacetic acid and belongs to the NSAID group of drugs, which are characterized by their antipyretic , anti-inflammatory , antiaggregation and analgesic effects.
The effectiveness of this medication is associated with its inhibitory effect on the enzyme COX ( cyclooxygenase ), which leads to the suppression of metabolic transformations of arachidonic acid and a decrease in the synthesis of prostaglandins . Also, one of the effects of the drug is inhibition of platelet aggregation .
Parenteral and oral administration of Indomethacin reduces the severity of pain , especially in relation to joint pain , both during movement and at rest, reduces the manifestations of morning swelling of the joints and their stiffness, and also increases the range of movements. The anti-inflammatory effect develops after 5-7 days of treatment.
External use of this drug helps eliminate pain, reduce swelling and weaken erythema, as well as reduce morning joint stiffness and increase motor activity .
Indomethacin tablets, when taken orally, are quickly absorbed from the gastrointestinal tract. Serum Cmax is observed after 120 minutes. After enterohepatic recirculation, further metabolic transformations occur in the liver. In plasma, the unchanged active ingredient and unbound metabolic products are determined - desbenzoyl , desmethyl , desmethyl-desbenzoyl metabolites. The average T1/2 lasts approximately 4.5 hours. Excretion of 60% of the drug, in the form of unchanged substance and metabolic products, is carried out by the kidneys and 33%, in the form of metabolites, by the intestines.
Rectal suppositories are characterized by rapid absorption in the rectum. Bioavailability with this route of administration of the drug is 80-90%. Approximately 90% of the active ingredient is bound to whey proteins. T1/2 varies between 4-9 hours. Metabolic transformations occur in the liver. Approximately 70% of the drug is excreted by the kidneys, and about 30% by the intestines.
Indications for use
Indications for the use of Indomethacin in the form of tablets and suppositories include:
- articular syndrome (including painful manifestations of gout , rheumatoid arthritis , ankylosing spondylitis , osteoarthritis );
- various neuralgia ;
- pain syndrome in the spine;
- dysmenorrhea;
- myalgia;
- diffuse painful conditions of connective tissue;
- traumatic inflammatory processes in joints and soft tissues;
- rheumatism;
- infectious and inflammatory processes noted with adnexitis , cystitis , prostatitis and diseases of the ENT organs (auxiliary therapy).
Indomethacin gel and ointment is indicated for use for:
- myalgia;
- traumatic inflammatory processes occurring in joints and soft tissues;
- articular syndrome (including painful manifestations of gout , rheumatoid arthritis , ankylosing spondylitis , osteoarthritis );
- pain in the spine;
- neuralgia.
Contraindications to the use of Indomethacin
Contraindications to the use of Indomethacin depend on the form in which you were prescribed the drug. General contraindications, regardless of method of application:
- individual intolerance to indomethacin;
- “aspirin triad” - a combination of bronchial asthma, recurrent polyposis of the nose and paranasal sinuses, intolerance to acetylsalicylic acid or other NSAIDs;
- disorders of hematopoiesis, liver and kidney function;
- pregnancy and lactation period.
Indomethacin ointment is contraindicated in:
- violation of the integrity of the skin at the site of application of the drug;
- children under 6 years of age.
Indomethacin tablets should not be used for:
- presence of laboratory confirmed hyperkalemia;
- severe forms of heart failure and arterial hypertension;
- congenital heart defects or recent coronary artery bypass surgery;
- pancreatitis;
- under 14 years of age.
Indomethacin suppositories are contraindicated for:
- inflammation of the rectum;
- recent rectal bleeding;
- under 14 years of age.
Contraindications
Indomethacin tablets (Sopharma, Balkanfarma, etc.), as well as Indomethacin suppositories (Berlin Chemie, Sopharma, etc.) are contraindicated for use in:
- Crohn's disease;
- liver failure or active liver pathologies ;
- hypersensitivity;
- ulcerative colitis;
- pregnancy;
- bronchial asthma;
- breastfeeding;
- acute rhinitis or urticaria , in the past caused by taking NSAIDs;
- confirmed hyperkalemia;
- gastrointestinal ulcer;
- CRF (with CC less than 30 ml/min) or progressive renal pathologies ;
- bleeding;
- recently performed coronary artery bypass surgery ;
- bleeding disorders;
- congenital heart defects ;
- hematopoietic disorders (including anemia and leukopenia );
- under the age of 14 years.
Additionally, Indomethacin 50/100 suppositories (Berlin Hemi, Sopharma, etc.) are prohibited for use when:
- manifestations of hemorrhoids ;
- rectal bleeding;
- symptoms of proctitis .
