Medicines in neonates
Evelyne Jacqz-Aigrain, Imti Choonara in Paediatric Clinical Pharmacology, 2021
Indomethacin may be administered prophylactically (usually within 24 h of birth), early symptomatic (2–3 days) or late symptomatic (8–10 days). Clyman evaluated these different strategies and found that the group receiving early symptomatic treatment with indomethacin had a reduction in bronchopulmonary dysplasia (OR=0.39; 95% CI 0.21–0.76; p<0.005), need for mechanical ventilation (p<0.005) and necrotising enterocolitis (NEC) (OR=0.24; Cl 0.06–0.96; p<0.05) compared with late symptomatic treatment [29]. Prophylactic treatment did not have any advantage in long-term pulmonary outcomes or NEC compared with early symptomatic treatment; however, the incidence of grade 3 and 4 intraventricular haemorrhage (IVH) was reduced (OR=0.51; CI 0.28–0.95; p<0.05). A recent meta-analysis that combined 19 eligible trials randomising 2872 infants [16], concluded that prophylactic indomethacin reduced the incidence of symptomatic PDA (pooled RR=0.44; CI 0.38–0.50), but showed no evidence that treatment influenced respiratory outcomes. No difference in mortality at latest follow-up between infants receiving prophylactic indomethacin and controls was found, (RR=0.96; CI 0.81–1.12). Prophylaxis reduced the need for surgical PDAligation (RR=0.51; CI 0.37–0.71), the incidence of grades 3 and 4 IVH, (RR=0.66; Cl 0.53–0.82), but increased the incidence of oliguria (RR=1.90; CI 1.45–2.47).
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Anton C. de Groot in Monographs in Contact Allergy, 2021
Indomethacin is an indole derivative and nonsteroidal anti-inflammatory drug (NSAID) with anti-inflammatory activity and chemopreventive properties. It inhibits the enzyme cyclooxygenase, which is necessary for the formation of prostaglandins. Indomethacin may also inhibit the expression of multidrug-resistant protein type 1, resulting in increased efficacies of some antineoplastic agents in treating multi-drug resistant tumors. Oral indomethacin is indicated for symptomatic management of (moderate to severe) rheumatoid arthritis including acute flares of chronic disease, ankylosing spondylitis, severe osteoarthritis, acute painful shoulder (bursitis and/or tendinitis) and acute gouty arthritis. In powder for injection solutions, indomethacin is present as indomethacin sodium trihydrate (CAS number 74252–25–8, EC number 200–186–5, molecular formula C19H21ClNNaO7), in other preparations indomethacin base is employed. In some countries indomethacin it is also available in topical preparations for the relief of pain and inflammation of the muscles and joints (1).
Headache Disorders
Sahar Swidan, Matthew Bennett in Advanced Therapeutics in Pain Medicine, 2020
The normal starting dosage of indomethacin for both CPH and HC is one 25 mg tablet three times a day for 3 days; this dose can be increased to two tablets (50 mg) three times a day if there is not total relief of pain. Most individuals will respond by 150 mg a day, and the response can be dramatic, with quick dissipation of headache symptoms regardless of how long the patient had suffered with head pain. A beneficial effect will normally be seen within 48 hours after the correct dosage has been found. Some individuals need a dose as high as 300 mg of indomethacin per day, but there is a true safety issue with this high of a dose, so going above 225 mg per day is not suggested. If there is no response at 150 mg a day, and the physician still suspects CPH or HC, an extra 25 mg dose of indomethacin can be added every 3 days, to a total of 225 mg a day or the onset of side effects. If the patient does not respond at 75 mg three times a day, one should consider an alternative diagnosis. There are both gastrointestinal and renal potential side effects with chronic indomethacin usage. After 3 months of doing well on indomethacin the medication should be tapered to see if still needed. Many patients cannot come off indomethacin without headache recurrence, however.
