Drug name: Indomethacin

Therapeutic effects: Indomethacin inhibits cyclooxygenase (COX-1 and COX-2), reduces the synthesis of prostaglandins, which cause development of pain in the inflammation focus, fever and increase in the tissue permeability. Indomethacin also has an antiplatelet effect, it inhibits platelet aggregation. Indomethacin causes relief of the pain of rheumatic and non-rheumatic nature.

Oral and parenteral use of Indomethacin help reduce pain, especially joints pain at rest and in motion, decrease morning stiffness and swelling of joints in their inflammation, increase range of motion in joints.

Indications:

• Articular syndrome
• Inflammatory diseases of the musculoskeletal system: rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile arthritis, etc.
• Degenerative diseases of the musculoskeletal system: osteochondrosis with radicular syndrome, deforming osteoarthrosis with the exception of degenerative diseases of the hip and small intervertebral joints
• Diffuse connective tissue diseases, rheumatic disease
• Bursitis, tendinitis
• Back pain, lumbago, sciatica, neuralgia, myalgia
• Headache, toothache
• Algomenorrhea
• Traumatic inflammation of the soft tissues and joints, including after surgery
• As an adjuvant in infectious and inflammatory diseases of upper respiratory tract (pharyngitis, tonsillitis, otitis media with pain syndrome), adnexitis, prostatitis, cystitis
• Febrile syndrome (including in lymphomatoid granulomatosis, lymphoma, tumors metastases) in the event of failure of aspirin and paracetamol

Side-effects:

• central and peripheral nervous system: possible dizziness, headache, depression, excessive fatigue, confusion; rare - anxiety, agitation, fainting, sleep disorders (somnolence or insomnia), muscle cramps, peripheral neuropathy, muscle weakness, involuntary muscle movements, mental disorders (depersonalization, psychotic episodes), paresthesias, dysarthria, parkinsonism
• sensory organs: rare - taste disturbance, impaired vision, diplopia, orbital and periorbital pain, hearing loss, tinnitus, deafness
• digestive system: nausea, anorexia, vomiting, heartburn, abdominal pain and abdominal discomfort, constipation or diarrhea, erosive and ulcerative lesions, gastrointestinal bleeding and perforation (NSAIDs gastropathy), rare - liver dysfunction, jaundice, hepatitis, intestinal strictures, stomatitis, gastritis, bloating, bleeding from the sigmoid colon or diverticulitis
• cardiovascular system: possible hypotension or hypertension, tachycardia, arrhythmia, chest pain, worsening of chronic heart failure, edema syndrome
• hematopoietic system and hemostasis: rare - bleeding (gastrointestinal, nasal, gingival, uteral, hemorrhoidal), anemia (including hemolytic and aplastic), leukopenia, thrombocytopenia, eosinophilia, agranulocytosis, petechiae or ecchymosis, purpura, DIC
• urinary system: rare - renal dysfunction, proteinuria, hematuria, interstitial nephritis, nephrotic syndrome, renal failure
• metabolism: rare - hyperglycemia, glycosuria, hyperkalemia
• allergic and dermatologic reactions: rare - itching, skin rash, urticaria, angioedema, bronchospasm, photosensitivity; very rare - erythema nodosum, vasculitis, anaphylaxis, exfoliative dermatitis, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (Lyell's syndrome), acute respiratory distress, pulmonary edema, hair loss
• other: rare - hot flashes, sweating, breast tension and enlargement, gynecomastia, aseptic meningitis (usually in patients with autoimmune diseases)

Drug interactions:

Indomethacin may interact with the following groups of drugs:

• antacids
• drugs used for reducing cholesterol levels in the blood
• diuretics
• ACE inhibitors
• beta blockers
• indirect anticoagulants
• antiplatelet agents, thrombolytics
• other NSAIDs
• antigout agents
• glucocorticosteroids
• corticotropin-releasing hormone
• some antibiotics (plicamycin, cephalosporins)
• anticonvulsants (Valproic acid)
• antimetabolites
• Li+ drugs
• insulin and hypoglycemic drugs
• myelotoxic drugs
• ethanol

Cautions and restrictions:

Indomethacin should not be used in the following conditions:

• Erosive and ulcerative lesions of the gastrointestinal tract in acute phase, gastric ulcer and duodenal ulcer
• Bleeding, including from the gastrointestinal tract
• Ulcerative colitis
• Severe cardiac, renal or hepatic failure
• Uncontrolled arterial hypertension
• Hypersensitivity to indomethacin
• Asthma, urticaria, acute rhinitis or other allergic reaction caused by acetylsalicylic acid or other nonsteroidal anti-inflammatory drugs (aspirin-induced asthma)
• Blood clotting, bleeding diathesis, thrombocytopenia, hypocoagulation, prolonged bleeding time, bleeding tendency
• Hematopoietic disorders, leukopenia, anemia
• Epilepsy, psychosis, Parkinson's disease, depression
• Diseases of the optic nerve
• Hearing loss, vestibular pathology
• Deficiency of glucose-6-phosphate dehydrogenase
• Pregnancy, lactation
• Children under the age of 14 years
• Proctitis, recent rectal bleeding, hemorrhoids (for rectal suppositories)

Additional information:

Keep out of reach of children at temperature not above 25 ° C. Shelf life of tablets is 5 years, for rectal suppositories – 2 years.