Both dosage forms of the drug should be prescribed with caution when:
- IHD;
- somatic diseases of a severe nature;
- cerebrovascular disorders;
- depression;
- CHF;
- parkinsonism;
- dyslipidemia;
- epilepsy;
- hyperlipidemia;
- mental disorders;
- diabetes mellitus;
- alcoholism;
- thrombocytopenia;
- pathologies of peripheral arteries;
- history of ulcerative lesions of the gastrointestinal tract
- arterial hypertension;
- long-term use of other NSAIDs;
- nicotine addiction;
- CRF (with CC 30-60 ml/min);
- hyperbilirubinemia;
- presence of Helicobacter pylori ;
- liver cirrhosis with concomitant portal hypertension ;
- parallel use of anticoagulants ( Warfarin ), oral glucocorticoids ( Prednisolone ), antiplatelet agents ( Clopidogrel , Aspirin ), SSRIs ( sertraline , Citalopram , Paroxetine , Fluoxetine );
- in old age.
Gel and ointment for topical use are contraindicated for:
- damage to the skin in the area of application;
- III trimester of pregnancy (if the drug is applied to large areas of the body);
- hypersensitivity;
- up to 1 year of age.
External dosage forms are prescribed with caution when:
- any combination of bronchial asthma with polyposis and intolerance to NSAIDs ;
- I and II trimester of pregnancy;
- exacerbation of gastrointestinal ulcer ;
- breastfeeding;
- bleeding disorders;
- up to 6 years old.
Indomethacin
Dosage form
Rectal suppositories
Composition per suppository:
Active substance
: indomethacin – 50 mg (100 mg).
Excipients
: solid fat (Vitepsol N 15) – 1.30 g (1.30 g), solid fat (Vitepsol W 35) – 0.65 g (0.60 g).
Description
Suppositories are torpedo-shaped with a smooth surface, white to light yellow, odorless. The cut surface should be smooth and uniform.
Pharmacotherapeutic group
Non-steroidal anti-inflammatory drug (NSAID).
ATX code
: M01AB01.
pharmachologic effect
Pharmacodynamics
Indomethacin has anti-inflammatory, analgesic, antipyretic and antiplatelet effects. Suppresses the activity of anti-inflammatory factors, reduces platelet aggregation. By inhibiting type II cyclooxygenase, it disrupts the metabolism of arachidonic acid, reduces the amount of prostaglandins both in the site of inflammation and in healthy tissues, and suppresses the exudative and proliferative phases of inflammation. Eliminates or reduces pain of a rheumatic and non-rheumatic nature (including pain in the joints at rest and during movement, reduces morning stiffness and swelling of the joints, helps to increase range of motion; in inflammatory processes that occur after operations and injuries, quickly relieves both spontaneous pain and pain during movement, reduces inflammatory swelling at the wound site).
Pharmacokinetics
Absorption is fast. Bioavailability by rectal route of administration is 80-90%. Bonding with plasma proteins is 90%, half-life is 4.5 hours. Metabolized mainly in the liver, 70% is excreted by the kidneys (30% unchanged), 30% through the gastrointestinal tract (GIT). Not removed by dialysis. Passes into breast milk.
Indications for use
- Acute and chronic pain in inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid arthritis; juvenile chronic arthritis; ankylosing spondylitis (ankylosing spondylitis); gouty arthritis; psoriatic arthritis; Reiter's disease;
- Rheumatic lesions of soft tissues: tendinitis, bursitis, tendobursitis, tendovaginitis;
- Discopathies, neuritis, plexitis, radiculoneuritis;
- Dysmenorrhea.
The drug is intended for symptomatic therapy, reducing pain and inflammation at the time of use, and does not affect the progression of the disease.
Contraindications
- Hypersensitivity to indomethacin or any of the excipients of the drug;
- Complete or incomplete combination of bronchial asthma, recurrent loliposis of the nose and paranasal sinuses and intolerance to acetylsalicylic acid or other non-steroidal anti-inflammatory drugs (including a history), urticaria or rhinitis;
- Peptic ulcer of the stomach and duodenum, inflammatory bowel diseases (ulcerative colitis, Crohn's disease), bleeding (including intracranial, from the gastrointestinal tract (GIT);
- Congenital heart defects (severe coarctation of the aorta, pulmonary atresia, severe tetralogy of Fallot), period after coronary artery bypass grafting;
- Severe heart failure;
- Renal failure (creatinine clearance less than 30 ml/min), active liver disease;
- Liver failure
- Blood clotting disorders (including hemophilia, prolongation of bleeding time, bleeding tendency);
- Hematopoietic disorders (leukopenia, anemia);
- Confirmed hyperkalemia;
- Pregnancy and breastfeeding;
- Children's age (up to 15 years).
