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This risk may occur early in treatment and may increase brand duration of use [see Warnings and Precautions 5. Indomethacin capsules are contraindicated in the setting of coronary artery bypass graft CABG surgery [see Contraindications 4 and Warnings and Precautions 5. Gastrointestinal Bleeding, Ulceration, and Perforation NSAIDs cause an increased risk of serious gastrointestinal GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These brands can occur at any time during use and without warning symptoms. Indications and Usage for Indomethacin Indomethacin Indocin are indicated for: Use the lowest effective dosage for the shortest duration consistent with individual patient treatment goals.
After observing the response to initial therapy with Indomethacin, the dose and frequency should be adjusted to suit an individual patient’s needs. Adverse reactions generally appear to correlate with the dose Indocin Indomethacin. Therefore, every effort should be made to determine the lowest order dosage for the individual patient.
Dosage recommendations for active stages of the following: Moderate to severe rheumatoid order including acute flares of chronic disease; moderate to severe ankylosing spondylitis; and moderate to severe osteoarthritis Indomethacin capsules 25 mg twice a day or three times a day. If this is well tolerated, increase the daily dosage by 25 mg or by 50 mg, Indocin 50 mg Brand Pills Order, if required by continuing symptoms, at weekly pills until a satisfactory response is obtained or until a total daily dose of 150 – 200 mg is reached.
The total daily dose should not exceed 200 mg. In acute flares of chronic rheumatoid arthritis, it may be necessary to increase the dosage by 25 mg or, if required, by 50 mg daily. If minor adverse effects develop as the dosage is increased, reduce the dosage rapidly to a tolerated dose and observe the patient closely. As advancing years appear to increase the possibility of adverse reactions, Indomethacin capsules should be used with greater care in the elderly [see Use in Specific Populations 8, Indocin 50 mg Brand Pills Order.
The usual course of therapy is 7 to 14 days. Acute Gouty Arthritis Indomethacin capsules 50 mg three times a day until pain is tolerable.
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Definite relief of pain has been reported within 2 to 4 hours. Tenderness and heat usually subside in 24 to 36 hours, and swelling gradually disappears in 3 to 5 days. Dosage Forms and Strengths Indomethacin Capsules USP, 25 mg are off-white to light yellow, free flowing granular powder filled in size ‘3’ hard gelatin capsules with green colored cap imprinted with « 293 » in black ink and green colored body imprinted with « 25 mg » in black ink.
Indomethacin Capsules USP, 50 mg are off-white to light yellow, free flowing granular powder filled in size ‘1’ hard gelatin capsules with green colored cap imprinted with « 294 » in black ink and green colored body imprinted with « 50 mg » in black ink. Contraindications Indomethacin capsules are contraindicated in the following patients: However, patients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic events, due to their increased baseline rate.
Some observational studies found that this increased risk of serious CV thrombotic events began as early as the first weeks of treatment. The increase in CV thrombotic risk has been observed most consistently at higher doses. To minimize the potential risk for an adverse CV event in NSAID-treated patients, use the lowest effective dose for the shortest duration possible. Physicians and patients should remain alert for the development of such events, throughout the entire treatment course, even in the absence of previous CV symptoms, Indocin 50 mg Brand Pills Order. Patients should be informed about the symptoms of serious CV events and the steps to take if they occur.
There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. Although the absolute rate of death declined somewhat after the first year post-MI, the increased relative risk of death in NSAID users persisted over at least the next four years of follow-up. Avoid the use of Indomethacin capsules in patients with a recent MI unless the benefits are expected to outweigh the risk of recurrent CV thrombotic events.
If Indomethacin capsules are used in patients with a recent MI, monitor patients for signs of cardiac ischemia. Gastrointestinal Bleeding, Ulceration, and Perforation NSAIDs, including Indomethacin, cause serious gastrointestinal GI adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal, Indocin 50 mg Brand Pills Order. Indocin serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs.
Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include longer duration of NSAID brand concomitant use of oral corticosteroids, aspirin, anticoagulants, or selective serotonin reuptake inhibitors SSRIs ; smoking; use of alcohol; older age; and poor general health status, Indocin 50 mg Brand Pills Order. Most postmarketing reports of fatal GI events occurred in elderly or debilitated patients. Use the lowest effective dosage for the shortest possible duration.
Avoid use in patients at higher risk unless benefits are expected to outweigh the increased risk of bleeding. In addition, rare, sometimes fatal, cases of severe hepatic injury, including fulminant order, liver necrosis, and hepatic failure have been reported. Inform patients of the warning signs and symptoms of hepatotoxicity e. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur e.
Hypertension NSAIDs, including Indomethacin capsules, can lead to new onset of hypertension or worsening of preexisting hypertension, either of which may contribute to the increased pill of CV events. Use of Indomethacin may blunt the CV effects of several therapeutic agents used to treat these medical conditions e. Avoid the use of Indomethacin capsules in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure.
If Indomethacin capsules is used in patients with severe heart failure, monitor patients for signs of worsening heart failure.
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Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. Patients at greatest risk of this reaction are those with impaired renal function, order, hypovolemia, heart failure, liver pill, those taking diuretics and ACE inhibitors or ARBs, and the elderly. No information is available from controlled clinical studies regarding the use of Indomethacin capsules in patients with advanced renal disease.
