Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used to manage pain, inflammation, and fever in conditions like arthritis, gout, and patent ductus arteriosus (PDA) in neonates. Nurses are essential in ensuring its safe and effective administration through careful assessment, monitoring, and patient education. Below is a detailed guide to nursing considerations and management for indomethacin.
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Drug Overview
Generic Name
- Indomethacin
Brand Names
- Indocin
- Tivorbex
- Indocid
Classification
- Nonsteroidal Anti-Inflammatory Drug (NSAID)
- Analgesic
- Antipyretic
- Anti-inflammatory agent
Dosage and Administration
Dosage Forms
- Oral Capsules: 25 mg, 50 mg
- Extended-Release Capsules: 75 mg
- Suppositories: 50 mg, 100 mg
- IV Solution: 1 mg vials (for neonatal PDA)
Recommended Dosages
Adults
- Acute Pain/Inflammation: 25–50 mg orally 2–3 times daily
- Gout: 50 mg orally three times daily until symptoms resolve
- Extended-Release: 75 mg orally once or twice daily
Pediatric
- PDA Closure (Neonates): 0.1–0.25 mg/kg IV every 12–24 hours, up to three doses
Administration Routes
- Oral: Administer with food or milk to minimize GI irritation.
- Rectal: Use when oral administration isn’t possible.
- IV: Infuse over 20–30 minutes in neonates; monitor rate closely.
Therapeutic Actions
Indomethacin inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin production, which alleviates inflammation, pain, and fever.
Indications
- Pain and inflammation (e.g., osteoarthritis, rheumatoid arthritis, ankylosing spondylitis)
- Acute gout flares
- PDA closure in preterm neonates
- Acute shoulder pain (bursitis/tendinitis)
Adverse Effects
Common
- GI: Nausea, dyspepsia, ulcers
- CNS: Headache, dizziness, drowsiness
- Renal: Fluid retention, edema
Serious
- GI Bleeding: Ulcers, perforation
- Renal Failure: Higher risk in dehydrated patients
- Cardiovascular: Hypertension, heart failure
- Hematologic: Prolonged bleeding time
- Allergic: Anaphylaxis, bronchospasm
Contraindications
- Allergy to NSAIDs (including aspirin)
- Active GI bleeding or ulcer history
- Severe renal or hepatic disease
- Late pregnancy (risk of fetal harm)
- Post-CABG surgery pain (cardiovascular risk)
Precautions
- Asthma (risk of bronchospasm)
- Heart failure (fluid retention risk)
- Hypertension
Nursing Considerations
Assessment
- History: Check for allergies, GI, renal, or cardiac issues.
- Medications: Identify potential interactions (e.g., anticoagulants, other NSAIDs).
- Vitals: Record baseline blood pressure (BP) due to hypertension risk.
- Pain: Assess severity using a pain scale.
- Labs: Review renal/liver function if available.
Interventions
- Administer with Food: Reduces GI upset.
- Monitor: Observe for GI distress, renal changes, or allergic reactions.
- Hydration: Ensure adequate fluid intake to protect kidney function.
- BP Monitoring: Check regularly for elevation.
- Evaluate Pain: Adjust therapy if pain relief is inadequate.
Patient Education
- Dosage: Follow prescribed schedule; avoid exceeding doses.
- Warning Signs: Report bleeding, swelling, or breathing difficulties immediately.
- Alcohol: Avoid to reduce GI bleeding risk.
- Interactions: Inform healthcare providers of all medications.
- Duration: Use for the shortest time necessary.
Pharmacokinetics
- Absorption: Peaks in 1–2 hours (oral)
- Distribution: Highly protein-bound; penetrates synovial fluid
- Metabolism: Liver processes into inactive metabolites
- Excretion: Via urine and bile; half-life ~4.5 hours
Special Populations
- Neonates: IV for PDA; monitor renal function and bleeding.
- Geriatric: Use lower doses; watch for GI/renal effects.
- Pregnant: Avoid, especially in third trimester.
- Renal Impairment: Use cautiously; monitor kidney function.
Conclusion
Indomethacin is a powerful tool for managing pain and inflammation, but its use demands vigilant nursing care. By assessing risks, implementing interventions, and educating patients, nurses can optimize outcomes and minimize complications.