Carefully
Coronary heart disease, cerebrovascular diseases, chronic heart failure, dyslipidemia, hyperlipidemia, diabetes mellitus, thrombocytopenia, peripheral arterial disease, arterial hypertension, smoking, chronic renal failure (creatinine clearance 36-60 ml/min), liver cirrhosis with portal hypertension, hyperbilirubinemia, a history of ulcerative lesions of the gastrointestinal tract, the presence of Helicobacter ruby infection, long-term use of NSAIDs, frequent alcohol consumption, severe somatic diseases, concomitant therapy with the following drugs: anticoagulants (including warfarin), antiplatelet agents (including acetylsalicylic acid, clopidogrel) , oral glucocorticosteroids (including prednisolone), selective serotonin reuptake inhibitors (including citalopram, fluoxetine, paroxetine, sertraline); mental disorders, epilepsy, parkinsonism, depression, old age.
Use during pregnancy and breastfeeding
Pregnancy
Indomethacin is not used during pregnancy.
Breast-feeding
Indomethacin is excreted in breast milk. If treatment with the drug is necessary, breastfeeding should be stopped.
Directions for use and doses
Rectally. Adults and children over 15 years of age: suppositories 50 mg twice a day or 100 mg once a day. The maximum daily dose is 200 mg. Doses above 150-200 mg increase the risk of side effects. Duration of treatment: no more than 7 days.
Side effects can be reduced by using the lowest effective dose for the shortest possible period of time.
Side effect
From the digestive system
– NSAID gastropathy, nausea, heartburn, loss of appetite, abdominal pain, hemorrhages and ulcers, vomiting (including blood), diarrhea, constipation, melena, ulcerative stomatitis, increased activity of “liver transaminases” (ALAT, ASAT) ), transient increase in bilirubin; rarely toxic hepatitis with or without jaundice; very rarely - fulminant hepatitis. With long-term use in large doses, ulceration of the mucous membrane of the gastrointestinal tract occurs.
From the nervous system
– headache, dizziness, insomnia, psychomotor agitation, irritability, excessive fatigue, drowsiness, depression, peripheral neuropathy.
From the senses
– diplopia, blurred vision, hearing loss, tinnitus, taste disturbance, corneal clouding, conjunctivitis.
From the cardiovascular system
– tachyarrhythmia, edema syndrome, increased blood pressure, development (worsening) of chronic heart failure.
From the urinary system
– renal dysfunction, nephrotoxic syndrome, proteinuria, hematuria, interstitial nephritis, papillary necrosis.
From the hematopoietic organs and hemostasis system
– bleeding (gastrointestinal, gingival, uterine, hemorrhoidal), leukopenia, thrombocytopenia, agranulocytosis, anemia (including hemolytic and aplastic), eosinophilia, thrombocytopenic purpura.
Allergic reactions
– usually itchy skin, skin rash; rarely - urticaria, bronchospasm, asthmatic attacks, angioedema; very rarely - bullous rashes, redness of the skin, eczema, exfoliative dermatitis, allergic purpura, Stevens-Johnson syndrome, in isolated cases - photosensitivity, toxic epidermal necrolysis (Lyell's syndrome), erythema nodosum, anaphylactic shock.
Laboratory indicators
– agranulocytosis, leukopenia, thrombocytopenia, hyperglycemia, glucosuria, hyperkalemia.
Local reactions
– irritation, heaviness in the anorectal area, exacerbation of hemorrhoids.
Others
– aseptic meningitis (more often in patients with autoimmune diseases), increased sweating, aplastic anemia, autoimmune hemolytic anemia.
Overdose
Symptoms
: nausea, vomiting, severe headache, dizziness, memory impairment, disorientation. In severe cases, paresthesia, numbness of the limbs, convulsions.
Treatment
: rapid elimination of the drug from the body, symptomatic therapy.
Hemodialysis is ineffective.