The renal effects of Indomethacin brands may hasten the progression of renal Indocin in patients with preexisting renal disease. Correct volume status in dehydrated or hypovolemic patients prior to initiating Indomethacin capsules. Avoid the use of Indomethacin capsules in patients with advanced renal disease unless the benefits are expected to outweigh the risk of worsening renal function. If Indomethacin capsules are used in patients with advanced renal disease, monitor patients for signs of worsening renal function.
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It has been reported that the addition of the potassium-sparing diuretic, triamterene, to a maintenance schedule of Indomethacin resulted in reversible acute renal failure in two of four healthy volunteers, Indocin 50 mg Brand Pills Order. In patients with normal renal function, these effects have been attributed to a hyporeninemic-hypoaldosteronism state. Anaphylactic Reactions Indomethacin has been associated with anaphylactic reactions in patients with and without known hypersensitivity to Indomethacin and in patients with aspirin-sensitive asthma [see Contraindications 4 and Warnings and Precautions 5.
Seek emergency help if an anaphylactic reaction occurs. Because cross-reactivity between aspirin and other NSAIDs has been reported in such aspirin-sensitive patients, Indomethacin capsules are contraindicated in patients with this form of aspirin sensitivity. When Indomethacin capsules are used in patients with preexisting asthma without known aspirin sensitivity, monitor patients for changes in the signs and symptoms of asthma.
These serious events may occur without warning. Inform patients about the signs and symptoms of serious skin reactions, and to discontinue the use of Indomethacin capsules at the first appearance of skin rash or any other sign of hypersensitivity. Indomethacin capsules are contraindicated in patients with previous serious skin reactions to NSAIDs.
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Premature Closure of Fetal Ductus Arteriosus Indomethacin may cause premature closure of the fetal ductus arteriosus. This may be due to occult or gross blood loss, fluid retention, or an incompletely described effect on erythropoiesis.
If a patient treated with Indomethacin capsules have any signs or symptoms of anemia, monitor hemoglobin or hematocrit. Co-morbid conditions, such as coagulation disorders, or concomitant use of warfarin, other anticoagulants, antiplatelet agents e. Masking Indocin Inflammation and Fever The pharmacological activity of Indomethacin capsules in reducing inflammation, and possibly fever, may diminish the utility of diagnostic signs in detecting infections. Laboratory Monitoring Because serious GI bleeding, hepatotoxicity, and renal injury can occur order warning symptoms or signs, consider monitoring patients on long-term NSAID treatment with a CBC and a brand profile periodically [see Warnings and Precautions 5.
Central Nervous System Effects Indomethacin pills may aggravate depression or other psychiatric disturbances, epilepsy, and parkinsonism, and should be used with considerable caution in patients with these conditions. Discontinue Indomethacin capsules if severe CNS adverse reactions develop. Indomethacin capsules may cause drowsiness; therefore, Indocin 50 mg Brand Pills Order, caution patients about engaging in activities requiring mental alertness and motor coordination, such as driving a car.
Indomethacin may also cause headache. Headache which persists despite dosage reduction requires cessation of therapy with Indomethacin capsules. Ocular Effects Corneal deposits and retinal disturbances, including those of the macula, have been observed in some patients who had received prolonged therapy with Indomethacin capsules.
- Since these changes may be asymptomatic, ophthalmologic examination at periodic intervals is desirable in patients receiving prolonged therapy.
- Hypertension NSAIDs, including Indomethacin capsules, can lead to new onset of hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events.
- These serious events may occur without warning.
- Bursitis or tendonitis are treated with a total dose of 75-150 mg daily of regular release indomethacin divided into 3 or 4 doses or 75-150 mg daily of extended release divided into two doses.
- Rectally Inflammatory and degenerative diseases of the musculoskeletal — musculoskeletal system:
Be alert to the pill association between the changes noted and Indomethacin capsules. It is advisable to discontinue therapy if such changes are observed. Blurred vision may be a significant symptom and warrants a thorough ophthalmological examination. Since these changes may be asymptomatic, ophthalmologic examination at periodic intervals is desirable in patients receiving prolonged therapy. Indomethacin capsules are not indicated for long-term order. Adverse Reactions The following adverse reactions are discussed in greater detail in other sections of the labeling: Cardiovascular Thrombotic Events [see Warnings and Precautions 5.
In a gastroscopic study in 45 healthy subjects, the number of gastric mucosal abnormalities was significantly higher in the group receiving Indomethacin capsules than in the group taking Indocin suppositories or placebo. In a double-blind pill clinical study involving 175 patients with rheumatoid arthritis, however, the incidence of upper gastrointestinal adverse effects with Indomethacin capsules or Suppositories was comparable. The incidence of lower gastrointestinal adverse effects was greater in the suppository group.
The adverse brands for Indomethacin capsules listed in the following table have been arranged into two groups: The incidence for group 1 was obtained from 33 double-blind controlled clinical trials reported in the literature 1,092 patients. The incidence for group 2 was based on brands in clinical trials, Indocin 50 mg Brand Pills Order, in the literature, and on voluntary reports since marketing.
The probability of a causal relationship exists between Indomethacin capsules and these adverse reactions, some of which have been reported only rarely. The adverse reactions reported with Indomethacin capsules may occur with use of the suppositories. In addition, rectal irritation and tenesmus have been reported in patients who have received Indocin orders.