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Indocin

Indomethacin (USAN) or indometacin (INN) is a non-steroidal anti-inflammatory drug commonly used to reduce fever, pain, stiffness, and swelling. It works by inhibiting the production of prostaglandins, molecules known to cause these symptoms. It is marketed under many trade names, including Indocin, Indocid, Indochron E-R, and Indocin-SR. more...

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Chemical properties

Indomethacin is a methylated indole derivative and a member of the arylalkanoic acid class of NSAIDs.

Indications

Clinical indications for indomethacin include:

ankylosing spondylitis
rheumatoid arthritis
arthritic gout
osteoarthritis
juvenile arthritis
psoriatic arthritis
Reiter's syndrome
Paget's disease of bone
Bartter syndrome
pseudogout
dysmenorrhea (menstrual cramps)
pericarditis
bursitis
tendinitis
nephrogenic diabetes insipidus (prostaglandin inhibits vasopressin's action in the kidney)
fever and pain associated with malignant diseases (tumors, bony metastasis, lymphogranulomatosis)

Indomethacin has also been used clinically to delay premature labor, reduce amniotic fluid in polyhydramnios, and to treat patent ductus arteriosus.

Indomethacin is a potent drug with many serious side effects and should not be considered an analgesic for minor aches and pains or fever. The drug is more potent than Aspirin, but the usually tolerated doses of Indomethacin do not allow a superior efficiency compared to Aspirin. In mild to moderate pain a usual oral dose of Indomethacin proved as efficient as 600mg Aspirin.

Contraindications

acutely existing Ulcus ventriculi and/or duodeni, or history of Ulcus
allergy against Indomethacin, Aspirin, or other NSAIDs
patients with nasal polyps reacting with an angioedema to other NSAIDS
children under 2 years of age
severe preexisting renal and liver damage
caution : preexisting bone marrow damage (frequent blood cell counts indicated)
caution : bleeding tendencies of unknown origin (Indomethacin inhibits platelet aggregation)
caution : Morbus Parkinson, epilepsy, psychic disorders (Indomethacin may worsen these conditions)

Mechanism of action

Indomethacin is a nonselective inhibitor of cyclooxygenase (COX) 1 and 2, enzymes that participate in prostaglandin synthesis from arachidonic acid. Prostaglandins are hormone-like molecules normally found in the body, where they have a wide variety of effects, some of which lead to pain, fever, and inflammation.

Prostaglandins also cause uterine contractions in pregnant women. Indomethacin is an effective tocolytic agent, able to delay premature labor by reducing uterine contractions through inhibition of PG synthesis in the uterus and possibly through calcium channel blockade.

Indomethacin has 2 additional modes of actions with clinical importance:

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Popular OTC supplement works
From Healthfacts, 3/1/04

An over-the-counter dietary supplement called SAM-e has been declared an effective treatment for depression, osteoarthritis and liver disease by the U.S. Agency for Healthcare Research and Quality. All the published studies (102) supporting SAM-e's use for these three conditions were reviewed.

SAM-e is short for S-Adenosylmethionine, a metabolite of methionine, which is an amino acid found in high-protein foods. Of the depression clinical trials in which people taking SAM-e were compared with people taking a fake look-alike pill (placebo), results generally favored the supplement. In the trials that compared SAM-e against an antidepressant drug, the effectiveness of the supplement was similar to that of the drug.

The same findings were shown in the ten clinical trials involving people with osteoarthritis pain. Whether the study compared SAM-e with a placebo, or SAM-e with a non-prescription painkiller, the supplement was better than a placebo and comparable to the drug. The painkillers used in these studies were from the drug class known as non-steroidal anti-inflammatory drugs, which includes aspirin, naproxen (Aleve), indomethacin (Indocin), and ibuprofen (Advil). SAM-e's painkilling effect on osteoarthritis was discovered accidentally when people who also had this condition enrolled in the depression clinical trials.

For certain types of liver disease, SAM-e was shown to be more effective than the standard medical treatments. For example, people treated with SAM-e were twice as likely as placebo-treated people to have a reduction in the pruritus (itching) associated with bile duct obstruction, which can occur in pregnancy, viral hepatitis, alcoholic hepatitis, and autoimmune liver diseases. SAM-e also showed a large effect in decreasing bilirubin levels in people with these liver diseases. One clinical trial showed that the standard medical treatment (ursodiol) was better than SAM-e for pruritus.

The reviewers of these SAM-e clinical trials identified the need for more research to provide a better understanding of the risk/benefit ratio of SAM-e supplement compared with medical treatments.

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