Interaction with other drugs
Increases plasma concentrations of digoxin, methotrexate and Li+ drugs, which can lead to increased toxicity. Combined use with paracetamol increases the risk of developing nephrotoxic effects. Ethanol, colchicine, glucocorticosteroids and corticotropin increase the risk of gastrointestinal bleeding. Enhances the hypoglycemic effect of insulin and oral hypoglycemic drugs; enhances the effect of indirect anticoagulants, antiplatelet agents, thrombolytics (alteplase, streptokinase and urokinase) - there is a risk of bleeding. Reduces the effect of diuretics; with the use of potassium-sparing diuretics, the risk of hyperkalemia increases; reduces the effectiveness of uricosuric and antihypertensive drugs (including beta-blockers); enhances the side effects of methotrexate, glucocorticosteroids, and other NSAIDs. Cyclosporine and gold preparations increase nephrotoxicity (apparently by suppressing the synthesis of prostaglandins in the kidneys). Cefamandole, cefoperazone, cefotetan, valproic acid, plicamycin increase the incidence of hypoprothrombinemia and the risk of bleeding. Antacids and cholestyramine reduce the absorption of indomethacin. Increases the toxicity of zidovudine (due to inhibition of metabolism); in newborns, it increases the risk of developing toxic effects of aminoglycosides (since it reduces renal clearance and increases blood concentrations). Myelotoxic drugs increase the manifestations of hemotoxicity of the drug.
special instructions
During treatment, monitoring of the peripheral blood picture and the functional state of the liver and kidneys is necessary. If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study.
To prevent and reduce dyspeptic symptoms, antacid medications should be used.
The drug should not be used simultaneously with other NSAIDs.
The drug can change the properties of platelets, but does not replace the preventive effect of acetylsalicylic acid in cardiovascular diseases. The use of the drug may adversely affect female fertility and is not recommended for women planning pregnancy.
Impact on the ability to drive vehicles and operate machinery
During treatment with indomethacin, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Release form
Rectal suppositories 50 mg, 100 mg.
1, 2, 3, 4, 5, 6, 7, 8, 9, 10 suppositories in a blister pack made of a two-layer film or a film made of PVC/PE polymer materials or a white combined PVC/PE film or a polyvinyl chloride film.
1, 2, 3, 4, 5, 6, 7, 8, 9, 10 blister packs together with instructions for medical use of the drug are placed in a cardboard pack.
Storage conditions
In a place protected from light at a temperature not exceeding 25 ° C.
Keep out of the reach of children.
Best before date
3 years.
Do not use after the expiration date stated on the packaging.
Vacation conditions
On prescription.
Side effects
Side effects when using tablets or suppositories
Digestive system:
- flatulence;
- nausea, vomiting;
- gastrointestinal bleeding;
- anorexia;
- jaundice;
- unpleasant or painful sensations in the abdomen;
- gastritis;
- constipation / diarrhea ;
- gastrointestinal perforation;
- erosive and ulcerative lesions of the gastrointestinal tract;
- stomatitis;
- intestinal strictures;
- bleeding from a diverticulum or sigmoid colon;
- hepatitis.
Nervous system:
- muscle weakness;
- fainting;
- dizziness;
- dysarthria;
- headache;
- parkinsonism;
- depression;
- paresthesia;
- feeling tired;
- sleep disorders;
- sense of anxiety;
- mental disorders (psychotic episodes, depersonalization );
- drowsiness;
- peripheral neuropathy;
- convulsions;
- involuntary muscle contractions.
The cardiovascular system:
- hematuria;
- swelling;
- heart failure (congestive);
- increased blood pressure;
- palpitation;
- tachycardia;
- arterial hypotension;
- chest pain;
- arrhythmia.
Hematopoietic system:
- petechiae;
- leukopenia;
- ecchymoses;
- thrombocytopenia;
- DIC syndrome;
- purpura;
- aplastic/hemolytic anemia.
Urinary system:
- impaired renal function;
- nephrotic syndrome;
- proteinuria;
- interstitial nephritis;
- renal failure.
Sense organs:
- deafness;
- visual perception disorder;
- hearing impairment;
- diplopia;
- tinnitus;
- periorbital pain.
Metabolism:
- hyperkalemia;
- glucosuria;
- hyperglycemia.
Allergic manifestations:
- hair loss;
- itching / rash ;
- angiitis;
- hives;
- anaphylactic phenomena;
- erythema nodosum;
- a sharp drop in blood pressure;
- exfoliative dermatitis;
- bronchial asthma;
- Stevens-Johnson syndrome;
- pulmonary edema;
- erythema multiforme;
- dyspnea;
- Lyell's syndrome;
- respiratory distress;
- angioedema.
Other:
- gynecomastia;
- vaginal bleeding;
- hyperhidrosis;
- tides;
- nose bleed;
- tightness/enlargement of the mammary glands.
Additionally for suppositories
- exacerbation of colitis ;
- irritation of the rectal mucosa;
- tenesmus;
- exacerbation of hemorrhoids .