Tolerability of pharmacological agents in the treatment of headache following brain injury: a scoping review
Published in Brain Injury, 2023
Heather M. MacKenzie, Michael Robinson, Amanda McIntyre
Two case reports (level 5 evidence) and one case series (level 4 evidence) (13,15,16) (n = 6) described the use of indomethacin for PTH. One case report (16) focused on an individual with chronic paroxysmal hemicrania, whereas the other two articles (13,15) involved individuals with hemicrania continua. The treatment dose of indomethacin ranged from 100 mg to 300 mg daily. Five out of six of the subjects experienced gastrointestinal upset/nausea as a side effect of indomethacin, including one individual who developed colitis; two of these individuals discontinued indomethacin due to this side effect. Of these five subjects, three required the addition of another pharmacological agent to counteract the gastrointestinal upset, specifically a proton pump inhibitor, misoprostol or famotidine. Of note, the sixth subject, who did not specifically report any gastrointestinal symptoms, was simultaneously prescribed misoprostol, which counteracts gastrointestinal inflammation. The subjects (n = 4) described by Lay et al. (13) reported that their headaches were “significantly better” or “significantly lessened” with indomethacin treatment. Evans et al. (15) described a reduction in headache frequency from daily to every other day; of note, this individual was concurrently treated with amitriptyline 25 mg at bedtime, but no tolerability information was provided for this medication. The subject in the article by Jacob et al. (16) reported a complete resolution of his headaches.
Thymol Reduces Hepatorenal Oxidative Stress, Inflammation and Caspase-3#xd; Activation in Rats Exposed to Indomethacin
Published in Egyptian Journal of Basic and Applied Sciences, 2022
Tijani Abiola Stephanie, Olori O. David, Ebenezer O. Farombi
Drug-induced multi-organ toxicities are common adverse reaction triggered by numerous drugs like indomethacin (IND). Indomethacin is one of the non-steroidal anti-inflammatory drugs used as analgesic and also has antipyretic property. However, its adverse side effects have raised a lot of concern for its continuous use in clinical settings. Indomethacin cause many organ toxicities including liver, kidney and gastrointestinal toxicities in humans and experimental animals [1,2]. In the liver, IND has been associated with hepatocellular enzymes elevation and cholestatic jaundice whereas in the kidney, IND caused acute interstitial nephritis typified by wide spread interstitial edema with infiltration of inflammatory cells [3,4]. The mechanisms by which IND causes its toxicities include prostaglandin synthesis inhibition, generation of reactive oxygen species (ROS) resulting to cellular oxidative stress, inflammation and apoptosis [5].
Perspectives on the use of non-biological pharmacotherapy for adult-onset Still’s disease
Published in Expert Opinion on Pharmacotherapy, 2022
Ilenia Di Cola, Paola Cipriani, Piero Ruscitti
NSAIDs have shown to mostly fail in managing AOSD during a flare of the disease. In fact, almost 80% of these patients did not achieve a clinical response following the administration of NSAIDs [26,27]. In this context, the use of indomethacin has been proposed since it could induce a clinical response in a minority of patients [26,27]. Thus, a temporary use of NSAIDs may be suggested during the diagnostic workup or for the relapse of the disease in limiting patient clinical symptoms before the administration of other therapeutic strategies [20]. Therefore, NSAIDs during AOSD should be combined as soon as possible with GCs, cs-, and/or bDMARDs [28]. Recently, a subset of patients with AOSD characterized by serositis has been pointed out [29]. In this context, the use of NSAIDs in combination with colchicine during AOSD has been described assessing 20 patients with AOSD affected by pericarditis. All were treated with NSAIDs, mostly ibuprofen, combined with colchicine. The authors reported that 65% of patients benefitted by this therapeutic strategy. An improvement of pericarditis has been also observed in these patients together with other concomitant clinical manifestations, including arthritis, skin rash, hepatomegaly [30].
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