Dosage for indomethacin
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Dosage for Indomethacin: A Comprehensive Overview
Introduction to Indomethacin Dosage
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) commonly used to treat pain and inflammation associated with conditions such as rheumatoid arthritis, osteoarthritis, and gout. The appropriate dosage of indomethacin can vary based on the condition being treated, the formulation of the drug, and individual patient factors.
Standard Dosage and Administration
Oral Dosage
Indomethacin is typically administered orally in doses ranging from 25 mg to 100 mg. For acute pain, a common regimen is 25 mg taken three times daily (tid). In some cases, the dosage may be increased to 50 mg three times daily, depending on the severity of the condition and patient response . Sustained-release formulations allow for less frequent dosing, such as 75 mg twice daily .
Rectal Dosage
Rectal administration of indomethacin is an alternative for patients who may have gastrointestinal issues with oral administration. A common rectal dose is 100 mg nightly, which has been shown to be as effective as oral dosing. The absorption rate is slower with rectal administration, but the bioavailability remains complete .
Pharmacokinetics and Bioavailability
Indomethacin is rapidly absorbed after oral administration, with peak plasma concentrations typically reached within 30 to 90 minutes . The drug follows a biphasic plasma decay, and its half-life ranges from 2.6 to 11.2 hours . Food can delay and decrease peak plasma levels, while antacids can delay the peak but slightly enhance subsequent concentrations.
Special Considerations
Sustained-Release Formulations
Sustained-release formulations of indomethacin, such as Indocin SR, provide a more convenient dosing schedule, typically once or twice daily. These formulations have been shown to have comparable safety and efficacy profiles to conventional indomethacin.
Dosage in Rheumatoid Arthritis
In patients with rheumatoid arthritis, various dosing schedules have been studied. For instance, indomethacin retard (sustained-release) 75 mg twice daily, conventional capsules 50 mg three times daily, and a combination of 100 mg suppository at night with 50 mg orally each morning have all shown significant clinical improvements. However, no significant differences in efficacy or side effects were observed between these regimens.
High-Dose Considerations
Higher doses of indomethacin, such as 200 mg daily, have been associated with a higher incidence of side effects, including gastrointestinal issues like peptic ulcers and bleeding . Therefore, it is generally recommended to start with lower doses and gradually increase as needed while monitoring for adverse effects.
Conclusion
The dosage of indomethacin must be tailored to the individual patient, considering factors such as the condition being treated, the formulation of the drug, and patient-specific factors like gastrointestinal tolerance. Standard oral doses range from 25 mg to 100 mg, with sustained-release formulations offering more convenient dosing schedules. Rectal administration is a viable alternative for those with gastrointestinal issues. Careful monitoring and adjustment of dosage are essential to minimize side effects and maximize therapeutic efficacy.
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