Side effects when using gel or ointment
- allergic phenomena;
- itching / rash in the area of application;
- dry/flushed skin;
- burning sensation ;
- systemic manifestations (with prolonged use);
- exacerbation of psoriasis (in isolated cases).
Indomethacin 100 Berlin-Chemie 100 mg 10 pcs. rectal suppositories
pharmachologic effect
Antiaggregation, antipyretic, analgesic, anti-inflammatory. Suppresses the activity of pro-inflammatory factors, reduces platelet aggregation. By inhibiting cyclooxygenase 1 and 2, it disrupts the metabolism of arachidonic acid, reduces the amount of PG both at the site of inflammation and in healthy tissues, and suppresses the exudative and proliferative phases of inflammation.
Composition and release form Indomethacin 100 Berlin-Chemie 100 mg 10 pcs. rectal suppositories
Suppositories for rectal use - 1 sup.:
- active substance: indomethacin - 50/100 mg;
- excipients: solid fat, corn starch.
In a blister pack 5 pcs.; in a cardboard pack there are 2, 6 or 10 packs.
Description of the dosage form
Suppositories are white with a yellowish tint, torpedo-shaped.
Directions for use and doses
Rectally. Before using the suppository, it is recommended to empty the intestines.
Indomethacin 50 Berlin-Chemie
Adults - 1 sup. (50 mg) 1–3 times a day, during an attack of gout - 200 mg/day.
Indomethacin 100 Berlin-Chemie
Adults - 1 sup. (100 mg) 1 time per day, during an attack of gout - 200 mg/day (2 supp.).
Pharmacodynamics
Causes a weakening or disappearance of pain of a rheumatic and non-rheumatic nature (including pain in the joints at rest and during movement, reduces morning stiffness and swelling of the joints, helps to increase the range of movements; in inflammatory processes that occur after operations and injuries, quickly relieves both spontaneous pain and pain with movement, reduces inflammatory swelling at the wound site).
Pharmacokinetics
Absorption is fast. Bioavailability by rectal route of administration is 80–90%. Plasma protein binding - 90%, T1/2 - 4-9 hours. Metabolized mainly in the liver. 30% of the drug is excreted unchanged. 70% is excreted by the kidneys, 30% through the gastrointestinal tract. Not removed by dialysis. Passes into breast milk.
Indications for use Indomethacin 100 Berlin-Chemie 100 mg 10 pcs. rectal suppositories
Inflammatory and degenerative diseases of the musculoskeletal system: rheumatoid arthritis, psoriatic, juvenile chronic arthritis, ankylosing spondylitis; rheumatic lesions of soft tissues; gouty arthritis.
As an adjuvant for infectious and inflammatory diseases of the ENT organs, adnexitis, prostatitis, cystitis, algodismenorrhea, neuritis, headache and toothache (as part of combination therapy).
Contraindications
Hypersensitivity, “aspirin asthma”, gastric and duodenal ulcers, ulcerative colitis, bleeding (intracranial, gastrointestinal), congenital heart defects (coarctation of the aorta, pulmonary atresia, tetralogy of Fallot), impaired color vision, cirrhosis of the liver with portal hypertension , diseases of the optic nerve, bronchial asthma, heart failure, edema, arterial hypertension, hemophilia, hypocoagulation, liver failure, chronic renal failure, hearing loss, vestibular apparatus pathology, glucose-6-phosphate dehydrogenase deficiency; blood diseases; proctitis, hemorrhoids; pregnancy, breastfeeding period, childhood and adolescence up to 18 years.
With caution - hyperbilirubinemia, thrombocytopenia, epilepsy, parkinsonism, depression, children and old age.
Application Indomethacin 100 Berlin-Chemie 100 mg 10 pcs. rectal suppositories during pregnancy and breastfeeding
Contraindicated during pregnancy. Breastfeeding should be stopped during treatment.
special instructions
During treatment, monitoring of the peripheral blood picture and the functional state of the liver and kidneys is necessary. If it is necessary to determine 17-ketosteroids, the drug should be discontinued 48 hours before the study.
During the treatment period, it is necessary to refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions.
Overdose
Symptoms: nausea, vomiting, severe headache, dizziness, memory impairment, disorientation. In severe cases - paresthesia, numbness of the limbs, convulsions.
Treatment: symptomatic therapy. Hemodialysis is ineffective.
Side effects Indomethacin 100 Berlin-Chemie 100 mg 10 pcs. rectal suppositories
From the digestive system: NSAID gastropathy, abdominal pain, nausea, vomiting, heartburn, anorexia, diarrhea, liver dysfunction (increased blood bilirubin, liver transaminases). With long-term use in large doses, ulceration of the gastrointestinal mucosa occurs.
From the nervous system: headache, dizziness, insomnia, agitation, irritability, fatigue, drowsiness, depression, peripheral neuropathy.
From the senses: hearing loss, tinnitus, taste disturbance, diplopia, blurred vision, corneal clouding, conjunctivitis.
From the cardiovascular system: heart failure, tachyarrhythmia, increased blood pressure.
From the urinary system: impaired renal function, proteinuria, hematuria, interstitial nephritis, nephrotic syndrome, papillary necrosis.
From the hemostatic system: bleeding (gastrointestinal, gingival, uterine, hemorrhoidal), thrombocytopenia.
Allergic reactions: skin rash, itching, urticaria, Quincke's edema, bronchospasm; rarely - Lyell's syndrome, erythema nodosum, anaphylactic shock.
Laboratory indicators: agranulocytosis, leukopenia, hyperglycemia, glucosuria, hyperkalemia, aplastic anemia, autoimmune hemolytic anemia.
Other: aseptic meningitis (more often in patients with autoimmune diseases), increased sweating, edema syndrome.
Local reactions: burning, itching, heaviness in the anorectal area, exacerbation of hemorrhoids.
Drug interactions
Reduces the effectiveness of uricosuric drugs, antihypertensive and diuretics (saluretics); enhances the effect of indirect anticoagulants, antiplatelet agents, fibrinolytics, side effects of mineralocorticosteroids, estrogens, and other NSAIDs; enhances the hypoglycemic effect of sulfonylurea derivatives.
Combined use with paracetamol increases the risk of nephrotoxic effects. Ethanol, colchicine, glucocorticosteroids - increase the risk of developing gastrointestinal complications accompanied by bleeding.
Increases the concentration of lithium, methotrexate and digoxin in the blood. Cyclosporine and gold preparations increase the nephrotoxicity of indomethacin. Cefamandole, cefoperazone, valproic acid - increase the risk of developing hypoprothrombinemia and the risk of bleeding. Reduces the elimination of penicillins. Potentiates the toxic effect of zidovudine.
Instructions for use of Indomethacin (Method and dosage)
Indomethacin tablets, instructions for use
The dosage regimen of the drug in the form of tablets is established individually, taking into account the severity of the negative symptoms of the diagnosed disease. The tablets are taken orally immediately after or during meals. As a rule, the initial daily dosage corresponds to 25 mg, which is indicated to be taken 2-3 times every 24 hours. If clinical efficacy is unsatisfactory, the daily dose should be doubled (2-3 times 50 mg). A maximum of 200 mg of the drug is allowed internally per day. After achieving a satisfactory effect, therapy is continued for 4 weeks at the same or reduced dosage. In case of long-term treatment, 75 mg of this medication can be taken for a maximum of 24 hours.
To relieve acute/severe conditions, it is possible to use indomethacin injections , and then switch to the use of tablets or suppositories. In case of observed pain in the organs of vision, eye drops with a similar active ingredient (for example, Indocollir ) can be prescribed.
Indomethacin suppositories, instructions for use
Indomethacin suppositories (Altfarm, Sopharma, etc.) are intended for rectal (into the rectum) use. The procedure for administering suppositories should be performed before bedtime after preliminary cleansing of the intestines. Indomethacin suppositories (Berlin Chemie, Biosynthesis, etc.) should be inserted into the rectum as deeply as possible in order to better absorb the drug. Typically, 3-time administration of 50 mg suppositories or a single administration of 100 mg suppositories are prescribed within 24 hours. In case of severe pain syndrome (for example, an attack of gout), rectal daily use of 200 mg of the drug in suppositories is allowed (in addition to oral administration).
Indomethacin gel and ointment, instructions for use
Indomethacin gel and ointment (Sopharma, Balkanfarma, etc.) are intended for application and rubbing into the skin located directly above the painful area of the body, for which Indomethacin gel or ointment (Sopharma, Akrikhin, etc.) is applied in a thin layer to the intact and previously cleansed skin.
5% external agents are indicated to be applied at intervals of 3-4 times every 24 hours. Applications of 10% drugs should be carried out 2-3 times a day. Single and maximum dosages of external forms of the drug are calculated based on the amount (in centimeters) of gel or ointment squeezed out of the tube. Adult patients can use 4-5 cm of squeezed out drug one time, and a maximum of 15-20 cm per day. Children are advised to use half the dosage.
Popular questions about Indomethacin
How to take Indomethacin?
Indomethacin tablets are taken orally after meals with plenty of water. If you have been prescribed the drug in the form of an ointment, it should be applied in a thin layer to the affected areas of the skin. Rectal suppositories are placed directly into the rectum.
Indomethacin suppositories - how to take?
You need to lie on your side, pull your knees towards your chest and carefully insert the suppository into the rectum. Doctors often recommend this procedure to be carried out in the morning and evening.
Indomethacin - what does the drug help with?
The drug Indomethacin helps relieve joint pain due to arthritis, reduces pain during muscle and soft tissue injuries, adnexitis, cystitis and prostatitis, and fights pain during menstruation.
What are Indomethacin suppositories prescribed for?
Indomethacin suppositories are prescribed to relieve pain in the insertion area and pelvic organs.
Overdose
Negative symptoms of an overdose of Indomethacin, most often observed with the use of oral or rectal dosage forms, are manifested by: nausea/vomiting, disorientation , severe headaches , memory impairment , dizziness . In particularly serious cases, numbness of the limbs , paresthesia , and convulsions .
The prescribed treatment should be consistent with the negative manifestations being monitored.
Interaction
The combined use of Methotrexate , lithium and Digoxin increases their serum concentrations, which may cause increased toxicity .
Concurrently taken ethanol-containing drugs, glucocorticoids , Colchicine and corticotropin increase the possibility of gastrointestinal bleeding .
Co-administration with medications including Paracetamol increases the risk of nephrotoxicity .
Combinatorial treatment with insulin and other hypoglycemic drugs enhances their effect.
Simultaneous use with indirect antiplatelet agents , anticoagulants and thrombolytics enhances their effects, which increases the possibility of bleeding .
Gold and Cyclosporine taken together increase nephrotoxicity (most likely due to inhibition of prostaglandin ).
Parallel use with potassium-sparing diuretics reduces their effects and, as a result, increases the risk of hyperkalemia .
Combination therapy with cefamandole , plicamycin, cefaperazone , valproic acid , cefotetan increases the risk of bleeding and increases the incidence of hypoprothrombinemia .
The simultaneous use of antihypertensive and uricosuric medications leads to a decrease in their effectiveness.
When estrogens , glucocorticoids and other NSAIDs , an increase in their inherent side effects is observed.
Cholestyramine and antacids reduce the absorption of indomethacin .
Combinatorial use with zidovudine may cause an increase in its toxicity (due to inhibition of metabolism).
Concurrent use of myelotoxic medications increases the manifestations of their hematotoxicity .
special instructions
Elderly people, patients with heart failure , gastrointestinal, liver/kidney pathologies, dyspepsia , epilepsy , arterial hypertension , parkinsonism , as well as patients after major surgical operations careful use of indomethacin
At the entire stage of treatment with oral and rectal forms of the drug, you should monitor the blood picture and the functionality of the liver / kidneys .
Concomitant use with diflunisal and other NSAIDs .
When combined with lithium , it is necessary to take into account the possibility of symptoms of its toxic effect .
There is a significant risk of developing complications from the gastrointestinal tract ( bleeding , ulcerative/erosive lesions, etc.) associated with the use of drugs from the NSAID , including indomethacin , for which reason it is better to combine them with meals.
Suppositories can be prescribed for prostatitis only if there is no damage to the rectum .
It is necessary to explain to the patient exactly how to use suppositories in gynecology (for example, for dysmenorrhea ). indomethacin suppositories are prescribed rectally (into the rectum).
Gel and ointment can be applied only to mechanically intact areas of the skin, and also avoid contact of these dosage forms with mucous membranes and eyes.
Special instructions when using Indomethacin
The drug should be used with caution in elderly patients and people with renal or hepatic impairment.
For people with exacerbation of erosive and ulcerative diseases of the gastrointestinal tract, treatment with Indomethacin is carried out under the supervision of a doctor.
If you are taking anticoagulants, antiplatelet agents, selective serotonin reuptake inhibitors or glucocorticosteroids, you should inform your doctor before using Indomethacin.
During treatment, it is recommended to refrain from activities that require increased concentration.
Analogs
Level 4 ATC code matches:
Voltaren Emulgel
Ultrafastin
Dicloran
Dicloran Plus
Dolgit
Nise
Ketonal
Ketorol
Febrofeed
Fastum gel
Diclofenac
Finalgel
Bystrumgel
Deep Relief
Butadion
Diklovit
Artrosilene
Olfen
Fanigan Fast
Indomethacin analogues are presented in oral, rectal and external dosage forms of drugs with a similar main effect:
- Adolor;
- Diclofenac;
- Aertal;
- Dicloran;
- Voltaren;
- Bioran;
- Diklak;
- Ketalgin;
- Ortofen;
- Ketorol;
- Rapten;
- Naklofen;
- Ketanov;
- Piroxicam;
- Ibuprofen;
- Nise , etc.
Reviews about Indomethacin
With regard to analgesic and anti-inflammatory effectiveness, reviews of tablets, as well as reviews of Indomethacin suppositories, are in most cases positive. For many patients, these dosage forms of the drug really helped to get rid of pain and swelling in the joints, muscles, back, etc. for various pathologies of the musculoskeletal system without causing any side effects. However, in some cases, Indomethacin tablets and suppositories (Berlin Chemie, Sopharma, etc.) did not have the expected effect, and even, on the contrary, led to the development in patients of various negative side effects inherent in this medication. All this suggests that this drug is not suitable for everyone and the choice of a drug from the NSAID group should be made on an individual basis.
The effectiveness of using Indomethacin gel or ointment also depends on the individual characteristics of the patient’s body, but in this case, even if the treatment is not effective, the development of side effects of the drug is unlikely.
It is also not uncommon to find references to the prescription of indomethacin suppositories in gynecology for pregnant women, which in itself looks at least strange, because the official instructions, and the experience of using NSAIDs in this period, prohibit the use of suppositories during pregnancy , as well as breastfeeding .
Note!
The description of the drug Indomethacin on this page is a simplified author’s version of the apteka911 website, created on the basis of the instructions for use.
Before purchasing or using the drug, you should consult your doctor and read the manufacturer's original instructions (attached to each package of the drug). Information about the drug is provided for informational purposes only and should not be used as a guide to self-medication. Only a doctor can decide to prescribe the drug, as well as determine the dose and methods of its use.
Indomethacin price, where to buy
The average price of Indomethacin in tablets No. 30 is: “Sopharma” - 50 rubles; "Balkanfarma" - 40 rubles.
The price of Indomethacin 100 mg suppositories No. 10 varies greatly depending on - 70 rubles; “Sopharma” – 90 rubles; “Berlin-Chemie” – 400 rubles.
The price of Indomethacin ointment 10% 40 grams varies within the following range: “Akrikhin” - 65 rubles; "Sopharma" - 80 rubles.
On average, gel 40 grams of “Balkanfarma” can be purchased: 5% – 50 rubles; 10% – 70 rubles.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Indomethacin Sopharma ointment 10% 40gSopharma AD
126 RUR order - Indomethacin ointment 10% 40gVetProm AD
120 rub. order
- Indomethacin 50 Berlin-Chemie rectal suppositories. 10 pieces Berlin-Chemie
RUB 346 order
- Indomethacin 100 Berlin-Chemie rectal suppositories. 10 pieces Berlin-Chemie
485 rub. order
- Indomethacin rectal suppositories. 100 mg 10 pcs. PAO Biosintez
63 RUR order
Pharmacy Dialogue
- Indomethacin rectal suppositories 50 mg No. 10Berlin-Chemie AG/Menarini
RUB 373 order
- Indomethacin rectal suppositories 50 mg No. 6Sopharma
105 rub. order
- Indomethacin rectal suppositories 100 mg No. 6Sopharma
120 rub. order
- Indomethacin ointment 10% 40gSopharma
115 rub. order
- Indomethacin ointment 10% 40gVetProm AD
132 RUR order
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Pharmacy24
- Indomethacin Plus 40 g ointment PAT"Khimpharmzavod"Chervona Zirka",Kharkiv, Ukraine
17 UAH.order - Indomethacin Sopharma 50 mg N6 suppositories AT "Sopharma", Bulgaria
32 UAH order
- Indomethacin 10% 40 g ointment AT "Sopharma", Bulgaria
21 UAH order
- Indomethacin 25 mg N30 tablets AT "Sopharma", Bulgaria
28 UAH order
PaniPharmacy
- INDOMETHACIN tablets Indomethacin tablets. 25 mg No. 30 Ukraine, Health LLC
23 UAH order
- INDOMETACIN suppository Indomethacin suppository 50 mg No. 6 Bulgaria, Sopharma
42 UAH order
- INDOMETHACIN ointment Indomethacin ointment 10% 40g Bulgaria, Sopharma
24 UAH order
- INDOMETHACIN tablets Indomethacin tablets. 25 mg No. 30 Bulgaria, Sopharma
34 UAH order
- Indomethacin plus ointment Indomethacin ointment Plus tube. 40g Ukraine, Krasnaya Zvezda JSC
19 UAH order
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